Bitewing X-rays Research Articles

AI-Dentify: deep learning for proximal caries detection on bitewing x-ray - HUNT4 Oral Health Study.

Dental caries diagnosis requires the manual inspection of diagnostic bitewing images of the patient, followed by a visual inspection and probing of the identified dental pieces with potential lesions. Yet the use of artificial intelligence, and in particular deep-learning, has the potential to aid in the diagnosis by providing a quick and informative analysis of the bitewing images. A dataset of 13,887 bitewings from the HUNT4 Oral Health Study were annotated individually by six different experts, and used to train three different object detection deep-learning architectures: RetinaNet (ResNet50), YOLOv5 (M size), and EfficientDet (D0 and D1 sizes). A consensus dataset of 197 images, annotated jointly by the same six dental clinicians, was used for evaluation. A five-fold cross validation scheme was used to evaluate the performance of the AI models. The trained models show an increase in average precision and F1-score, and decrease of false negative rate, with respect to the dental clinicians. When compared against the dental clinicians, the YOLOv5 model shows the largest improvement, reporting 0.647 mean average precision, 0.548 mean F1-score, and 0.149 mean false negative rate. Whereas the best annotators on each of these metrics reported 0.299, 0.495, and 0.164 respectively. Deep-learning models have shown the potential to assist dental professionals in the diagnosis of caries. Yet, the task remains challenging due to the artifacts natural to the bitewing images.

Proposed values for diagnostic reference levels in intraoral dental radiography in Serbia

Values for diagnostic reference levels are proposed for intraoral dental radiography in the Republic of Serbia. Proposed numbers for diagnostic reference levels were based on measurements on 119 intraoral units in clinical settings for an adult posterior bitewing X-ray. Values of 3.17 mGy, 3.11 mGy, and 1.58 mGy incident air kerma were found for image receptors film E class, charge-coupled device, and photostimulable phosphor plate, respectively. Similarly, 89.6 mGycm2, 88 mGycm2, and 44.6 mGycm2 air kerma-area products were found for the same detectors. All values are greater than those published in several other similar studies. This is especially true for charge-coupled device image receptors since this technology enables lower patient doses as reported before. This calls for urgent action to optimize intraoral dental imaging, so we present the radiographic techniques used and equipment description to help guide optimization actions.

Establishment of a local diagnostic reference level for dental intraoral bitewing X-rays.

A state-based local diagnostic reference level (LDRL) for dental intraoral X-rays has been established. LDRL values of 2.0 mGy incident air kerma (IAK) and 57 mGy•cm2 air kerma-area product (KAP) for an adult posterior bitewing X-ray were determined based on 811 X-ray units surveyed. This IAK LDRL value is greater than those established in several other nations and regions around the world in similar studies. Analyses of radiographic technique and equipment usage are included to provide broad guidance as to ways that imaging could be optimised, such as in the selection of exposure factors, collimators, image receptors, and X-ray unit models.

Relação de ensino e aprendizagem a partir de diagnósticos e condutas clínicas de radiografias interproximais

The aim of the present paper is to prove the difficult of diagnosis and the variations in clinical procedure from Bite Wing x-rays as well as to analyze the relation teaching - leaving based on such x-rays. To reach the objective of the research we counted on the participation os students from the 6th and 8th semesters of F.O. UFRGS who made the diagnosis and conducted the clinical procedures based on the 4 Bite Wing x-rays. These had been previosly analysed by the professors of the course on Radiology, the results of which were taken as a pattern. The research sought to identify the existance of homogeneity or the lack of it, in the formulation of diagnosis and of clinical procedures, using as criteria the variables of sex and level of education.

Visual Examination, Fluorescence-Aided Caries Excavation (FACE) Technology, Bitewing X-Ray Radiography in the Detection of Occlusal Caries in First Permanent Molars in Children.

