Bitewing Radiographs Research Articles

Dental Faculty Accuracy When Using Diagnostic Codes: A Pilot Study.

The aim of this study was to examine the accuracy of dental faculty members' utilization of diagnostic codes and resulting treatment planning based on radiographic interproximal tooth radiolucencies. In 2015, 50 full-time and part-time general dentistry faculty members at one U.S. dental school were shown a sequence of 15 bitewing radiographs; one interproximal radiolucency was highlighted on each bitewing. For each radiographic lesion, participants were asked to choose the most appropriate diagnostic code (from a concise list of five codes, corresponding to lesion progression to outer/inner halves of enamel and outer/middle/pulpal thirds of dentin), acute treatment (attempt to arrest/remineralize non-invasively, operative intervention, or no treatment), and level of confidence in choices. Diagnostic and treatment choices of participants were compared to "gold standard" correct responses, as determined by expert radiology and operative faculty members, respectively. The majority of the participants selected the correct diagnostic code for lesions in the outer one-third of dentin (p<0.0001) and the pulpal one-third of dentin (p<0.0001). For lesions in the outer and inner halves of enamel and the middle one-third of dentin, the correct rates were moderate. However, the majority of the participants chose correct treatments on all types of lesions (correct rate 63.6-100%). Faculty members' confidence in their responses was generally high for all lesions, all above 90%. Diagnostic codes were appropriately assigned by participants for the very deepest lesions, but they were not assigned accurately for more incipient lesions (limited to enamel). Paradoxically, treatment choices were generally correct, regardless of diagnostic choices. Further calibration is needed to improve faculty use and teaching of diagnostic codes.

Digital transillumination in caries detection versus radiographic and clinical methods: an in-vivo study

This article aimed to evaluate: (a) the agreement between a near-infrared light transillumination device and clinical and radiographic examinations in caries lesion detection and (b) the reliability of images captured by the transillumination device. Two calibrated examiners evaluated the caries status in premolars and molars on 52 randomly selected subjects by comparing the transillumination device with a clinical examination for the occlusal surfaces and by comparing the transillumination device with a radiographic examination (bitewing radiographs) for the approximal surfaces. Forty-eight trained dental hygienists evaluated and reevaluated 30 randomly selected images 1-month later. A high concordance between transillumination method and clinical examination (kappa = 0.99) was detected for occlusal caries lesions, while for approximal surfaces, the transillumination device identified a higher number of lesions with respect to bitewing (kappa = 0.91). At the dentinal level, the two methods identified the same number of caries lesions (kappa = 1), whereas more approximal lesions were recorded using the transillumination device in the enamel (kappa = 0.24). The intraexaminer reliability was substantial/almost perfect in 59.4% of the participants. The transillumination method showed a high concordance compared with traditional methods (clinical examination and bitewing radiographs). Caries detection reliability using the transillumination device images showed a high intraexaminer agreement. Transillumination showed to be a reliable method and as effective as traditional methods in caries detection.

The diagnostic accuracy of a laser fluorescence device and digital radiography in detecting approximal caries lesions in posterior permanent teeth: an in vivo study

The aim of this in vivo study was to test the diagnostic accuracy of a pen-type laser fluorescence (LFpen) device in detecting approximal caries lesions, in posterior permanent teeth, at the cavitation and non-cavitation thresholds, and compare it with that of digital bitewing radiography. Thirty patients (aged 18–37), who attended the Faculty of Dentistry at Damascus University for a dental examination, were consecutively screened. Ninety approximal surfaces of posterior permanent teeth without frank cavitations, enamel hypoplasia or restorations were selected and examined using the LFpen (DIAGNOdent pen) and digital bitewing radiography. The reference standard was the visual-tactile inspection, after performing temporary tooth separation, using orthodontic rubber rings, placed for 7 days. The status of included approximal surfaces was recorded as intact/sound, with white/brown spots or cavitated. One trained examiner performed all examinations. There were statistically significant differences in LFpen readings between the three types of approximal surface status (P < 0.001). The optimal cut-off values for detecting approximal caries lesions in posterior permanent teeth were >16 and 8 at the cavitation and non-cavitation thresholds respectively. The sensitivity, specificity and accuracy (measured by the area under the receiver-operating characteristic curve) were 100, 85 and 95 and 92, 90 and 95% at the cavitation and non-cavitation thresholds respectively. The intra-class correlation coefficient for intra-examiner reliability was 0.95. The diagnostic accuracy of the LFpen was significantly higher than that of digital bitewing radiography (P < 0.001). The LFpen’s diagnostic performance was accurate and significantly better than digital bitewing radiography in detecting approximal caries lesions, in posterior permanent teeth.

