Bitewing Radiographs Research Articles

Convergence Angle of Preparations for Lithium Disilicate Glass-Ceramic Crowns by Dental Students and Its Effect on Crown Retention.

The aims of this study were to determine the convergence angles of posterior teeth prepared by dental students at the University of Toronto for lithium disilicate glass-ceramic (LDGC) CAD/CAM crowns and to investigate their effect on loss of retention rate. A total of 280 preparations for posterior monolithic LDGC CAD/CAM crowns were performed on 270 patients (169 women and 101 men). Crowns were cemented with RelyX Unicem and Calibra Universal resin cements. Mesial, distal, and angle of convergence were measured on the bitewing radiographs. Cemented crowns were followed for up to six years. Data were analyzed for tooth type and location and for operator experience. The results showed the majority of convergence angles were greater than the recommended guidelines but fell within a clinically acceptable range (20 to 24 degrees). However, angles of convergence for mandibular molar preparations were highest (28.06±5.50 degrees), while maxillary premolars exhibited the lowest values (24.72±6.59 degrees). No significant difference was found between the results of dental students and foreign-trained dentists. Over a six-year observation period, only two crowns lost retention. The findings of this study indicated that ideal taper angles were impractical and difficult to achieve in clinical education settings.

Radiographic Yield for Clinical Caries Diagnosis in Young Adults: Indicators for Radiographic Examination

This prospective cohort study investigated the distribution pattern of carious lesions diagnosed by visual tactile and radiographic examinations, assessed the radiographic yield for clinical caries diagnosis, and estimated how accurately commonly used indicators for caries identified young adults who would benefit from radiographs at different thresholds. Overall, 576 patients aged 16–32 years seeking a first consultation were included. Patients were examined for caries and answered a validated questionnaire on sociodemographics and oral health behavior. Almost 10% of clinically sound approximal surfaces presented radiolucency in enamel/dentine. Of the clinically diagnosed noncavitated approximal and occlusal lesions, 22.5 and 17.7%, respectively, presented radiolucency reaching dentine at the radiographic examination. Noncavitated/enamel lesions detected radiographically were mainly at approximal surfaces (73.2%), while at occlusal surfaces these were negligible (0.7%). More than half of approximal dentine lesions were only detected radiographically (61.3%), while more than half of occlusal dentine lesions were only clinically diagnosed (57.1%). The hierarchical logistic regression analysis showed that patient’s caries activity, D₁MFS scores ≥17, and frequent consumption of soft drinks were significantly associated with detection of approximal enamel/dentine lesions. Also, patient’s caries activity and frequent consumption of soft drinks were significantly associated with occlusal dentine caries (p ≤ 0.05). The indicator power of grouping these indicators as a predictor for the presence of radiographically detected lesions showed high sensitivity (0.84–0.91) and moderate specificity (0.64–0.73) for all surfaces and thresholds tested. In conclusion, radiographs increased significantly the number of approximal enamel/dentine and occlusal dentine lesions diagnosed. The ability to identify young adults with approximal lesions from the predictor was satisfactory. Bearing in mind that an essential contribution of bitewing radiographs to clinical examination is the detection of approximal noncavitated/enamel lesions that can be inactivated by nonoperative interventions, our results support the prescription of radiographs in young adults seeking a first consultation. Updating of current guidelines’ recommendation of radiographs is warranted.

Diagnosing periodontal and dental indicators with horizontal and vertical bitewing radiographs.

