Digital Intraoral Periapical Radiographs Research Articles

Assessment of Digital Intraoral Periapical Radiograph for the Detection of Apical Root Resorption in Inflammatory Periapical Pathologies: A Radiovisiography Study.

Introduction Resorption often takes the form of external inflammatory root resorption. Apical periodontitis or an apical cyst is the most typical cause of external inflammatory root resorption. Failure of endodontic treatment can occur if severe apical root resorption occurs.This is due to the difficulty of reaching these sites.Apical root resorption is usually discovered during routine radiographs and is usually in its later stages. If the lesion is advanced, extraction is the only viable solution. An accurate diagnosis of incipient root resorption is essential.This research is designed to analyze the effectiveness of digital intraoral periapical radiographs in assessing apical root resorption (ARR) related to periapical pathologies. Material and methods Thiscross-sectional radiographic observational researchwas conductedin a dental college and hospital in central India. Radiovisiography (RVG) images of 190 patients' teeth with inflammatory periapical pathologies were evaluated to determine the presence or absence of resorption in the apical area of the root. After the radiographic assessment of the apical root resorption, the extraction of the affected teeth was done under all aseptic conditions. The periapical tissue was sent for histological analysis and the extracted tooth sample was examined for the presence or absence of apical root resorption. Results In comparison to apical periodontitis, the proportion of severe root resorption patients was significantly higher in abscess and periapical granuloma. Using Pearson's Chi-square test, the difference in patient proportions according to the kind of resorption in the three radiological diagnosis groups was statistically significant with a p-value of 0.0058. Conclusion It was concluded that on radiographic examination, digital intraoral periapical radiographs were found to be accurate in determining periapical apical pathologies and apical root resorption.

Predictability of Proximal Enamel Thickness Assessment using Intraoral Periapical Radiographs: A Cross-sectional Study

Introduction: Measurements of tooth crown dimensions and enamel thickness are useful guides for interproximal stripping procedures aimed at creating space. In borderline non extraction orthodontic treatment cases, interproximal stripping is performed to gain space. Intraoral periapical radiographs and bitewing radiographs are commonly used to determine Proximal Enamel Thickness (PET). Aim: To determine the predictability of using IOPA-based PET measurements for assessing real/anatomic PET. Materials and Methods: This was a single-centre, crosssectional study conducted at Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India, between March 2022 and April 2022. Digital Intraoral Periapical Radiographs (IOPAs) of 40 premolar teeth with intact crown structures were obtained using the paralleling technique. The PET of both the mesial and distal sides of the same teeth was measured using Carestream Imaging software. Subsequently, the extracted teeth were sectioned and examined under a Stereomicroscope (SM), and PET measurements of the mesial and distal surfaces were obtained along the heights of contour using ImageJ analysis software. Pearson’s correlation, along with linear and polynomial regression analyses, was performed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) software. Results: A low but significant positive correlation between the PET of the sectioned teeth and the PET measured from IOPAs was observed (p=0.002, R=0.55). A significant difference in PET between the two methods for both sides was noted (p<0.05). The mean distal enamel thickness was significantly greater than the mean mesial enamel thickness for both the IOPA and SM methods (p<0.05). A polynomial regression equation, Y=2.084- 1.234X+0.318X3 , was established to predict PET of the sectioned teeth (Y) based on PET measured from IOPAs (X). Conclusion: The present study establishes a correlation between the true PET of teeth measured using cut-sections and PET measured from IOPAs, which are readily available in clinical practice. A correlation coefficient was determined, and PET can be predicted using IOPAs, although not with absolute accuracy. Distal PET was found to be higher than mesial PET, with no significant difference in enamel thickness between the two sides.