Assessment of cavitation in artificial approximal dental lesions with near-IR imaging.

Bitewing radiography is still considered state-of-the-art diagnostic technology for assessing cavitation within approximal carious dental lesions, even though radiographs cannot resolve cavitated surfaces but instead are used to measure lesion depth in order to predict cavitation. Clinicians need new technologies capable of determining whether approximal carious lesions have become cavitated because not all lesions progress to cavitation. Assessing lesion cavitation from near-infrared (NIR) imaging methods holds great potential due to the high transparency of enamel in the NIR region from λ=1300-1700-nm, which allows direct visualization and quantified measurements of enamel demineralization. The objective of this study was to measure the change in lesion appearance between non-cavitated and cavitated lesions in artificially generated lesions using NIR imaging modalities (two-dimensional) at λ =1300-nm and λ=1450-nm and cross-polarization optical coherence tomography (CP-OCT) (thee-dimensional) λ =1300-nm. Extracted human posterior teeth with sound proximal surfaces were chosen for this study and imaged before and after artificial lesions were made. A high speed dental hand piece was used to create artificial cavitated proximal lesions in sound samples and imaged. The cavitated artificial lesions were then filled with hydroxyapatite powder to simulate non-cavitated proximal lesions.

Comparison of Visual Examination, Bite-wing Radiography, and Fiberoptic Transillumination on Caries Detection

ABSTRACTIntroductionThe detection of carious lesions in the initial stages of development is very important to prevent the occurrence of cavitation. Visual examination and the use of a dental probe, bite-wing radiography, and fiberoptic transillumination (FOTI) have long been recommended for this purpose. Visual examination and probing of suspected lesions are useful for detecting occlusal caries, but achieve no gain of sensitivity and might cause irreversible tooth damage. Bite-wing radiography helps to detect approximal lesions better than clinical examination and probing the lesion. But the diagnostic performance of bite-wing radiography at approximal and occlusal sites is different. The FOTI is a quick and inexpensive method that can enhance visual examination of all tooth surfaces.The aim of thisin vivostudy is to compare FOTI with bite-wing radiography and visual examination in the detection of approximal and occlusal caries.Materials and methodsA total of 46 patients without missing teeth and dentures in the posterior region of jaws were examined for the evaluation of all premolar and molar teeth contacts. Three blinded practitioners examined the patients. First one evaluated radiologically, second one visually, and the last one evaluated with FOTI.ResultsAccording to statistical results, bite-wing radiograph had the highest sensitivity. However, evaluation with FOTI had acceptable results to detect approximal caries.ConclusionStudy of the results has shown that clinically FOTI is an adjunct method for detection of approximal caries.How to cite this articleEren H, Yuksel HT, Inceoglu B, Kursun ES, Gorgun S. Comparison of Visual Examination, Bite-wing Radiography, and Fiberoptic Transillumination on Caries Detection. J Contemp Dent 2017;7(2):77-81.

Validity of Digital Imaging of Fiber-Optic Transillumination in Caries Detection on Proximal Tooth Surfaces.

