Digital Bitewing Radiographs Research Articles

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.

Reliability of digital radiographs in measuring the vertical and horizontal dental implants’ dimensions a retrospective study

Introduction: Digital radiography can take accurate measurements. In implant dentistry, intraoral periapical (PA), bite-wing (BW) and panoramic (OPG) radiographs are being used, although it had limitations of distortion. This research aims to assess the accuracy of digital radiography in measuring dental implants and to evaluate the SIDEXIS software’s reliability in measuring their dimensions.Materials and Methods: Over 192 implants from 316 radiographs were selected. All radiographs were analyzed using SIDEXIS software. Statistical analysis was performed using SPSS.Results: Statistically significant differences (P &lt; 0.5) between the actual heights and widths compared to the measured radiographic dimensions. Over all the distortion was greatest in OPGs. The magnifications were 2.48mm in height and 0.82mm in width for OPGS, 0.17mm in width for BWs while in PAs it was 1.37mm in height and 0.156mm in width. The magnification was more in maxilla for PAs and OPGs. Anteriorly the PAs had the greatest magnification (2.16mm), and OPGs had the greatest at (3.03mm) in height posteriorly.Conclusion: Digital OPG, PA and Bitewing radiographs are reliable for performing dimensions linear measurements for implants, and PAs have the highest precision. Additionally, SIDEXIS software provided accurate results and can be considered a reliable method for implants’ assessment. Â

Presence of Candida species in the subgingival oral biofilm of patients with peri-implantitis.

There are no studies that have investigated the presence of Candida species in the subgingival oral biofilm (OB) of patients with peri-implantitis. The aim was to assess the presence of Candida species in the subgingival OB of patients with peri-implantitis. Individuals with (group A) and without (group B) peri-implantitis were included. Life style related and demographic data were collected using a questionnaire. In both groups, peri-implant plaque-index (PI), bleeding-on-probing (BOP), and probing-depth (PD) were evaluated and crestal bone loss (CBL) were measured on digital bitewing radiographs. In both groups, subgingival OB samples were collected using sterile paper points. Identification of Candida species was performed using ChromAgar medium and colony forming units per milliliter (CFU/mL) were determined. Statistical analysis was performed, and level of significance was set at P < 0.05. The mean age of individuals in groups A (n = 43) and B (n = 41) were 52.2 ± 4.4 and 55.1 ± 2.3 years, respectively. All participants were male. In groups A and B, implants were in function for 7.4 ± 1.3 and 6.8 ± 0.6 years, respectively. Scores of peri-implant PI (P < 0.001), BOP (P < 0.001), PD (P < 0.001), and CBL (P < 0.001) were significantly higher in group A than group B. Subgingival Candida was isolated from the OB of 33 (76.7%) patients in group A and 5 (12.2%) individuals in group B. The most common yeast species was Candida albicans, which was isolated from 67.4% to 60% individuals in groups A and B, respectively. The number of subgingival oral yeasts CFU/mL were significantly higher in group A (3147.54 ± 1052.6 CFU/mL) compared with group B (496.68 ± 100.2 CFU/mL; P < 0.01). Candida species (predominantly C. albicans) are present in the subgingival OB of patients with peri-implantitis. Community-based efforts toward routine oral hygiene maintenance are needed to improve oral health and minimize the risks of peri-implant diseases in populations.

Soft tissue status and crestal bone loss around conventionally-loaded dental implants placed in cigarette- and waterpipe (narghile) smokers: 8-years' follow-up results.