The aim of this study is to compare information provided by the 2 orientations of bitewing radiographs, horizontal (HBW) and vertical (VBW) taken in a dental school. Radiographic records were reviewed at Tufts University School of Dental Medicine (TUSDM) for patients showing posterior bone loss who had both HBW and VBW. 320 records were reviewed with 6 criteria: visibility of crestal bone from the distal of the cuspids to the distal of the most posterior tooth, visibility of horizontal or angular bone loss, the crestal density of bone, visibility of interproximal contact areas, visibility of the entire anatomical crown, and visibility of furcations. Significantly higher number of VBW compared with HBW (P<0.0001) showed the levels of alveolar bone loss (52.81% vs. 3.75%), the type of loss (angular or horizontal) (50.94% vs. 3.75%), the crestal bone density (28.75% vs. 0.63%), the contact areas (20.63% vs. 14.38%), and the furcations (43.44% vs. 1.25%). A greater number of HBW showed the entire anatomical crown compared with VBW. No significant difference was detected in the number of radiographs taken per HBW and VBW set. For patients with alveolar bone loss, VBW are superior to HBW when assessing bone levels, density, morphology, tooth furcations, and evaluating interproximal contact areas for caries. It is recommended that the vertical bitewing technique be taught as a standard in dental, dental hygiene, and dental assisting schools for adult patients showing evidence of posterior interdental bone loss.

Annual alveolar bone loss in subjects with cardiovascular disease adjusting for associated systemic diseases and risk factors: a retrospective study

BackgroundTo detect annual alveolar bone loss in subjects with cardiovascular disease (CVD) adjusting for associated systemic diseases and risk factors.MethodsA total number of 132 subjects that reported having CVD from 2008 to 2015 (N = 132). For longitudinal data analysis, 58 subjects eligible for inclusion with at least two exposures of complete mouth set or repeated BW radiographs with at least one-year interval compared with a control group. Alveolar bone level on mesial and distal sites of posterior teeth was measured on bitewing (BW) radiographs available in the electronic health records of each subject.ResultsSubjects who reported having cardiovascular diseases experienced higher annual mean alveolar bone loss (0.062 mm per year) compared to Subjects with no cardiovascular diseases (0.022 mm per year).ConclusionSubjects who have reported CVD had higher rate of annual bone loss compared to subjects who did not have any CVD. This observation indicates that targeting high-risk individuals for risk assessment is fundamental to provide the best healthcare possible to those who are the most in need. Periodic examination and assessment of periodontal health is an essential key factor for better oral health, however, it has to be more emphasized and prioritized for individuals that are more prone to the disease.

Two calcium silicate-based materials used in direct pulp capping (in-vivo study)

Aim The aim was to clinically and radiographically evaluate mineral trioxide aggregate (MTA) and TheraCal LC as direct pulp capping (DPC) materials. Materials and methods Twenty male patients aged 17–35 years with immediate mechanical pulp exposure in lower molars were randomly divided into two equal groups (n = 10). Group 1: pulp exposures were capped using MTA. Group 2: pulp exposures were capped using TheraCal LC. Immediately after DPC, a base-line digital bitewing and periapical radiographs were taken. Clinical evaluation was performed at 1, 4, 12, and 24 weeks after DPC for presence/absence of spontaneous pain, tenderness to percussion, draining sinuses and pulp response to thermal pulp vitality test. At 24 weeks after DPC, digital periapical, and bitewing radiographs were taken. Digitalized bitewing radiographs were submitted to image analysis software to measure dentin bridge thickness in comparison to the base-line bitewing radiographic image. Digitalized preoperative and postoperative periapical radiographs were submitted to the same software to evaluate changes in the width of periodontal ligament space. Results Clinically, all cases showed criteria of successful treatment except 3, four cases in groups 1 and 2, respectively. Statistical analysis revealed no statistically significant difference between both groups (P > 0.05). All of the thirteen cases that were available for evaluation after 6 months showed dentin bridge formation. In MTA group, the mean value of dentin bridge formed was higher than in TheraCal LC group with no statistically significant difference (P = 0.710). Changes in the width of periodontal ligament space were not significantly different between both groups recording (P > 0.05). Conclusion Clinically and radiographically, MTA and TheraCal LC are favorable materials for DPC inducing adequate dentin bridge formation and minimal widening of periodontal ligament space.