Objective The aim of our study was to evaluate the validity of the digital imaging fiber-optic transillumination (DIFOTI) method in comparison with clinical visual examination (CV) and bitewing (BW) radiography on detecting caries lesions on proximal surfaces of teeth. Materials and Methods Proximal tooth surfaces of premolars and molars (n = 2,103) of 91 voluntary university students aged from 18 to 30 years were examined with CV, BW radiography, and the DIFOTI method. ResultsDIFOTI detected more initial and manifested caries lesions compared with CV and BW. Of the analyzed tooth surfaces, 69.8% were classified as sound by DIFOTI, 80.3% by BW, and 91.6% by CV. Initial caries lesions were found in 21.2% of the surfaces by DIFOTI, in 14.1% by BW, and in 6.2% by CV, whereas the proportions for manifested dental caries lesions were 9.0%, 5.6%, and 2.2%, respectively. The interexaminer agreement regarding the DIFOTI findings between an experienced clinician and a fifth-year dental student was high: κ = 0.67 for initial and κ = 0.91 for manifested caries lesions. ConclusionsThe noninvasive DIFOTI method seems to offer a potential tool for everyday clinical practice. In clinical use, DIFOTI finds well even initial caries lesions on proximal surfaces, thus providing an instrument for detecting lesions potential for arresting as well as for monitoring the outcome after preventive measures.

Detection of proximal caries using quantitative light-induced fluorescence-digital and laser fluorescence: a comparative study.

PURPOSEThe purpose of this study was to evaluate the in vitro validity of quantitative light-induced fluorescence-digital (QLF-D) and laser fluorescence (DIAGNOdent) for assessing proximal caries in extracted premolars, using digital radiography as reference method.MATERIALS AND METHODSA total of 102 extracted premolars with similar lengths and shapes were used. A single operator conducted all the examinations using three different detection methods (bitewing radiography, QLF-D, and DIAGNOdent). The bitewing x-ray scale, QLF-D fluorescence loss (ΔF), and DIAGNOdent peak readings were compared and statistically analyzed.RESULTSEach method showed an excellent reliability. The correlation coefficient between bitewing radiography and QLF-D, DIAGNOdent were −0.644 and 0.448, respectively, while the value between QLF-D and DIAGNOdent was −0.382. The kappa statistics for bitewing radiography and QLF-D had a higher diagnosis consensus than those for bitewing radiography and DIAGNOdent. The QLF-D was moderately to highly accurate (AUC = 0.753 – 0.908), while DIAGNOdent was moderately to less accurate (AUC = 0.622 – 0.784). All detection methods showed statistically significant correlation and high correlation between the bitewing radiography and QLF-D.CONCLUSIONQLF-D was found to be a valid and reliable alternative diagnostic method to digital bitewing radiography for in vitro detection of proximal caries.

Hard Facts about Stones: Pulpal Calcifications: A Review

Pulp calcifications stones are discrete calcifications within the pulps of teeth. They are a frequent finding on bitewing and periapical radiographs. Johnson and Bevelander stated that a single tooth may have stones ranging from 1 to 12 or even more, with sizes varying from minute particle to large masses that occlude the pulp space. They often develop in teeth that appear quite normal in other respects. They have been seen in both functional as well as embedded teeth. Inspite of this frequent occurrence, they have received relatively little attention in textbooks. The purpose of this review was to examine these pulp stones from all the aspects including their pathogenesis, clinical aspects, histopathology, current perspectives and contemporary research on the same.

Caries Progression Rate in Primary Teeth: A Retrospective Study.

The rate of caries progression in primary teeth has rarely been studied, with most studies on early childhood caries reporting the percentage of lesions that remain at a certain stage of disease over a period of time. The aim of the present study was to examine the prevalence and behavior of proximal and occlusal carious lesions in primary teeth among children from low socio-economic status. This retrospective study was based on bite-wing radiographs of 95 children aged 5-12 taken at 6-12 months intervals, with a follow-up period of at least three years. One hundred thirty-five teeth and 141 tooth surfaces were examined. The degree of proximal surfaces and occlusal caries advancement was scored and statistical analyses (Mann-Whitney, Kruskal-Wallis and Kaplan-Meier analysis) were performed to evaluate caries progression rate. The results revealed that approximately 0.8 years were required for a carious lesion to progress from the outer enamel to the dentino-enamel junction, and an additional 1.4 years for it to reach the inner part of the dentin. The caries progression rate found in the present study is more rapid than previously found and affects more the lower socio economic population.

Periodontal Initial Radiological Findings of Genetically Predisposed Finnish Adolescents.