We hypothesized that crestal bone loss (CBL) and peri-implant soft tissue inflammation are increased when conventionally-loaded dental implants are placed in cigarette and waterpipe smokers compared to nonsmokers. The present 8-years' follow-up retrospective clinical study evaluated the stability of the conventionally-loaded dental implants placed in cigarette- and waterpipe (narghile) smoking and nonsmoking population group. Self-reported cigarette-smokers, waterpipe users along with never-smokers have been included. Data pertaining to gender, age, duration and frequency of cigarette-smoking, and usage of waterpipe were collected using a preformed questionnaire. Probing depth (PD), bleeding on probing (BOP), and peri-implant plaque index (PI) were recorded measuring mesial and distal CBL on digital bitewing radiographs. Study power estimated with group comparisons performed using the Kruskal-Wallis and Bonferroni post-hoc adjustment tests. Statistically significant P-values of less than 0.05 were considered. Forty-one cigarette-smokers, forty waterpipe-users, and forty-two never-smokers with mean ages of 44.5 ± 4.3, 41.2 ± 4.7, 43.3 ± 2.8 years, respectively, were included. The mean duration of smoking habit and duration of each session of cigarette-smoking was 5.5 ± 0.3 years and 7.7 ± 1.2 minutes, respectively. The mean period of waterpipe use and time of each session of was 10.6 ± 0.8 years and 20.2 ± 3.1 minutes, respectively. Among cigarette-smokers, waterpipe-users and never-smokers, the implants had been in function for 8.5 ± 0.3, 8.6 ± 0.3, and 8.5 ± 0.5 years, respectively. PD, CBL, and peri-implant PI were positively more among cigarette and waterpipe smoking users (P < 0.05) than with never-smokers. Peri-implant bleeding on probing was significant among never-smokers (P < 0.05) compared to waterpipe-users and cigarette-smokers. There was no difference in Peri-implant PI, PD, and CBL in cigarette-smokers and waterpipe-users. Cigarette-smokers and waterpipe users are vulnerable to peri-implant soft tissue inflammation and CBL than never-smokers. There is no variation in the severity of peri-implant soft tissue inflammation and CBL in waterpipe and cigarette users.

Detection of proximal caries with digital intraoral bitewing radiography: An interobserver analysis

Objectives: The present study was undertaken to analyze bitewing digital images detection of interproximal caries through interobserver agreement. Materials and Methods: The study evaluated 152 bitewing radiographs for detection of interproximal caries by two observers: an operative dentist and oral radiologist. Results: The Kappa values for interobserver agreements were 0.47 and 0.44 in the first and second observations, while for intraobserver agreements, these values were 0.61 and 0.69 for the operative dentist and oral radiologist, respectively. Comparison of area under the receiver operating characteristic curves for inter- and intra-observer ratings was nonsignificant. Conclusion: The digital bitewing radiography resulted in no variation in both the agreements, and it was useful with respect to the reliability of diagnosis of interproximal caries.

Accuracy of pen-type laser fluorescence device and radiographic methods in detecting approximal carious lesions in primary teeth - an invivo study.

The diagnosis of approximal lesions is limited due to the difficulty of direct examination of these areas. To determine the accuracy of pen-type laser fluorescence (LFpen) device, compared to digital bitewing (BW) radiography, in diagnosing approximal carious lesions in posterior primary teeth at cavitation and non-cavitation thresholds. A total of 46 children (aged 3-9years) were assessed and 195 approximal surfaces of 184 primary molars were examined by digital BW and LFpen. Visual-tactile inspection based on the International Caries Detection and Assessment System (ICDAS-II) was used as the reference standard. All examinations were performed by the same examiner. Sensitivity, specificity, and accuracy were calculated. Spearman's correlation coefficients were calculated between LFpen and BW readings and the reference standard. Sensitivity, specificity and AUC were 81.8, 86.7, and 0.84 for BW and 49.1, 87.9, and 0.69 for LFpen both at non-cavitation thresholds. At cavitation thresholds, BW showed higher specificity (96.0), sensitivity (93.0), and AUC (0.98) than did LFpen (72.0, 86.9, and 0.82, respectively), but a lower correlation was indicated by LFpen readings. Bitewing had a better diagnostic accuracy and significantly outperformed LFpen in the detection of non-cavitated lesions. Similar results were obtained by the two methods at the cavitation threshold.