Age Estimation of an Individual by Pulp-Tooth Ratio measurement using radiographs - A forensic perspective

Objective: To estimate the age of a person by pulp/tooth ratio using digital intraoral periapical radiographs (IOPARs) of maxillary permanent lateral incisors.Material and Methods: The present study analyzed radiographs from randomly selected sample of 100 (50males and 50 females) individuals, within the age group of 16–65 years, further grouped as: Group A – 16 – 25 years of age, Group B – 26 – 35 years, Group C – 36 – 45 years, Group D – 46 – 55 years and Group E – 56 – 65 years of age. The pre-existing digital intraoral periapical radiographs(IOPARs) were collected from the archives of the institution. The images were saved as a high resolution JPEG files on a desktop computer and imported to the Adobe Photoshop CS7 image-editing software program for further analysis.Results: A statistically significant correlation between age and pulp/tooth ratio was observed and no significant difference between chronological and estimated ages was noted.Conclusion: An accurate age of a person can be estimated by pulp/tooth ratio using digital intraoral periapical radiographs(IOPARs) of maxillary permanent lateral incisors.

Digitilized Radiographic Analysis of Coronal Pulp for Age Estimation in Adults using Tooth Coronal Index Method – A Pilot Study

Background: Teeth have become a valuable index to estimate age of an individual in forensic odontology. Although various methods have been reported in forensic literature for age estimation, radiographic methods are simple and require less expertise. Digitalization of panoramic radiographs and intraoral periapical radiographs helps in obtaining the more precise images and accurate measurements. Secondary dentin continuously gets deposited on pulpal surface throughout the life thus reducing the size of the pulp cavity. The Tooth Coronal Index (TCI) method is the indirect assessment of secondary dentin deposition for age estimation. Aim: This study aims to estimate the Tooth Coronal Index of mandibular first molar and its correlation with chronological age to derive a regression equation. Materials and Methods: A total of 50 adults above 20 years of age were selected from the outpatient department of our college. Digital intraoral periapical radiographs were taken by using Radiovisiography (RVG) for mandibular first molar. The crown height and Coronal Pulp Cavity Height were measured and then TCI was calculated. Further the data were subjected to statistical analysis. Results: Statistically significant difference was observed between age and TCI (p<0.05*) and statistically insignificant difference observed between gender and TCI (p>0.05). Conclusion: The Tooth Coronal Index provides more accurate estimation of age and it is a simple, non invasive and cost-effective method that could be easily applied for both living and dead individuals without any highly specialized equipment.

Quality Assurance Audit of Digital Intraoral Periapical Radiographs at the Undergraduate Dental Clinics.

To assess the quality of digital intraoral periapical radiographs by investigating the percentage of radiographic images that satisfied the good quality standards. An audit. Undergraduate Dental Clinics, Qassim University College of Dentistry, Saudi Arabia, from April to September 2018. This standard-based audit was conducted at the clinics of undergraduate dental school. A total of 506 intraoral periapical radiographs taken by dental students were graded, according to the standards set by Health Protection Agency, by two evaluators after the necessary calibration to reduce the inter-evaluator differences.In addition to the grading of radiographs, the documentation of errors like coning off, foreshortening/elongation, contact overlap, poor contrast, and image blurring was done. The data analysis was carried out with Microsoft excel software by utilising simple descriptive statistics. Out of the 506 digital periapical radiographs, 231 (45.7%) radiographs were categorised as Grade 1, 190 (37.6%) radiographs were categorised as Grade 2, and 85 (16.7%) radiographs were categorised as Grade 3, requiring a repeat radiograph; and were diagnostically unacceptable. Considering the aforementioned results, the findings of the first cycle fell short of the required standards. According to the results of the quality assurance audit, the radiographs were below the standards set by the Health Protection Agency. Recommendations were made for improvement measures in the radiology department, and re-audit was planned after one year. Key Words: Quality assurance, ALARA, Radiation protection, Audit, Digital dental radiography.

Evaluation of Clinical and Radiographic Parameters as Dental Indicators for Postmenopausal Osteoporosis.