Periodontitis is a multifactorial infectious disease of the supporting tissues of teeth in which bacterial, genetic and lifestyle factors such as smoking have an important role. The aim was to examine if Bleeding On Probing (BOP ≥ 20%) and ≥ 4 mm deep pockets correlated with any suspicion of initial radiological findings of periodontitis and bone loss. We also investigated whether any pro-inflammatory-related candidate Single Nucleotide Polymorphisms (SNPs) were associated with any suspicion of radiological findings. Altogether 47 generally healthy adolescent patients of one birth cohort had given their approval for their saliva samples to be used for DNA analysis. One participant was excluded after discrepant gender check. An oral radiologist analysed right and left bitewing radiographs of 47 patients. Clinical parameters such as BOP ≥ 20%, ≥ 4 mm pockets, Visible Plaque Index of all teeth (VPI%), as well as smoking habits were recorded. DNA was extracted and 71 SNPs from candidate genes for initial periodontitis were genotyped. The association between ≥ 4 mm pockets and BOP ≥ 20% with radiological findings and selected SNPs was modelled using logistic regression. Variants in Toll-Like Receptors 4 (TLR4) gene (rs498670) (OR=5.8, {CI95% 1.6-20.7}, p=0.02, FDR q-value=0.13) and TNFSF11 gene (rs2277438, OR=0.3 {CI95% 0.1-0.9}, p=0.002, FDR q-value=0.56) were associated with any suspicious radiological findings; however the significance vanished after False Discovery Rate analysis (FDR). The association between BOP ≥ 20% and any radiographic signs of periodontitis was found to be statistically significant, OR=1.6, CI 95% 1.0-2.4, p=0.04. Only TLR4 (rs498670) and TNFSF11 (rs2277438) genes were found to have a positive correlation with radiological findings suggestive of initial periodontitis after adjustment for smoking and visible plaque.

Prevalence of intrabony defects in a Swedish adult population. A radiographic epidemiological study

Aim: The purpose of this radiographic study was to evaluate the prevalence of intrabony defects and to study the correlation between these defects and clinical variables in a Swedish adult population. Another aim was to study the combined relationship of intrabony defects and furcation involvement with clinical variables.Materials and methods: The present study was performed using bitewing and apical radiographs from 329 subjects. The clinical and radiographic data were collected from the study that was carried out in Jönköping 2003. Intrabony defects were measured from the bottom of the pocket to the highest point of alveolar bone crest. Furcations were considered healthy if the furcation was filled with bone up to the fornix. SPSS was used to analyze the results.Results: 2014 molars and 5898 non-molars were included in the study. The prevalence of intrabony defects was 2.2% in the whole population. Multivariate analysis showed that periodontal pockets (p < 0.0001), plaque (p < 0.001), age (p < 0.02) and gender (p < 0.03) had a significant relationship with the occurrence of intrabony defects. On the other hand, gingivitis, smoking habits and education level were not associated with intrabony defects. Multivariate analysis showed that the only variable associated with presence of intrabony defects and furcation involvement was presence of periodontal pockets (p < 0.0001). Whilst, gingivitis, education level, plaque, gender, age and smoking habits were not associated with the outcome.Conclusions: Mandibular second molars were most likely to display intrabony defects, whilst mandibular incisors were the least likely to do so.

Correction to Intraoral versus extraoral bitewing radiography in detection of enamel proximal caries: an ex vivo study.

Correction to Intraoral versus extraoral bitewing radiography in detection of enamel proximal caries: an ex vivo study.

Prevalence of furcation-involved molars in a Swedish adult population. A radiographic epidemiological study.

The purpose of this study was to identify the prevalence of molars with furcation involvements grades II and III in adults participating in the Jönköping Oral Health Study 2003. The second aim was to study correlations between different variables and the presence of furcation involvement in these individuals. The present study was performed using bitewing and apical radiographs from 329 subjects. Furcations were considered healthy if the furcation was filled with bone up to the fornix. Two thousand fourteen molars fulfilled the inclusion criteria. The prevalence of molars with furcation involvements was 8.3%. Univariate analysis showed that plaque, age, and presence of periodontal pockets were significantly correlated with furcation‐involved molar/s (P ˂ 0.0001). Gingivitis and education were also significantly correlated to the presence of furcation involvement (P ˂ 0.006) and (P ≤ 0.01), respectively. Gender had no association with presence of involvements. Multivariate analysis showed that age and presence of periodontal pockets were significantly correlated with furcation involvement (P ˂ 0.0001). Smoking was also found to be associated with furcation involvement (P ˂ 0.04). The tooth most frequently and least likely displaying furcation involvement was the maxillary first molar and the mandibular second molar, respectively. Periodontal pockets, age, and smoking were risk indicators for furcation involvement.