Clinical validation of near-infrared light transillumination for early proximal caries detection using a composite reference standard

ObjectivesThe aim of this in vivo prospective clinical study was to validate a near-infrared light transillumination (NILT) device for the detection of proximal caries lesions and compare it to the established diagnostic method of bitewing radiography (BWR). Materials and methodsA total of 116 interproximal posterior teeth/surfaces without gross cavitation were included and assessed with BWR and NILT. After clinical examination, the teeth with sound surfaces or non-cavitated caries lesions were separated with the use of an orthodontic separation rubber for 24h. Upon removal of the separator a silicon impression was obtained and the teeth surfaces were directly investigated. Intra- and inter-examiner reproducibility, sensitivities (SE) and specificities (SP) as well as the area under ROC curves (AUC) were calculated. ResultsThe SE of NILT was 0.92 in D1 lesions and 1.00 in D2 and D3 lesions, respectively. BWR showed SE values of 0.81 in D1 lesions, 0.74 in D2 and 1.00 in D3 lesions, respectively. However, NILT showed lower values of SP (D1 0.38, D2 0.42 and D3 0.99) compared to BWR (D1 0.65, D2 0.88, D3 1.00). Intra-examiner reproducibility increased for both examiners from the initial examination (0.68 and 0.62) to the recall appointment (0.89 and 0.76) respectively. ConclusionThe performance of NILT in detection of enamel caries was comparable to BWR. NILT could be considered as a useful and reliable tool in clinical practice. However, monitoring of enamel lesions might not be accurate, since a low specificity of NILT at D1,2 level and a tendency to false positive ratings have been shown. Therefore, it is recommended that treatment decisions should not be based on NILT alone. Clinical relevanceThis study might indicate that NILT can be used for routine patient screening but the use of BWR is still important for treatment decisions.

Outcomes of Class II composite restorations placed by dental students: An observational study

Introduction: Main objectives of restoring the teeth is to remove the caries and replace the tooth structure to restore form and function. This radiographic study aimed to determine the defective Class II composite restorations in permanent teeth placed by the undergraduate dental students in a private dental school. Materials and Methods: A retrospective analysis of bitewing radiographs of Class II composite restorations placed by the clinical dental students of 2017–2018 year was assessed to determine the defective restorations. Bitewing radiographs were examined to record voids, open contact, residual caries, open margin, defective restoration, and acceptable composite Class II restorations. Results: A total of 1514 permanent teeth filled with composite Class II restorations were assessed using bitewing radiographs. Almost 935 teeth showed signs of failure of Class II restorations. Reasons for the failure of most of the Class II composite restoration were due overhang 197 (13.01%), followed by voids 184 (12.15%), open contact 167 (11%), poor contour 165 (10.88%), open margin 135 (8.91%), and residual caries 87 (5.75%). A significant difference between male and female students was observed with regard to voids (P = 0.026), overhang (P = 0.016), and open margins (P = 0.001) of the Class II composite restorations. Conclusion: Overhang was the most common, and residual caries was the least common defects observed in the bitewings. Male dental students placed higher defective composite Class II restorations compared to the female dental students.

Pulp Stones as Risk Predictors for Coronary Artery Disease.

Background:Coronary artery disease (CAD) has been the leading cause of morbidity and mortality worldwide. Studies indicate that patients with CAD show higher degree of pulp calcifications. Localized pulp calcifications are microscopically apparent in more than half of the teeth in young adolescents. However, pulp stones extending to the entire dentition are infrequent and need further evaluation to predict the risk of other probabilities of associated diseases. The present study was planned to estimate the prevalence of pulp stones in patients diagnosed with or, undergoing treatment for CAD.Methods:The present study consisted of 300 subjects within an age range of 20-55 years who were divided into the study group consisting of 150 patients including 108 males and 42 females as well as 150 age- and sex-matched healthy controls. Pulp stones were imaged using bitewing radiographs using paralleling technique under standard conditions.Statistical Analysis Used:The statistical analysis was performed using IBM SPSS statistics 20 Core system software (SPSS Inc., Chicago, IL, USA) while Chi-square test was used to check the prevalence of pulp stones in patients with CAD in addition to their arch-wise and region-wise distribution. P value <0.05 was considered statistically significant.Results:The present study revealed 100% prevalence of pulp stones in the study group while 90% of the subjects in the control group were also afflicted with pulp stones, though the total number of pulp calcifications observed were lesser in number in the control group compared to the study group (P < 0.05). No significant difference was found, although in the gender predilection for the development of pulp stones in the study group while the control group revealed a definite male predilection with around 96.24% of the males afflicted with pulp stones (P < 0.05). Furthermore, maxillary teeth had a statistically significant predilection for the development of pulp stones in both the study as well as the control groups (P < 0.05).Conclusions:The patients with CAD have high chance of being affected with pulp stones. Higher prevalence of this entity in multiple teeth may warrant such an individual, in the presence of other compounding risk factors, as a candidate for CAD to be ruled out.