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

Teeth Segmentation of Bitewing X-Ray Images Using Wavelet Transform

Within the recent twenty years, the dental X-ray images have widely been employed in forensic odontology for human identification, particularly where mass disasters happen. In this paper, a novel method is proposed for the process of teeth segmentation and individual teeth isolation of Bitewing X-ray radiographs. The main objective of this study is to develop an automatic teeth segmentation approach that can be used in an Automated Dental Identification System (ADIS). The proposed method is based on separating teeth according to edge lines between crowns of teeth. It comprises four phases as image enhancement, edge detection by using wavelet transform, Region of Interest (ROI) definition, and morphological processing. Image enhancement in our case is done by image sharpening using a Butterworth high pass filter. Directional changes of the image and a blurred version of it are obtained by wavelet transform in the second phase. In ROI definition the upper and lower jaws are first separated using the integral intensity projection and then a region containing the desired edge lines are defined. In the final stage, some morphological operations are applied to isolate the teeth based on separating edge lines. The evaluation of the teeth segmentation is measured by isolating accuracy and visual inspection. Experimental results with 90.6% isolation accuracy of total 681 teeth illustrate that the proposed method is more efficient that the existing algorithms.

Correlation between Vista Cam, ICDAS-II, X-ray bitewings and cavity extent after lesion excavation: an in-vivo pilot study.

To correlate fluorescence-based camera (FC), visual inspection (ICDAS-II) and radiographic examination X-rays bitewings (BW) to the extent of caries after excavation. The occlusal sites of 20 permanent first and second molars in 14 young adolescents (12±2 years old) were examined at 1st Observation Unit of Department of Oral and Maxillofacial Sciences, "Sapienza" University of Rome. All the enrolled patients were asked to provide with X-rays bitewing of the studied teeth. The assessment of ICDAS-II and FC was performed by a trained operator. Then a second blind operator removed the carious lesion and evaluated the cavity extent (depth, width, length) after caries removal with a calibrated probe. To correlate FC measurements with bitewing sensitivity, 10 dentists evaluated the presence/absence of caries on the X-rays. All the occlusal sites assessed by fluorescence camera, ranged from 1.7 to 2, indicating in all cases deep enamel lesions with possible extent to dentine with a mean of 1.7±0. In accordance, visual inspection by ICDAS-II showed scores of 3 and 4. By contrast, the radiographic documentation, i.e. bitewing X-rays, was evaluated in only 6 cases as presence of caries. The extent of the cavities was determined by three consecutive measurements: depth, width and length, with a mean of 3.5+1.73, 2.8+1.07 and 3.2+1.64 mm respectively. These results confirmed the agreement between FC and ICDAS-II for diagnosis of cavities with extent to enamel and dentine, while showed the low sensitivity of bitewings X-rays, in accordance with the existing evidence in Literature. Moreover, the results of this study for the first time provide information about the cavity extent after caries removal for the occlusal sites with ICDAS-II 3 and 4 scores and FC≥1.7. X-rays evaluation showed diagnostic accuracy in 6% of the sample. VistaCam measurement of 1.7 was correlated to a cavity with 3.5, 2.8 and 3.2 mm of depth, width and length.

Peri-implant soft tissue status and crestal bone loss around immediately-loaded narrow-diameter implants placed in cigarette-smokers: 6-year follow-up results.

It is hypothesized that in the long-term, soft tissue inflammation (reflected by increased scores of peri-implant probing-depth [PD]) and crestal bone loss (CBL) is higher in cigarette-smoker than nonsmokers with narrow diameter implants (NDIs). The aim of the present 6-years' follow-up clinical observational study was to compare the peri-implant soft tissue inflammatory parameters (plaque index [PI], gingival index [GI], and PD) and CBL around immediately-loaded NDIs placed in cigarette-smokers and nonsmokers. In all groups, peri-implant GI, PI and PD were measured on six sites (distolingual/palatal, mesiolingual/palatal mesiobuccal, distobuccal, midlingual/palatal, and midbuccal) per implant. The CBL was gauged on digital bitewing x-rays, which were standardized using the long cone paralleling technique. CBL was demarcated as the vertical distance from 2 mm below the implant-abutment connection to the most crestally-positioned alveolar bone. All study-participants were male. Twenty-six cigarette smokers and twenty-five nonsmokers were included. The mean age of cigarette-smokers and nonsmokers was 45.5 ± 10.3 and 47.4 ± 9.4 years, respectively. Cigarette-smokers had a smoking history of 10.6 ± 0.4 pack years. Family history of tobacco usage was more often reported by cigarette-smokers (57.7%) than nonsmokers (20%). All cigarette-smokers and nonsmokers were aware that smoking is a risk-factor of loss of implant. Three (11.5%) of cigarette-smokers reported that they have attempted to quit smoking and 76.9% of cigarette-smokers (n = 20) reported that they had no intention to quit smoking in the future. The peri-implant P-I (P < .01), PD (P < .01) and mesial (P < .01), and distal (P < .01) CBL were significantly high in cigarette-smokers compared with nonsmokers. There was no statistically significant difference in GI among the groups. Cigarette-smoking enhances peri-implant soft tissue inflammation and increases CBL around immediately-loaded NDIs.