Changes in the craniofacial complex and alveolar bone height of young adults: Applications to dental medicine.

The few studies on craniofacial complex changes in adults have reported contradictory findings. The aim of this study was to radiographically evaluate changes in the craniofacial complex and alveolar bone height of young adults over a 4-year period. This prospective study included 82 young adults (62 men; mean age, 19.0 ± 0.8 years; 20 women; mean age, 18.8 ± 0.9 years). Three radiographic examinations were performed longitudinally: the first (T0) was conducted at the start of the study, the second (T1) was conducted 2 years later, and the third (T2) was conducted at the end of the study period. As part of these examinations, lateral cephalograms, maxillary and mandibular anterior periapical radiographs, and bilateral posterior bitewing radiographs were obtained. During the 4-year follow-up period, all linear cephalometric measurements were significantly greater in men than in women. The amount of increase in the anterior facial height between T1 and T2 was lower in women than in men (P = 0.029). The rate of uprighting of the upper incisors was lower in men than in women over time (P = 0.020). The apex of the nose moved inferiorly between T0 and T2 (P = 0.006). The average overall change in the alveolar bone height was 0.27 mm and the yearly change was 0.07 mm over the 4-year period (P< 0.001). Significant changes in the skeletal, dental, and soft tissue, as well as, natural changes in alveolar bone, occur in young adults over time. Clin. Anat. 29:1011-1017, 2016. © 2016 Wiley Periodicals, Inc.

A radio-odontometric analysis of sexual dimorphism in deciduous dentition

ObjectiveIt has been suggested that the level of sexual dimorphism in deciduous dentition is relatively lower than that in permanent dentition. However, in sub adult skeletal remains whose osseous morphological traits of the sex have not defined yet, predicting sex on the basis of odontometric features may be the most precise technique. The aim of the present study was to assess the degree of sexual dimorphism in marginal enamel, dentin and pulp dimensions of second molar deciduous teeth in a pediatric population. Method and materialsThe present study was conducted on bitewing radiographs of 64 males and 60 females. The greatest width of enamel, dentin and pulp on mandibular and maxillary second molar deciduous teeth were measured. Student's t-test and discriminant analysis were used to compare the differences in the odontometric parameters between females and males. ResultsAmong the second molar measurements, only the maxillary pulp width did significantly discriminate the sex groups. The accuracy of sex identification of a case based on deciduous second molar tooth was approximately 68%. ConclusionsThe application of second molar deciduous teeth in sex prediction showed moderate level of sexual dimorphism. In this respect, the maxillary pulp width had the greatest amount of contribution in sex discrimination. Therefore, these odontometric traits, in conjunction with other skeletal features, can be used as a supplementary sexing tool for gender prediction in forensic anthropology.

Panoramic radiographs in dental diagnostics

Panoramic radiographs are frequently used in dental practice in addition to bitewing radiographs and periapical radiographs. The way a panoramic photograph is created is different from that of a projection image, such as bitewing and periapical radiographs. As a result, the sharpness of detail is much less, and overlap of structures occurs in different areas of the image. Consequently the diagnostic utility is limited to the recognition of anomalies for which small details play a lesser role. The advantage of a panoramic radiograph is that structures over a large area are shown in their relative location. Because of the lower resolution and the higher dose of radiation to the patient compared with a series of intraoral images, the panoramic radiograph is not indicated during a periodic check-up. If clinical inspection indicates a need for it and as a supplement to an intraoral radiograph, a panoramic radiograph can, however, be appropriate in cases of abnormalities that extend over a larger area, such as tumours and developmental disorders.