Automatic exposure compensation and subjective image enhancement in the radiographic diagnosis of caries.

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.

Stainless steel crowns as a restoration for permanent posterior teeth in people with special needs: A retrospective study

BackgroundLimited information exists regarding the use of stainless steel crowns (SSCs) in permanent teeth. The objective of this retrospective cohort study was to present the long-term clinical outcomes of the SSC compared with those of amalgam and composite resin restorations and the SSC radiographic outcomes in a special-needs population. MethodsThis study included 271 patients with at least 1 SSC restoration from the Mount Sinai Hospital Dentistry Clinic for Persons with Special Needs in Toronto, Ontario, Canada. A total of 2,621 posterior permanent tooth restorations were documented: 766 SSCs, 1,651 amalgam restorations, and 204 composite resin restorations. Clinical analysis included patient demographics, treatment parameters, and outcome assessments for each restoration recorded. Radiographic analysis of SSC restorations included 127 bite-wing radiographs and 118 periapical radiographs, measurement of interproximal bone loss, and assessment of periapical status using the Periapical Index Scale. ResultsThe 10-year survival rates for new SSC and amalgam restorations were 79.2% and 63.5%, respectively. The 91 SSC failures included 2 recementations, 33 replacements, and 56 extractions. Primary diagnoses at the time of failure included chronic periodontal disease (25) and loose or lost SSCs (24). Of the 528 failed conventional restorations that were replaced, 60% were replaced with SSCs. The mean alveolar bone loss from mesial and distal sites was 1.36 millimeters and 1.40 mm, respectively. Therefore, 93% of the sites recorded were less than 2 mm and classified as healthy. All pre-SCC and post-SSC periapical radiographs had healthy Periapical Index Scale scores (1 or 2) recorded over an average duration of 8.4 years (1-29.1 years). ConclusionsSSCs are a durable treatment option for the restoration of the posterior permanent dentition. Practical ImplicationsPosterior permanent teeth restored with stainless steel crowns can be expected to last for 10 years and represent a viable treatment choice for severely carious or fractured posterior permanent teeth.

Rubber Dam Isolation in Clinical Adhesive Dentistry: The Prevalence and Assessment of Associated Radiolucencies

Aim: This study aims to identify the prevalence of the use of rubber dam (RD) for isolation during resin composite restorations in a clinical scenario. It also aims to evaluate restorations done with and without RD for radiolucencies present postoperatively. Methods: A total of 50 voluntarily participating dentists were asked to do posterior composite restorations for primary caries lesions affecting the occluso-proximal surfaces. The isolation protocols followed were noted, and postoperative bitewing radiographs were evaluated independently by two investigators. The presence of radiolucencies between the tooth-restorative interface and in the body of the restoration was assessed and statistically evaluated using Chi-square test at a significance level of P≤ 0.05. Results: The results showed that 71.5% of the restorations were not done under RD isolation. There was a statistically significant difference in the number of radiolucent areas seen in restorations done with and without RD. Conclusion: This study shows a low percentage of clinicians use RD for isolation during composite restorations. It also indicates that radiolucent areas are more often associated with restorations done without RD isolation. This study stresses that there is a need to change the clinician's convictions about isolation protocols followed during composite restorations.