Restorative Direct Management of Cavitated Proximal Carious Lesions of Permanent Molars using Elastic Separators in Children and Adolescents

Purpose: The purpose of this study was to assess the longevity of direct amalgam and composite restorations placed on the mesial surface of permanent molars after separation with elastic separators. Design: One hundred and seventy seven (177) restorations placed on the mesial surfaces of first and second permanent molars in 140 patients aged 10-25 years-old (median age 12.2 years) were followed for a period of 1 to 12 years (median time 4.3 years). Eighty four (84) amalgam and 93 composite resin restorations were placed randomly on carious lesions that were detected by bite-wing x-rays at the dentino-enamel junction and verified as cavitated after tooth separation. Restorations were evaluated clinically according to the modified Ryge criteria. Flexible parametric proportional-hazards and proportional-odds models for censored survival data was used to analyze the data, with application to prognostic modelling and estimation of treatment effects at 95% CI. Results: Of the 177 restorations, 13 (7.2%) failed in a median time to failure of 8.8 years. There was no statistically significant difference on the cumulative median time to failures between amalgam and composite while statistically significant difference was found between patients that were using fluoride mouthrinse or not (p<0.048) and if there was bleeding detected at the interproximal area of the restoration or not (p<0.001). Conclusions: Restorative management of cavitated proximal carious surfaces of permanent teeth with amalgam or composite resin, using elastic separators, seems to be a very good and promising alternative technique in the context of the minimal invasive dentistry in children and adolescents.

Auxiliary techniques for the diagnosis of incipient interproximal caries, in deciduous molars of children from 4 to 10 years old

Objective: The incipient carious lesion known for their clinical characteristics like white opaque after drying shows a rough surface, this is the first evidence of caries which is actively and visible on the surface of the dental tissue observed in a pit and fissure, proximal surfaces near the contact point along the gingival margin, in relation to the proximal surfaces by having a difficult accessibility, just by visual inspection is a big obstacle, so the objective of this study is identify the auxiliary a proximal decay incipient technique with improved an outcome to diagnosis in primary molars. Materials and Methods: A transversal and descriptive study was performed. The sample was composed by 50 children from 4-10 years old. A medical history was applied, which recorded all the dental information about the diagnosis, taking into account the criteria according to ICDAS in 2005. The examination was took place various sessions, a prophylaxis was previously performed, for this study we used an oral mirror, magnifying glass, a type of viscera which increased (3.5X), LED lamp and per apical bitewing x-rays. Results: A significant difference in efficacy for detection of interproximal caries lesions among emerging techniques evaluated were found. Conclusion: A 3.5X magnification technique made it possible to detect more caries lesions in primary molars with a total of 69. Followed by visual and radiographic being Trans illuminations which had the lowest levels of effectiveness.

Effect of orthodontic treatment and comorbidity risk factors on interdental alveolar crest level: A radiographic evaluation.