In the early stages, osteoporosis is relatively a silent disease characterised by low bone density with microarchitectural deterioration of the bone tissue leading to enhanced bone fragility. The objective of this study was to evaluate the relationship between age, body mass index, oral signs, and osteoporosis among postmenopausal women. The study included postmenopausal women who were divided into two groups of subjects. The osteoporotic group comprised 30 patients with osteoporosis who were diagnosed using dual-energy X-ray absorptiometry, and the non-osteoporotic group (control group) comprised 30 subjects with no evidence of osteoporosis. Panoramic radiography was performed, followed by the acquisition of two direct digital intraoral periapical radiographs from the mandibular premolar-molar region. Chi-square test revealed a statistically significant difference (p = 0.001) in the mandibular cortical shape index between the two groups. However, a statistically non-significant difference in cortical width, the panoramic mandibular index, mandibular alveolar bone resorption degree, fractal dimension, and mean number of teeth was found between the two groups. A statistically significant difference was observed in the mean age between the osteoporotic and non-osteoporotic groups. The mandibular cortical index findings (MCI) on panoramic radiograph are effective indicators of osseous changes in postmenopausal osteoporosis, thereby determining early prediction of osteoporotic fracture risk and reducing its related morbidity.

Coronal pulp: An age biomarker - A cross-sectional radiographic study in children.

Background:Age plays an important role in personal identification, treatment planning, forensic dentistry, and legal issues. It is one of the key identification tools for distinguishing one person from another and one population from another. An intraoral radiographic technique for age estimation is an easier approach. The widely accepted age estimation method in children is the Demirjian system. Tooth coronal index is another method that gained popularity for adult age estimation.Aim:This study aims to estimate the tooth coronal index (TCI) of mandibular right and left second deciduous molar and its correlation with chronological age to derive a regression equation.Settings and Design:The present study is a cross-sectional radiographical study which is conducted in AME's Dental College and Hospital, Raichur, Karnataka, India.Materials and Methods:A total of 100 children aged 5–10 years were selected. Digital intraoral periapical radiographs were taken for right and left deciduous mandibular second molar. The length of the tooth crown and the coronal pulp cavity were measured. Statistical Analysis: Further, the data are subjected to student's unpaired t-test and ANOVA test for the statistical analysis and simple linear regression to derive the regression equation.Results:TCI showed a statistically significant reduction with increasing age in both right and left mandibular deciduous second molar (P ≤ 0.05), and the strength of the correlation is moderate (r = −0.59) if age is correlated with TCI using simple linear regression.Conclusion:The tooth coronal index method is found as a simple, noninvasive, nondestructive and cost-effective method for age assessment in children.

A randomized controlled trial comparing the radiographic evaluation of crestal bone resorption in single implant versus two implant-retained overdentures.

Aim:The aim of this study was to evaluate and compare radiographically the amount of crestal bone resorption during healing and loading period in single implant versus two implant–retained mandibular overdentures in totally edentulous patients.Materials and Methods:A total of 20 edentulous patients (12 male and 8 female) with age range of 58.6 years were included in this clinical trial which was completed in four phases (clinical and radiographic diagnosis, surgical phase, implant loading phase, and bone level measurement phase). The eligible patients were randomly allocated in two equivalent groups of 10 participants each per group. The allocation was in 1:1 ratio via randomized chit method. Group I included the case group, that is, single implant, and Group II included the control group, that is, two implants located in mandible. A total of 30 implants were placed in Group I and 20 implants in Group II. Digital intraoral peri-apical radiographs (RVG 5100) were used for measuring the bone level immediately after implant surgery, 1 month, 3 months, 4 months, and 6 months.Result:This study showed that there was a mean crestal bone loss of 0.7 mm between the tip of the implant and alveolar crest at the end of 6 months after implant placement in single implant Group I while 0.67 mm in case of Group II two-implant-retained mandibular overdentures. The percentage of crestal bone loss after 6 months follow-up was 6.45% in Group I which was statistically insignificant compared with Group II where 6.25% of bone loss was recorded.Conclusion:Single implant–retained mandibular overdentures could be used as another alternative treatment option for completely edentulous elderly patients with severely resorbed ridges and financially and systemically compromised conditions.