Annual alveolar bone loss in older adults taking oral bisphosphonate: a retrospective cohort study

BackgroundAlthough several studies assessed the effect of bisphosphonate (BIS) administration on alveolar bone loss, this relationship has not been fully investigated using longitudinal analysis. The aim of the this article is to predict annual alveolar bone loss in a subpopulation of older adults patients who were taking oral bisphosphonate (BIS), adjusting for systemic diseases and associated risk factors.MethodsThis is a retrospective cohort study. We identified all subjects who reported receiving oral bisphosphonate from 2008 to 2015 (N = 30) using the electronic health records of each patient to identify suitable radiographs for analysis. For the longitudinal data analysis, 26 subjects were eligible for inclusion, having at least two exposures of the complete mouth set or repeated bitewing radiographs at least a one-year interval; they were then matched on age and sex to another 26 patients who did not report receiving bisphosphonate at any point of their life.ResultsMild periodontitis was higher in the BIS group compared to the no BIS group; however, moderate periodontitis was higher in the no BIS group. For those who did not take oral BIS, change over time was not significant after the two-year period. However, the BIS group had experienced 0.088 mm more bone loss compared to the no BIS group (95% CI: 0.001, 0.176. P-value = 0.048), adjusting for all other variables included in the model.ConclusionThe group that reported receiving oral bisphosphonates showed no improvement in maintaining alveolar bone level, and the use of oral BIS may not be effective in reducing annual alveolar bone loss; however, emerging evidence is promising for the use of bisphosphonate as an adjunctive local delivery medication for the management of periodontal diseases.

Best clinical practice guidance for prescribing dental radiographs in children and adolescents: an EAPD policy document.

The European Academy of Paediatric Dentistry (EAPD) proposes this best clinical practice guidance to help practitioners decide when and how to prescribe dental radiographs in children and adolescents. Four expert working groups conducted each a systematic review of the literature. The main subjects were radiation protection, intraoral dental radiography (bitewing and periapical radiographs), panoramic radiography (PR) and cone-beam computed tomography (CBCT). In addition, three workshops were held during the corresponding EAPD Interim Seminar in Chania (Crete, Greece) in 2019. On the basis of the identified evidence, all invited experts presented their findings and during the workshops aspects of clinical relevance were discussed. Several clinical-based recommendations and statements were agreed upon. There is no or low-grade evidence about the efficacy of dental radiographic examinations in young populations. The given recommendations and rationales should be understood as best clinical practice guidance. It is essential to respect the radiological principles of an individualized and patient-specific justification. When a dental radiograph is required, its application needs to be optimized, aiming at limiting the patient's exposure to ionising radiation according to the ALADAIP principle (As Low As Diagnostically Achievable being Indication-oriented and Patient-specific).

Prevalence of periodontitis and alveolar bone loss in a patient population at Harvard School of Dental Medicine

BackgroundAlthough several studies assessed the prevalence of alveolar bone loss, the association with several risk factors has not been fully investigated. The aim of this article is to measure the prevalence of periodontitis by calculating the mean alveolar bone loss/level of posterior teeth using bitewing radiographs among the patients enrolled in the clinics at Harvard School of Dental Medicine and address risk factors associated with the disease.MethodsOne thousand one hundred thirty-one patients were selected for radiographic analysis to calculate the mean alveolar bone loss/level by measuring the distance between the cementoenamel junction and the alveolar bone crest on the mesial and distal surfaces of posterior teeth. Linear regression with Multi-level mixed-effect model was used for statistical analysis adjusting for age, sex, race, median household income, and other variables.ResultsMean alveolar bone level of the whole sample was 1.30 mm (±0.006). Overall periodontitis prevalence for the sample was 55.5% (±1.4%). Moderate periodontitis prevalence was 20.7% (±1.2%), while 2.8% (±0.5%) of the whole sample had severe periodontitis. Adjusted mean alveolar bone loss was higher in older age groups, males, Asian race group, ever smokers, and patients with low median household income.ConclusionThe effect of high household income on the amount of bone loss can be powerful to the degree that high household income can influence outcomes even for individuals who had higher risks of developing the disease. Public health professionals and clinicians need to collaborate with policy makers to achieve and sustain high quality of healthcare for everyone.