Alveolar bone loss is regarded as a potential adverse event during orthodontic treatment, especially in adults. The purposes of this study were to evaluate the prevalence and severity of interdental alveolar crest height loss in adult orthodontic patients compared with an untreated control group and to identify comorbidity risk factors for such bone loss (high BMI score, high blood pressure, high cholesterol levels, and smoking). Standardized bitewing radiographs of patients' buccal segments were taken before and after treatment of 34 consecutive adults treated in an orthodontic clinic. The control group included 29 patients from the operative dental clinic matched according to age and sex. Mean ages of the participants before treatment were 35.7±6.7 and 35.6±7.3years for the control and treatment groups, respectively. Before orthodontic treatment, the patients were evaluated, treated as needed, and approved by a periodontist. They were periodontically healthy before treatment. Interdental alveolar crest height loss was calculated by subtracting the distance on a bitewing x-ray from the cementoenamel junction to the interdental alveolar crest at each interproximal tooth surface from the mesial aspect of the first premolar to the distal aspect of the secondmolar (8 sites per quadrant). Changes in interdental alveolar crest height were calculated by subtracting the cementoenamel junction-interdental alveolar crest distance before treatment from the corresponding distance after treatment. The mean individual bone losses of all interproximal surfaces were 0.130±0.192 and 0.072±0.280mm in the treatment and control groups, respectively. These differences did not reach statistical significance (P=0.353). Twenty-two patients (65%) from the treatment group and 10 patients (34%) from the control group had an increase in the cementoenamel junction-interdental alveolar crest distance of more than 1mm in at least 1 site, with borderline significance between the groups (P=0.079). Notably, no association was observed between bone loss with any comorbidity factor. The results of this study correspond to the conventional understanding in the orthodontic and periodontal literature that orthodontic tooth movement per se does not cause attachment loss. However, orthodontists should always be aware of the possibility of periodontal deterioration during orthodontic treatment. Therefore, comprehensive periodontal examination is necessary during orthodontic treatment, especially in adults.

SNP Analysis of Caries and Initial Caries in Finnish Adolescents.

Background Dental caries is the most common infection in the world and is influenced by genetic and environmental factors. Environmental factors are largely known, but the role of genetic factors is quite unknown. The aim was to investigate the genetic background of caries in Finnish adolescents. Materials and Methods This study was carried out at the Kotka Health Center in Eastern Finland. 94 participants aged 15–17 years gave approval for the saliva and DNA analyses. However, one was excluded in DNA analysis; thus, the overall number of participants in analysis was 93. Caries status was recorded clinically and from bite-wing X-rays to all 94 participants. Genomic DNA was extracted by genomic QIAamp® DNA Blood Mini Kit and genotyped for polymorphisms. The results were analyzed using additive and logistic regression models. Results No significant associations between caries and the genes studied were found. However, SNPs in DDX39B and MPO showed association tendencies but were not statistically significant after false discovery rate (FDR) analysis. SNPs in VDR, LTA, and MMP3 were not statistically significant with initial caries lesions after FDR analysis. Conclusion The present study could not demonstrate statistically significant associations between caries and the genes studied. Further studies with larger populations are needed.

Correlation Of Clinical And Radiographic Diagnosis Of Carious Lesions In Posterior Teeth

ABSTRACT. Introduction: dental caries is a public health problem affecting a large percentage of the population. The carious process is highly variable and has periods of progression that alternate with periods of stability of the damaged tissue. There are different techniques to diagnose dental caries, including clinical and radiographic evaluation. Objective: the objective of this study was to establish correlation between the clinical and radiographic caries diagnosis suggested by ICCMS TM , in deciduous and permanent molars of a school population. Methods : descriptive study evaluating a sample for convenience of 1174 proximal and occlusal tooth surfaces of permanent and deciduous molars, taken from the database of 35 outpatients treated at the school of dentistry, who were clinically and radiographically evaluated for caries as recommended by the ICCMS TM based on bitewing x-rays. Results: the clinical and radiographic diagnosis was correlated in 1174 proximal and occlusal surfaces, with 0.41 Spearman's rank correlation coefficient (p < 0,05). The findings suggest that 95.6% of teeth diagnosed as healthy coincided with the clinical and radiographic results; in early mild stages, there was coincidence in only 8.16% and 6.4% respectively. Conclusions: there is low correlation between the clinical diagnosis of caries and the radiographic examination, in relation to ICCMS TM standards

The need for endodontic treatment and systemic characteristics of hematopoietic stem cell transplantation patients.