A novel classification system for assessment of approximal caries lesion progression in bitewing radiographs

To design and pilot a novel classification system for the assessment of caries lesion progression in bitewing radiography and to report rater agreement of the system. A classification system with drawings and text was designed to assess caries lesion progression. Guidelines for Reporting Reliability and Agreement Studies were used to study and report rater agreement. Pairs of posterior bitewing radiographs (baseline and 1-year follow-up) with different status concerning caries lesion progression were selected from files from public dental health clinics. 10 raters, 5 general dental practitioners and 5 specialists in oral and maxillofacial radiology were asked to assess the radiographs with the aid of the classification system. Seven raters repeated their assessments. Rater agreement was expressed as percentage of agreement and kappa. Kappa for the interrater agreement of 10 raters assessing progression was 0.61, indicating substantial agreement. Agreement was moderate for progression in the outer half of the dentine (kappa 0.55) and within enamel (kappa 0.44). Pairwise interrater agreement varied (range 69-92%; kappa 0.42-0.84). For about half of the pairs of raters, kappa was substantial (≥0.61). Intrarater agreement assessing progression was substantial (kappa 0.66-0.82). We demonstrated the applicability of the proposed classification system on caries lesion progression with respect to rater agreement. This system can provide a common framework for clinical decision-making on caries interventional methods and patient visiting intervals. Scientifically, this system allows for a comparative analysis of different methods of prevention and treatment of caries as well as of different caries risk assessment methods.

Genotoxic effects of X-rays in buccal mucosal cells in children subjected to dental radiographs.

Objectives/Aims:Bitewing and digital dental panoramic radiographs have become important adjuvants for successful dental practice in pediatric dentistry. Both methods lead to genetic changes in the oral buccal epithelium that have not yet been satisfactorily explored. The aim of the present study was to evaluate the genotoxic effects induced by X-ray radiation from bitewing and panoramic dental radiography in exfoliated buccal epithelial cells of children, using the Buccal Micronucleus Cytome assay.Materials and Methods:Children (n=40) who met the inclusion criteria and provided signed informed consent were included in the study. Children were selected for undergoing bitewing radiographs (group 1; n=20) or digital dental panoramic radiographs (group 2; n=20). Exfoliated buccal mucosal cells were obtained by scraping the right/left buccal mucosa with a wooden spatula immediately before the X-ray exposure and 10±2 days after exposure.Results:The frequency of micronuclei increases significantly post exposure to both bitewing and digital dental panoramic radiography in children, but the frequency was higher in bitewing radiographs.Conclusion:It was concluded that the frequency of micronuclei increases post exposure to both bitewing and digital panoramic radiographs. Increased radiation exposure results in an increase in micronuclei frequency.

Association Between Visual Inspection, Caries Activity Status, and Radiography with Treatment Decisions on Approximal Caries in Primary Molars.

The purpose of this study was to evaluate the in vivo performance of the International Caries Detection and Assessment System (ICDAS), Lesion Activity Assessment (LAA), and bitewing radiographs (BW) in detecting carious lesions on approximal surfaces of primary teeth and determine their association with treatment decisions (TDs). Eighty-nine primary molars (166 approximal surfaces) in 56 eight- to 12-year-old children were clinically evaluated by a single examiner before and after temporary tooth separation. After exfoliation/ extraction, the teeth were histologically analyzed for caries depth and activity. Sensitivities for ICDAS and ICDAS-LAA were higher after tooth separation, while specificities were lower (P<0.05). The sensitivity and specificity values for BW were 0.49 and 0.79, respectively. The strongest correlations were found between ICDAS and BW before and after tooth separation, and between ICDAS and ICDAS-LAA and ICDAS and TDs before tooth separation (P<0.05). The International Caries Detection and Assessment System assessment after tooth separation presented better clinical performance than bitewing radiography for the detection of approximal carious lesions in primary molars. There was a high correlation between treatment decisions based on ICDAS, ICDAS-Lesion Activity Assessment, and bitewing radiography, highlighting the functional similarity of these tools in the clinical decision-making process.

Age Related Prevalence of Pre-Eruptive Intracoronal Radiolucent Defects in the Permanent Dentition.

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. 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. 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. 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.