Evaluation of occlusal caries detection and assessment by visual inspection, digital bitewing radiography and near-infrared light transillumination

This study compared the diagnostic outcomes of visual inspection (VI), digital bitewing radiography (BWR), and near-infrared light transillumination (NIR-LT, DIAGNOcam, KaVo, Biberach, Germany) for occlusal caries detection and assessment of posterior teeth. This study included 203 patients (mean age 23.0years). All individuals received a meticulous VI. Additionally, BWR and NIR-LT images were collected. All BWR and NIR-LT images were blindly evaluated for the presence of enamel caries lesions (ECLs) and dentin caries lesions (DCLs). The descriptive statistical analyses included calculation of frequencies, cross tabulations, and pairwise comparisons using Pearson chi-square tests. The majority of ECLs/DCLs were detected by VI in this low-risk adult population. The additional diagnostic outcomes in terms of ECLs/DCLs amounted to 5.0% (BWR) and 6.8% (NIR-LT). The combined usage of VI/NIR-LT or VI/BWR identified 95.7 and 94.4% of all ECLs/DCLs on occlusal surfaces, respectively. This comparative diagnostic study showed that VI detected the majority of occlusal caries lesions. Both additional methods showed limited benefits. Due to the valuable features of NIR-LT, i.e., X-ray freeness and clinical practicability, this method might be preferred over X-ray-based methods. Nevertheless, BWRs should be prescribed in clinical situations where insufficient fillings or multiple (deep) caries lesions are diagnosed or where there is a need to assess the caries extension in relation to the pulp. VI has to be understood as caries detection method of choice on occlusal surfaces in low-risk adult population which may help to avoid multiple diagnostic testing, overdiagnosis, and overtreatment.

Inter- and intraexaminer reliability of bitewing radiography and near-infrared light transillumination for proximal caries detection and assessment.

The purpose of this in vitro study was to evaluate the inter- and intraexaminer reliability of digital bitewing (DBW) radiography and near-infrared light transillumination (NIRT) for proximal caries detection and assessment in posterior teeth. From a pool of 85 patients, 100 corresponding pairs of DBW and NIRT images (~1/3 healthy, ~1/3 with enamel caries and ~1/3 with dentin caries) were chosen. 12 dentists with different professional status and clinical experience repeated the evaluation in two blinded cycles. Two experienced dentists provided a reference diagnosis after analysing all images independently. Statistical analysis included the calculation of simple (κ) and weighted Kappa (wκ) values as a measure of reliability. Logistic regression with a backward elimination model was used to investigate the influence of the diagnostic method, evaluation cycle, type of tooth, and clinical experience on reliability. Altogether, inter- and intraexaminer reliability exhibited good to excellent κ and wκ values for DBW radiography (Inter: κ = 0.60/ 0.63; wκ = 0.74/0.76; Intra: κ = 0.64; wκ = 0.77) and NIRT (Inter: κ = 0.74/0.64; wκ = 0.86/0.82; Intra: κ = 0.68; wκ = 0.84). The backward elimination model revealed NIRT to be significantly more reliable than DBW radiography. This study revealed a good to excellent inter- and intraexaminer reliability for proximal caries detection using DBW and NIRT images. The logistic regression analysis revealed significantly better reliability for NIRT. Additionally, the first evaluation cycle was more reliable according to the reference diagnoses.

Assessment of matrix metalloproteinase-8 and -9 levels in the peri-implant sulcular fluid among waterpipe (narghile) smokers and never-smokers with peri-implantitis