Radiographic assessment of apical root resorption in inflammatory periapical pathologies

Introduction: Apical root resorption (ARR) is a common condition associated with periapical pathologies which is invariably detected by intraoral periapical radiographs. Although it is common, its distribution in different periapical pathologies has not been assessed so far. The aim of this study was to determine the distribution and severity of ARR in common inflammatory periapical pathologies. Materials and Methods: A cross-sectional radiographic study was conducted on 333 patients who visited SEGi Oral Health Centre in the 6-month period of the study. Digital intraoral periapical radiographs of patients with clinically established periapical pathologies were taken. Data were collected using a structured proforma regarding the type of periapical lesions, presence or absence of ARR. Collected data were analyzed using SPSS version 21 and Chi-square test was applied to check the association between ARR and periapical pathologies. Results: During this study period, 333 patients with inflammatory periapical pathologies were reported. Of which 135 (40.5%) showed definite ARR. Among 135 ARR, 97 (71.9%) were moderate resorption and 38 (28.1%) were severe resorption. ARR was significantly greater in periapical granuloma and cyst (72.8%) followed by periapical abscess (35%) and acute apical periodontitis (18.1%) which was statistically significant (P

Classification of Digital Intra Oral Periapical Radiographs by Selecting a Feature Vector using Hybrid Method for Selection of Features

Objectives: Study the characteristics of Intra Oral Periapical Radiographs (IOPA) and design a feature vector to automatically classify individual tooth as either healthy or non healthy using perception. Methods/Statistical Analysis: The Intra Oral Periapical Radiograph (IOPA) is segmented so that each image contains exactly one tooth. In this paper input for classification algorithm is the segmented IOPA. Feature vector is generated for each image. While determining feature vector, statistical as well as structural properties of the image are considered. Feature vector input to the classifier is multidimensional. The classification is carried out so that input IOPA is classified as an image of a healthy tooth or a non-healthy tooth. Findings: Algorithm is tested on 50 radiographic images containing healthy as well as diseased teeth. The classification algorithm presented in this research work is a two class classifier. This algorithm can be very easily adopted for multi class classification by calling the same repetitively using the classification strategy one against rest. Applications/Improvements: Selection of a feature vector and classification based on this vector is fully automatic. The algorithm incorporates hybrid method for feature selection and uses perception for classification based on feature vector. The algorithm can be improved by designing multi-class classifier for the same data.

Identification of the Procedural Accidents During Root Canal Preparation Using Digital Intraoral Radiography and Cone Beam Computed Tomography

Abstract Crown or root perforation, ledge formation, fractured instruments and perforation of the roots are the most important accidents which appear during endodontic therapy. Our objective was to evaluate the value of digital intraoral periapical radiographs compared to cone beam computed tomography images (CBCT) used to diagnose some procedural accidents. Material and methods: Eleven extracted molars were used in this study. A total of 18 perforations and 13 ledges were created artifically and 10 instruments were fractured in the root canals. Digital intraoral periapical radiographs from two angles and CBCT scans were made with the teeth fixed in position. The images were evaluated and the number of detected accidents were stated in percentages. Statistical analysis was performed using the chi square-test. Results: On digital periapical radiographs the evaluators identified 12 (66.66%) perforations, 10 (100 %) separated instruments and 10 (76.9%) created ledges. The CBCT scans made possible the recognition of 17 (94.66 %) perforations, 9 (90 %) separated instruments and 13 (100%) ledges. The totally recognized accidental procedures showed significant differences between the two groups. (p<0.05) Conclusion: Digital periapical radiographs are the most common imaging modalities used during endodontic treatments. Though, the CBCT allows a better identification of the procedural accidents.