Baseline probing depth and interproximal sites predict treatment outcomes of non-surgical periodontal therapy

Background/purposeThe efficacy of non-surgical periodontal therapy (NSPT) has been well discussed. The aim of this study was to investigate whether the baseline clinical periodontal parameters, radiographic defect angle, and interproximal site predict the treatment outcome of NSPT. Materials and methodsA total of 39 patients who were diagnosed with generalized chronic periodontitis and met the inclusion criteria were enrolled in this study. All patients received full-mouth periodontal examination by two well-trained periodontists. Clinical periodontal parameters, including probing depth (PD), recession (Rec), and clinical attachment level (CAL), were recorded, and vertical bitewing radiographs were taken as baseline data. Revaluation was performed after 4 weeks of non-surgical periodontal treatment. Pearson's correlation coefficient and multivariate logistic regression were performed to examine the association between favorable treatment outcome (PD reduction ≥ 3 mm) and various clinical parameters. ResultsA significant improvement was observed in PD reduction and CAL gain after NSPT. The radiographic defect angle was strongly correlated with baseline Rec, baseline CAL, and interproximal sites in teeth with a deeper PD. Baseline PD and interproximal sites emerged as significant prediction factors for favorable treatment outcome with a PD reduction of ≥3 mm. ConclusionOur study is the first to report that distal sites show wider radiographic angles with shallow infrabony defects and that pocket reduction is more obvious at distal sites than at mesial sites. These data provide evidence that baseline PD and interproximal sites may predict the treatment outcome of NSPT.

Combined Near-Infrarred Light Transillumination and Direct Digital Radiography Increases Diagnostic In Approximal Caries

The objective of this study was to evaluate the clinical ability of Near-Infrared Light-Transillumination (NILT) for approximal dentinal caries detection and to compare with direct digital-radiography (DDR), as well as to determine whether the combination of both techniques improves the diagnostic capacity of the lesions. From 88 patients (over 18 years), 138 posterior teeth (76 molars and 62 premolars), that had approximal caries reached into dentine determined by DDR, were included. Lesion extension and DDR images were scored as follows: D0 = sound surface, D1/D2 = caries restricted to the outer/inner-half of the enamel, and D3/4 = caries restricted to the outer/inner-half of the dentin. Opening of the approximal surface using 0.5 mm-in-diameter diamond-bar was used as gold-standard. The lesion extension was then determined by the following criteria: no dentinal caries (D0/1/2) or dentinal caries (D3/4). Seventy-one lesions were D3 and 67 lesions were D4. Sensitivities of overall/D3/D4 were 98.0/95.7/100.0 (NILT) and 100/100/100 (DDR), respectively. Correlations with gold-standard were 0.92 (NILT) and 0.42 (DDR), respectively. The correlation increased to 0.97 (p = 0.045) on combining NILT and DDR. There was no difference in sensitivity between the methods (p > 0.05); but was differences in the correlation (p < 0.01). It can be concluded that NILT showed sensitivity similar to that of DDR and higher correlation than DDR for approximal dentinal caries detection. Accordingly, it may be used to monitor the progression of caries without exposing the patient to ionizing radiation, this being of particular interest in growing patients and in pregnant women. In this respect, NILT can be an effective diagnostic tool adjunctive to bitewing radiographs in detecting approximal dentinal caries. The combination of NILT and DDR represents an increase in the diagnosis of approximal lesions The proposed diagnostic protocol comprises visual examination, followed by NILT and DDR only if the former technique detects approximal caries.