Objectives: It is hypothesized that levels of matrix metalloproteinase (MMP)-8 and MMP-9 are significantly higher in the peri-implant sulcular fluid (PISF) of waterpipe-smokers (WS) compared with never-smokers with peri-implantitis. The aim of the present convenience sample case-control study was to compare the levels of MMP-8 and MMP-9 in the PISF of WS and never-smokers with peri-implantitis.Material and Methods: Individuals smoking waterpipe (Group 1) and never-smokers (Group 2) were included. Demographic data was collected using a questionnaire. Peri-implant probing depth (PPD) was measured and crestal bone loss (CBL) was measured on digital bitewing radiographs. PISF samples were collected using paper strips and the collected PISF volume was determined. Levels of MMP-8 and MMP-9 were measured using enzyme-linked immunosorbent assay. Study sample-size was estimated and statistical analysis was performed. p values < .05 were considered statistically significant.Results: Sixty-six individuals (33 individuals in Group 1 and 33 in Group 2) were included. In Groups 1 and 2, 41 and 44 implants, respectively were placed. The mean total PPD (p < .001) and peri-implant CBL (p < .001) was statistically significantly higher around implants affected by peri-implantitis in Group 1 compared with Group 2. The PISF volume (p < .05) collected and levels of MMP-8 (p < .01) and MMP-9 (p < .01) were statistically significantly higher among individuals in Group 1 compared with Group 2.Conclusion: PISF levels of MMP-8 and MMP-9 are significantly higher among WS compared with never-smokers with peri-implantitis.

Comparison between conventional and digital radiography in assessing alveolar bone loss: An original research

Aim: The aim of this study was to compare the efficiency of conventional and digital radiography in assessing alveolar bone loss. Materials and Methods: The study group comprised 50 participants (25 males and 25 females) between 25 and 45 years of age. The participants were screened for all clinical features of periodontitis. A series of conventional bitewing radiographs of right and left of both maxillary and mandibular posterior region (15,16,17,25,26,27,35,36,37,45,46,47) were taken for each of 50 patients by examiner 1. Similarly, a series of digital bitewing radiographs were taken by examiner 2 for each 50 patients by using RVG of Planmeca Dixi 2 B Series. In digital bitewing radiographs, the measurement was done by examiner 2, using Planmeca Dixi 2 B Digital Software, by dragging the cursor to make a line by joining the linear points. Bone level less than 2 mm from the cementoenamel junction (CEJ) was considered normal while above that was considered bone loss. In case of conventional bitewing radiographs, alveolar bone loss was measured by the same examiner by measuring the distance from the CEJ to the most apical level of crestal bone using a divider and transparent ruler. The above collected data of examiners 1 and 2 were handed over to examiner 3 for statistical evaluation. Results: Comparison of conventional and digital radiographic techniques in left maxilla, left and right mandible, and between maxilla and mandible in the total sample and in females aged 25–35 and 36–45 years yielded a significant correlation while comparison of the two techniques in the right maxilla and between maxilla and mandible in males yielded a nonsignificant correlation. Conclusion: Direct digital radiography provides an edge over conventional radiography in assessing the periodontal bone destruction.

A clinical study comparing digital radiography and near-infrared transillumination in caries detection.

The purpose of this study was to compare the effectiveness of detecting proximal carious lesions utilizing a new near-infrared transillumination (NIRTI) system (CariVu, Dexis) to traditional digital bitewing radiography (BWXR). Thirty patients received four posterior BWXRs and all premolars and molars were individually imaged with the NIRTI device. Sixty-seven proximal carious lesions were classified based on their depth into enamel or dentin for both BWXR and NIRTI images. The caries depth classification between the two systems were strongly correlated (rs =0.66; Spearman range: 0.60-0.79=strong) and significant (P<.001) with a median score of 3 for NIRTI and 2 for BWXR. The new NIRTI system (CariVu) may serve as an adjunct to BWXR in the diagnosis of proximal caries. The NIRTI system could serve as an adjunct diagnostic system that could be used in high-caries risk programs where patients are closely monitored with regimented follow-up appointments. NIRTI could also be beneficial with pregnant or pediatric patients, and in situations where radiography may not be available such as remote humanitarian missions.

Assessment of interleukin-1β, interleukin-6, and tumor necrosis factor-Α levels in the peri-implant sulcular fluid among waterpipe (narghile) smokers and never-smokers with peri-implantitis.