Multipoint Search Algorithm for Automatic Segmentation of Tooth from Digital Intra Oral Periapical Radiographs

Objectives: In the present study digitally recorded Intra Oral Periapical radiographs (IOPA) are investigated. Methods/Analysis: This paper presents an innovative algorithm for automatic segmentation of the digital IOPA radiograph in one or more qualified regions of interest. Segmentation of IOPA is done repetitively till all teeth in the image are extracted. These segmented images resulting from this algorithm will now have one tooth in one image. Findings: A radiograph with exactly one tooth in image is extremely useful for further study and analysis of individual tooth in many and diverse applications of computer assistance in processing of dental radiographs. The segmentation algorithm proposed in this paper, necessarily being a spatial segmentation method, separates regions of interest without any loss or alterations in the data. The algorithm works successfully on 76 digital IOPA radiographs out of 80 images in test data. Novelty/Improvements: The algorithm proposed in the paper is fully automatic and does not require any human intervention. The segmentation algorithm proposed separates one tooth with its perimeter region intact in one image. The number of output images generated are equal to number of teeth in input IOPA.

Age estimation using intraoral periapical radiographs.

Context:Changes in the size of dental pulp caused by the apposition of secondary dentin and occlusal wear are morphometric parameters for estimating age.Aim:To estimate the accuracy of age evaluation by Kvaal's method and the effect of occlusal wear on age using digital intraoral periapical radiographs in a subset of the Indian population.Materials and Methods:A total of 300 teeth were radiographically evaluated using intraoral periapical digital radiographs from 50 adult patients. A few modifications were made in the design of the study compared to the original Kvaal's method. The radiographs of three teeth from each jaw were taken and morphometric measurements in ratios were analyzed, which included the pulp length to tooth length (X1), pulp length to root length (X2), pulp width to root widths at three defined levels (X3), and tooth length to root length (X4).Statistical Analysis:The Pearson product-moment correlation coefficient (PCC) between age and the morphological variables showed that among them X1, X2, and X3 were statistically significant but not the tooth root length ratio (X4).Conclusions:The ratios X1, X2, and X3 were good indicators of age and hence a multiple linear regression model for age estimation was derived using these three variables. However, it was found that X4 was not a good indicator of age estimation in said population.

Pulp polyp - A periapical lesion: Radiographic observational study

Introduction: Pulp polyp (PP) is a chronic hyperplastic condition resulting in formation of granulation tissue and proliferative mass. The radiographic appearance of PP has innumerable presentations. Diagnosing and treatment planning of periapical lesions, heavily relies on the radiographic changes surrounding the root structures. Objective: To evaluate different radiographic periapical changes in clinically detected PP patients. Materials and Methods: Patients reporting to Department of Oral Medicine and Radiology and who were clinically diagnosed with PP by an oral diagnostician were subjected to radiographic examination. Digital intraoral periapical radiographs of 50 patients with PP were taken. Various periapical changes in the digital radiographs were recorded by a skilled oral radiologist. The data obtained was subjected to statistical analysis using SPSS ver 17.0 and P-value was set at <0.05 as significant. Result: Periapical changes like periodontal space widening (PDLW), loss of lamina dura, periapical abscess, periapical granuloma, hypercementosis, condensing osteitis and root resorption were noted. Periodontal space widening was seen in all patients (100%), loss of lamina dura was noted in 72%, periapical rarefying osteitis in 56%, condensing osteitis in 8%, hypercementosis, periapical granuloma, and root resorption were seen in 4% of PP patients. Majority of PP were asymptomatic (66%). Pulp polyp was commonly seen in mandibular first molar followed by mandibular second molar and maxillary first molar. Statistically significant difference was noticed between periapical changes in PP patients (P value <0.0001). All PP patients showed definite periapical changes suggesting it to be a periapical lesion. Conclusion: Pulp polyp is confined to the pulpal portion of the tooth which, may or may not cause changes in periapical region. The results of the present study showed that majority of the PP patients were associated with definite periapical changes. This observation suggests that clinically detected PP are radiographically associated with definite periapical changes suggesting it to be a periapical lesion.