The aim of this study is to investigate the relationship between the epidemiological and clinical profiles of patients before and after hematopoietic stem cell transplantation (HSCT) and the need for endodontic treatment. The subjects included 188 individuals enrolled in the dental care program for transplanted patients of the School of Dentistry, Federal University of Minas Gerais (Faculdade de Odontologia da Universidade Federal de Minas Gerais, FO-UFMG) from March 2011 through March 2016. The patients were subjected to an HSCT conditioning dental regimen based on a thorough clinical and radiographic evaluation. Intraoral periapical and bite-wing X-rays were obtained, and after evaluation, specific dental treatment was planned and performed. The following demographic and clinical data were collected from the patients' medical records: age, gender, transplantation stage, primary disease, transplant type, medication used, complete blood count at the time of visit, and need for endodontic treatment. The Kolmogorov-Smirnov and the chi-square tests were used. Leukemia (31.3%) and multiple myeloma (17.9%) were the most prevalent primary diseases. Most patients were subjected to allogeneic-related transplantation (83.6%). Most patients exhibited platelet counts and hemoglobin concentrations below the reference values in the pre-transplantation stage, while the neutrophil and platelet counts and the hemoglobin levels were within the reference ranges in the post-transplantation stage. The proportions of individuals requiring endodontic treatment were similar between the pre- and post-transplantation groups: 24.3% and 24.7%, respectively. The systemic conditions of the patients referred for dental treatment were compromised.

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.

Imaging and detection of early stage dental caries with an all-optical photoacoustic microscope

Tooth decay, at its earliest stages, manifests itself as small, white, subsurface lesions in the enamel. Current methods for detection in the dental clinic are visual and tactile investigations, and bite-wing X-ray radiographs. These techniques suffer from poor sensitivity and specificity at the earliest (and reversible) stages of the disease due to the small size (<100μm) of the lesion. A fine-resolution (600 nm) ultra-broadband (200 MHz) all-optical photoacoustic microscopy system was is used to image the early signs of tooth decay. Ex-vivo tooth samples exhibiting white spot lesions were scanned and were found to generate a larger (one order of magnitude) photoacoustic (PA) signal in the lesion regions compared to healthy enamel. The high contrast in the PA images potentially allows lesions to be imaged and measured at a much earlier stage than current clinical techniques allow. PA images were cross referenced with histology photographs to validate our experimental results. Our PA system provides a noncontact method for early detection of white-spot lesions with a high detection bandwidth that offers advantages over previously demonstrated ultrasound methods. The technique provides the sensing depth of an ultrasound system, but with the spatial resolution of an optical system.

Weakest students benefit most from a customized educational experience for Generation Y students.

Most current dental students were born in the 1980s and 1990s and are defined as Generation Y (Gen Y). The authors developed a customized educational experience that brought together some characteristics of Gen Y and the objective of this educational experience was to develop the critical thinking skills of Gen Y students. The objective of the current study is to evaluate outcomes from pre-session and post-session tests. Additionally, we wanted to integrate aspects of team-based learning, self-directed learning and peer-to-peer teaching as a means of reducing the need for intense faculty supervision but maintain positive educational outcomes. Single bitewing x-ray was displayed and informal class discussion was facilitated by a Senior Tutor. A list of questions and concepts that needed to be understood more clearly was made. Student groups self allocated research tasks to members. After conducting research, students presented to class and faculty facilitated discussions aiming to foster critical thinking and identify what information needed to be more thoroughly understood. Pre-session and post-session tests were conducted and compared. Students who scored below 85% in their pre-session test improved their score in the post-session test by a mean of 9.5 points (p = 0.02). Those who scored above 95% in their pre-session test scored less in the post-session test (mean reduction of 6.31 points, p = 0.001). Findings from this study demonstrate that the weakest students in the class (those who scored below 85% correct in the pre-session test) benefitted most from this unique educational experience.

Comparative characterization of maxillary expansion and alternate maxillary expansions and constrictions in rats.

The purpose of this study was to evaluate whether the cranial and circumaxillary sutures react differently to maxillary expansion (ME) and alternate maxillary expansions and constrictions (Alt-MEC) in a rat model. Twenty-two male Sprague-Dawley rats (6 weeks old) were used and divided into three groups. In ME group (n=9), an expander was activated for 5 days. In Alt-MEC group (9 animals), an alternate expansion and constriction protocol (5-day expansion and 5-day constriction for one cycle) was conducted for 2.5 cycles (25 days total). The control group comprised 4 animals with no appliances used, each of two sacrificed on day 5 and day 25 respectively. Midpalatal suture expansion or constriction levels were assessed qualitatively and quantitatively by bite-wing X-rays and cast models. Distances between two central incisors and two maxillary first molars were measured on cast models after each activation. Circumaxillary sutures (midpalatal, maxillopalatine, premaxillary, zygomaticotemporal and frontonasal suture) in each group were characterized histologically. Results showed that midpalatal suture was widened and restored after each expansion and constriction. At the end of activation, the widths between both central incisors and first molars in Alt-MEC group were significantly larger than those in ME group (P<0.05). Histologically, all five circumaxillary sutures studied were widened in multiple zones in Alt-MEC group. However, only midpalatal suture was expanded with cellular fibrous tissue filling in ME group. Significant osteoclast hyperplasia was observed in all circumaxillary sutures after alternate expansions and constrictions, but osteoclast count increase was only observed in midpalatal suture in ME group. These results suggested that cranial and circumaxillary sutures were actively reconstructed after Alt-MEC, while only midpalatal suture had active reaction after ME.