It is hypothesized that levels of interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF)-α are significantly higher in the peri-implant sulcular fluid (PISF) of waterpipe-smokers (WS) compared with never-smokers with peri-implantitis. The aim of the present convenience sample case-control study was to compare the levels of IL-6, IL-1β, and TNF-α in the PISF of WS and never-smokers with peri-implantitis. Demographic data was collected using a questionnaire. Peri-implant probing depth (PPD) was measured and crestal bone loss (CBL) was measured on digital bitewing radiographs. PISF samples were collected using paper strips and the collected PISF volume was determined. levels of IL-6, IL-1β, and TNF-α were measured using enzyme linked immunosorbent assay. Study sample-size was estimated and statistical analysis was performed. P values less than .05 were considered statistically significant. Sixty-six individuals (33 individuals in group-1 and 33 in group-2) were included. In groups 1 and 2, 41 and 44 implants, respectively were placed. The mean total PPD (P < .001) and peri-implant CBL (P < .001) was statistically significantly higher around implants affected by peri-implantitis in group-1 compared with group-2. The PISF volume (P < .05) collected and levels of IL-1β (P < .01), IL-6 (P < .01), and TNF-α (P < .01) were statistically significantly higher among individuals in group-1 compared with group-2. WS with peri-implantitis present increased expression of local proinflammatory cytokines in the PISF than never-smokers.

The Accuracy of Senior Students of Rasht Dental School in Detecting Proximal Caries in Digital Bitewing Radiographs

The Accuracy of Senior Students of Rasht Dental School in Detecting Proximal Caries in Digital Bitewing Radiographs

Peri-implant soft-tissue parameters and crestal bone levels among narghile smokers and nonsmokers

This retrospective convenient sample case–control study investigated the peri-implant soft-tissue inflammatory parameters and crestal bone loss (CBL) among narghile smokers (NS) (Group I) and nonsmoking controls (Group II). Demographic data were collected using a questionnaire. Peri-implant plaque index (PI), bleeding-on-probing (BOP) and pocket-depth (PD) were assessed; and peri-implant CBL was measured on standardized digital bite-wing radiographs. Sample-size was estimated and statistical analysis were done using Mann–Whitney U-test. Level of significance was set at p < .05. Seventy-two male individuals (35 in Group I and 37 in Group II) were included. The mean age of individuals in Groups I and II were 45.3 ± 5.2 and 42.6 ± 3.3 years, correspondingly. In Group 1, the duration and daily frequency of narghile smoking was 17.5 ± 1.6 years and 6.3 ± 0.5 times per day, respectively. The mean duration of each narghile smoking session was 28.5 ± 0.6 min. The mean peri-implant PI (p < .05), PD (p < .05) and mesial (p < .05) and distal (p < .05) CBL were statistically significantly higher among individuals in Group I compared with Group II. BOP was significantly higher in Group II than Group I (p < .05). Narghile smoking increases peri-implant soft-tissue inflammation and CBL.

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.

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.

Estimation of Remnant Dentin Thickness under Proximal Caries Using Digital Bitewing Radiography: An In-Vitro Study

Objectives: In restorative dentistry, it is essential to estimate the amount of remnant tooth structure after caries removal to make the best treatment plan. The present study was aimed to determine whether there is a correlation between the real thickness of remnant dentin under carious lesion and the radiographical measurement from photostimulable phosphor plates (PSPs). Methods: a whole number of 68 unrestored permanent human molar and premolar teeth with 82 proximal carious surfaces were mounted in an artificial arch. Digital bitewing radiographs with PSPs were taken, carious lesions were removed and radiographic imaging was repeated. Teeth were sectioned mesiodistally in two parts and thickness of remnant tooth structure to pulp was measured. Measurements of remnant dentin under caries from radiographic images and teeth structures were compared. Result: The mean measurements of remnant dentin on primary radiographs were statistically different from the measurements on teeth structures. The mean thickness of remnant dentin on tooth structure was around 30% less than what measured on radiographic image. Conclusion: The real thickness of remnant dentin under caries is about 70% of its thickness measured on digital bitewing radiographs prepared by PSPs as image receptor.