A RETROSPECTIVE STUDY ON MOLAR FURCATION ASSESSMENT VIA CLINICAL DETECTION, INTRAORAL RADIOGRAPHY, AND CONE BEAM COMPUTED TOMOGRAPHY

Background It is challenging to assess molar furcation bone loss by clinical detection and intraoral radiographs in many instances. Cone beam computed tomography (CBCT) is expected to open a new horizon in periodontal assessment. Objective(s) The aim of this study was to compare and correlate molar furcation assessment via clinical detection, intraoral radiography, and CBCT. Study Design Eighty-three patients, seen at the University of Texas School of Dentistry (UTSD), with chronic periodontitis who had existing CBCT scans were included. Furcation involvement was assessed on maxillary and mandibular first molars. Periodontal charts (modified Glickman classification), intraoral (periapical and/or bitewing) radiographs, and sagittal and axial CBCT reconstructions were used to identify furcation involvement on buccal and palatal/lingual sites. The correlation of furcation assessment by the 3 methods was evaluated by Pearson's analysis. Results There were significant correlations (P < .05) between clinical detection and intraoral radiography, clinical detection and CBCT, and intraoral radiography and CBCT at all the measured sites (r values ranged from 0.230 to 0.644). CBCT exhibited generally higher correlation with clinical detection compared with intraoral radiography, especially at the distal–palatal side of the maxillary first molar (P < .05). In addition, CBCT provided more accurate furcation assessment, because it measured up to 2 decimals in millimeters, whereas clinical detection had 3 classes, and the intraoral radiographs usually only detected the presence of furcation involvement in Glickman Class 2 and 3. Discussion/Conclusions This study validates that CBCT is a valuable tool in molar furcation assessment in addition to clinical examination and intraoral radiography. It is challenging to assess molar furcation bone loss by clinical detection and intraoral radiographs in many instances. Cone beam computed tomography (CBCT) is expected to open a new horizon in periodontal assessment. The aim of this study was to compare and correlate molar furcation assessment via clinical detection, intraoral radiography, and CBCT. Eighty-three patients, seen at the University of Texas School of Dentistry (UTSD), with chronic periodontitis who had existing CBCT scans were included. Furcation involvement was assessed on maxillary and mandibular first molars. Periodontal charts (modified Glickman classification), intraoral (periapical and/or bitewing) radiographs, and sagittal and axial CBCT reconstructions were used to identify furcation involvement on buccal and palatal/lingual sites. The correlation of furcation assessment by the 3 methods was evaluated by Pearson's analysis. There were significant correlations (P < .05) between clinical detection and intraoral radiography, clinical detection and CBCT, and intraoral radiography and CBCT at all the measured sites (r values ranged from 0.230 to 0.644). CBCT exhibited generally higher correlation with clinical detection compared with intraoral radiography, especially at the distal–palatal side of the maxillary first molar (P < .05). In addition, CBCT provided more accurate furcation assessment, because it measured up to 2 decimals in millimeters, whereas clinical detection had 3 classes, and the intraoral radiographs usually only detected the presence of furcation involvement in Glickman Class 2 and 3. This study validates that CBCT is a valuable tool in molar furcation assessment in addition to clinical examination and intraoral radiography.