Beware of the evidence!: a cautionary note.

Evidenced-based publications are the ‘‘premier’’ publications that are being read and referred to for valid research information. In this context, it is essential that the reader understands how evidence-based clinical research is conducted. The reader should be aware of research design methodologies, understand the difference between clinical significance and statistical significance, and appreciate the difference between associations and causality. Having this knowledge will allow the cultivation of critical appraisal skills which ultimately benefit the discerning reader of evidence-based studies, enabling them to critically examine the publication in order to determine the validity of the study’s research design, and conclusions. Knowledge seekers should never blindly accept the conclusions of evidence-based study just because it was published in a peer reviewed journal, by reputable authors from a respected university. Last year an American Broadcasting Association (ABC) headline took the Dental community by surprise. The headline: ‘‘Early Dental X-rays Linked to Brain Tumors’’ [1]. This ABC report summarized a publication authored by a group of MDs and PhDs from Yale University School of Medicine’s Department of Epidemiology and Public Health, published in the journal of cancer [2]. The article concluded that exposure to traditional dental X-ray investigation over the years may lead to an increase risk of developing meningioma. A critical review of this publication discovered several flaws in study’s methodologies and the conclusions were questioned. An example of one such flawed interpretation was the statement that there was a statistically significant increase in the risk of developing meningioma in patients receiving bitewing X-rays and panoramic X-rays. On the other hand, there was no significant risk of developing meningioma detected in patients receiving full-mouth dental X-rays. Does this make sense? The astute reader would have realized that bitewing X-rays are included in the full mouth series as well, so why are patients at higher risk of developing meningioma in the group that got bitewing X-rays when compared to the full mouth X-ray group. The full report is available from the American Dental Association [3]. Therefore, proficiency in critical review is an essential skill every practitioner who reads journal articles to improve his/her knowledge to better serve his/her patients. The blind acceptance of an author’s conclusions without examination of the methodology, analysis and interpretations should be a matter of the pass; as cited even the most reputable authors and journals are susceptible to mistakes at times. S. Quek (&) Rutgers School of Dental Medicine, Newark, NJ, USA e-mail: queksa@sdm.rutgers.edu

Ultrashort echo time (UTE) MRI for the assessment of caries lesions

Objective:Direct in vivo MRI of dental hard tissues by applying ultrashort echo time (UTE) MRI techniques has recently been reported. The objective of the presented study is to clinically evaluate the applicability of UTE MRI for the identification of caries lesions.Methods:40 randomly selected patients (mean age 41 ± 15 years) were enrolled in this study. 39 patients underwent a conventional clinical assessment, dental bitewing X-ray and a dental MRI investigation comprising a conventional turbo-spin echo (TSE) and a dedicated UTE scan. One patient had to be excluded owing to claustrophobia. In four patients, the clinical treatment of the lesions was documented by intraoral pictures, and the resulting volume of the cavity after excavation was documented by dental imprints and compared with the MRI findings.Results:In total, 161 lesions were identified. 157 (97%) were visible in the UTE images, 27 (17%) in the conventional TSE images and 137 (85%) in the X-ray images. In total, 14 teeth could not be analysed by MR owing to artefacts caused by dental fillings. All lesions appear significantly larger in the UTE images as compared with the X-ray and TSE images. In situ measurements confirm the accuracy of the lesion dimensions as observed in the UTE images.Conclusion:The presented data provide evidence that UTE MR imaging can be applied for the identification of caries lesions. Although the current data suggest an even higher sensitivity of UTE MRI, some limitations must be expected from dental fillings.