Comparision between Conventional Radiography (IOPA) and Digital Radiography Using Bitewing Technique in Detecting the Depth of Alveolar Bone Loss

Objective: To assess the depth of alveolar bone loss by using Conventional radiography (IOPA) and Digital radiography (RVG) technique in periodontitis as it affects the connective tissue attachment and supporting bone around the teeth. Methods: The study was carried out on 40 males and 10 females aged between 20-65 years who have generalized mild to severe chronic periodontitis. A series of conventional bitewing radiographs and digital bitewing radiographs (15, 16,17,25,26,27,35,36,37,45,46,47) were taken for each patient. The Statistical software namely SPSS version 16.0 was used for data analysis. Paired t-test was performed on all the variables to evaluate between both the groups at p ≤ 0.05. Results: The overall results showed the mean statistical difference between both the conventional and digital bitewing radiographs as 0.4595. It was observed that overall digital bitewing radiographs averaged about 0.4mm greater bone loss than conventional bitewing radiographs. Conclusion: It was concluded that digital radiographs showed better results when compared to conventional radiographs in terms of alveolar bone loss as RVG has superior image recording capabilities.

Influence of Image Filters and Variation in Horizontal Angle of Incidence of X-ray Beam in Digital Interproximal Radiographs for Diagnosis of Secondary Caries in Esthetic Restorations

Secondary or recurrent caries are located around restoration margins or under these lesions, and can lead to tooth loss. The interproximal or bite wing radiograph is the technique of choice to assist diagnosis of secondary caries. To evaluate diagnostic accuracy of secondary caries in pulpal walls artificially created in extracted human premolars, observed in digital bitewing radiographs using variations in horizontal X-ray beam angle of incidence and application of enhancement filters. The sample consisted of 20 healthy premolars, in which secondary caries lesions were simulated by means of subjecting the pulpal wall of the cavity to wear with spherical carbide drill half, fitted to a high speed handpiece, under constant cooling, focused perpendicular to the tooth surface. The orifices were filled with wax and all teeth were restored with composite resin Filtek Z350 XT(®). Later teeth were radiographed with a digital sensor complementary metal-oxide-semiconductor (CMOS) varying the horizontal angle at intervals of 2°, covering a range of -10 to +10°. The results showed that in the diagnosis of secondary caries, there was no statistically significant difference between the 2 pseudocolor filters, and negative and direct digital radiography. The pseudocolor filter no. 1 showed statistically significant differences, except at a horizontal angle of 0°, thus indicating lower efficiency in the diagnosis of secondary caries. Secondary caries with esthetic pulp wall restoration can be diagnosed irrespective of variation in the horizontal angle of incidence of the X-ray beam. The use of different radiographic enhancement filters did not result in improved diagnosis of secondary caries.

Deep carious lesions and other consequences of caries among 18-year-olds at Public Dental Health Service in Northern Norway: A cross-sectional age cohort study

Objectives. To document deep carious lesions and other consequences of caries (DCL-CC) in molars of 18-year olds leaving the free-of-charge Public Dental Health Service (PDHS). To explore the association between background factors and DCL-CC. Materials and methods. The final study sample (n = 1876) comprised 95% of individuals born in 1993 and registered in the PDHS in Troms County, Northern Norway. The most recent digital bitewing radiographs of each subject were examined for DCL-CC (deep untreated carious lesions, deep restorations, root canal obturations or extractions due to caries). Inter- and intra-observer kappa scores were 0.62 and 0.87, respectively. Information on background factors (gender, clinic location, history of medical problems, bitewing examination interval, DMFT score and planned recalls) were retrieved from dental records. Results. About one-quarter of subjects (488) had at least one molar with DCL-CC. There were 848 molars in total with DCL-CC; the majority were deep restorations (70%), but 4% were deep untreated carious lesions. More than a quarter of DCL-CC were either root canal obturations (14%) or extractions (12%). Multivariable logistic regression analyses showed that a 1-unit increase in DMFT score was associated with deep untreated carious lesions and extractions due to caries. There was no association between urban/rural clinic location, which indicated socio-economic status, and either DMFT score or DCL-CC. Conclusions. Despite the existence of a free-of-charge dental service, more than one-quarter of the subjects in the present study had at least one molar with DCL-CC.