DOSIMETRY AND DIAGNOSTIC ACCURACY OF INTRAORAL AND EXTRAORAL BITEWINGS IN DETECTING APPROXIMAL CARIES

<h3>Background</h3> Traditionally, interproximal caries has been diagnosed radiographically by intraoral bitewing radiographs. Although this has been the conventional practice, the challenge of accommodating the film/ image receptor in the mouth, especially in patients with a gag reflex, has affected image acquisition and quality. A new method of acquiring bitewings with an extraoral approach has been recently introduced but the quality and diagnostic efficacy along with the radiation dosage of these techniques have not been well studied. <h3>Objective(s)</h3> The aim of this study was to evaluate the diagnostic accuracy of intraoral and extraoral bitewings (IOBs and EOBs) in their ability to detect proximal caries and to compare the effective doses from both techniques. <h3>Study Design</h3> Human teeth with or without proximal caries were used in this study. Carious lesions were created with different degrees of decalcification on 60 teeth (120 surfaces). These teeth were then placed into sockets of dry human skulls. Intraoral bitewings were acquired using a Kavo LM/CM109 wall-mounted X-ray tube with exposure parameters of 70 KVp, 7 mA, and 0.125 second. Extraoral bitewings were acquired with a Planmeca Promax at 74 kVp,7 mA, and 7.5 seconds. Two radiologists and a general dentist scored the radiographs using standardized software (MiPACS) and display monitors. Dose measurements were done on an anthropometric RANDO phantom. OSLdot dosimeters were used at 24 sites for radiation dose measurements. Fifteen exposures were performed for each dosimeter, and absorbed dose was calculated as an average of the15 exposures using the International Commission on Radiological Protection (ICRP, 2007) tissue weighting factors. <h3>Results</h3> For the diagnosis of interproximal caries, extraoral bitewings showed a sensitivity of 92.3% and specificity of 93.4%, whereas intraoral bitewings showed sensitivity of 94.5% and specificity of 96.8%, Interim dosimetry analysis showed that the doses for IOBs and EOBs were comparable but were slightly different for intraoral membranes. <h3>Discussion/Conclusions</h3> EOBs showed comparable results to IOBs in the detection of approximal caries and had similar effective doses.

Detection of Approximal Caries Lesions in Adults: A Cross-sectional Study.

Detection and management of posterior approximal caries lesions are still problematic. Inspection of approximal surfaces is challenging, and bitewing radiographs are used when direct vision is not possible. Unfortunately, there is no definite radiographic appearance to identify lesion cavitation with absolute certainty. Many lesions detected radiographically within the outer half of dentin are not cavitated, often resulting in unnecessary restorative treatment. Our study compared radiographic depth of approximal caries lesions with presence of cavitation in adults using visual inspection following temporary tooth separation (TTS). We conducted this observational descriptive cross-sectional study at two dental schools in two cities in Chile. Clinicians were unaware of radiographic depths of lesions and examined 147 participants (57.3% female and 42.7% male) following TTS. Using the common classification system that consists of E0 (no lesion), E1 (lesion within the outer half of enamel), E2 (lesion within the inner half of enamel), D1 (lesion within the outer third of dentin), D2 (lesion within the middle third of dentin), and D3 (lesion within the inner third of dentin), a trained dentist evaluated all the processed films. Cavitation was detected in only three sites (0.22%) within the E0 category, seven sites (3.41%) in E1, five sites (14.8%) in E2, four sites (14.8%) in D1, six sites (50%) in D2, and eight sites (61.5%) in D3. Considering that restorative treatment should be indicated strictly for cavitated lesions, our findings support indication for restorative treatment for D3 lesions and the rationale for TTS for D1-D2 caries lesions to allow direct visual inspection to determine whether there is surface cavitation.

The Effect of Resin Infiltration on the Progression of Proximal Caries Lesions: A Randomized Clinical Trial

Objective: The aim of this clinical trial was to assess the effect of resin infiltration on the progression of proximal caries lesions. Subjects and Methods: Forty-one patients, aged between 15 and 33 years, with 2 or more non-cavitated proximal caries lesions were included. In 41 of the adolescent and young adults, 45 pairs of proximal lesions with radiological extension into the inner and outer half of the enamel, or into the outer third of the dentin, were randomly allocated to the test groups (resin infiltration application + fluoridated toothpaste and flossing use) or to the control group (fluoridated toothpaste and flossing use). Standardized geometrically aligned digital bitewing radiographs were obtained using individual biting holders. The radiographic progression of the lesions was assessed after 1 year by digital-subtraction radiography. The McNemar test was used for statistical analysis. Results: In the test group 1/45 of the lesions (2.2%) and in the control group 9/45 of the lesions (20%) showed progression. The caries progression rate of the control group was significantly higher than that of the test group (p < 0.05). Conclusions: Resin infiltration of proximal caries lesions is effective in reducing progression of the lesion.