Digital Intraoral Radiography Research Articles

Evaluation of the effects of postprocessing settings in digital bitewing radiographs on proximal caries detection.

Radiographs are an integral part of detecting proximal caries. The aim of this study was to evaluate the effect of contrast, brightness, noise, sharpness, and γ adjustment of digital intraoral radiographs on the diagnosis of proximal caries. In this in vitro study, 40 extracted teeth including 20 premolars and 20 molars with enamel lesions (white spot or dentin discoloration seen through the enamel) were mounted together in groups of eight inside the skull. Bitewing radiographic images of each dental group were obtained by a photostimulable phosphor plate sensor with exposure conditions of 8 mA, 70 kV, and 0.2 s. The images were reconstructed by the built-in software and examined by two oral and maxillofacial radiologists in various settings of contrast, brightness, sharpness, noise, and γ. The teeth were then cut mesiodistally and the presence or absence of caries was confirmed by an oral and maxillofacial pathologist using a stereomicroscope. The data were then analyzed using the κ agreement coefficient, sensitivity, specificity, and accuracy (α = .05). Adjustment of brightness and contrast led to higher diagnostic performance with an accuracy of 82.5% and 83.8 (for observers 1 and 2, respectively) and 82.5% (for both observers), respectively. Noise adjustment was the least helpful approach for diagnosis of proximal dental caries among other adjustments, with an accuracy of 78.8% and 77.5% for observers 1 and 2, respectively. Brightness and contrast setting was more efficient in improving the diagnostic potential of bitewing radiographs compared to other adjustments.

Comparative evaluation and patient satisfaction with an electrical impedance-based device versus digital radiography in the estimation of remaining dentin thickness in carious posterior permanent teeth: (Diagnostic accuracy study)

BackgroundAccurate assessment of remaining dentin thickness (RDT) is paramount for restorative decisions and treatment planning of vital teeth to avoid any pulpal injury. This diagnostic accuracy study compared the validity and patient satisfaction of an electrical impedance based device Prepometer™ (Hager & Werken, Duisburg, Germany) versus intraoral digital radiography for the estimation of remaining dentin thickness in carious posterior permanent teeth.MethodsSeventy patients aged 12–25 years with carious occlusal or proximal permanent vital posterior teeth were recruited. Tooth preparation was performed to receive an adhesive restoration. Pre- and post-excavation RDT were measured radiographically by two calibrated raters using the paralleling periapical technique. Prepometer™ measurements were performed by the operator. Patients rated their satisfaction level with each tool on a 4-point Likert scale and 100 mm visual analog scale (VAS). Inter and intragroup comparisons were analyzed using signed rank test, while agreement between devices and observations was tested using weight kappa (WK) coefficient.Resultsthe intergroup comparisons showed that, before and after excavation, there was a significant difference between measurements made by both techniques (p < 0.001). After excavation, there was a weak agreement between measurements (WK = 0.2, p < 0.001), whereas before excavation, the agreement was not statistically significant (p = 0.407). Patients were significantly more satisfied with Prepometer™ based on scales and VAS (p < 0.001).ConclusionPrepometer™ could be a viable clinical tool for determining RDT with high patient satisfaction, while radiographs tended to overestimate RDT in relation to the Prepometer™.

The implant loading influence on crestal bone remodelling around hybrid titanium implants: a prospective clinical study

The aim of this work was to analyze the changes of the mesial and distal cortical bone peaks around the hybrid titanium implants in relation to the masticatory load up to 7 years of follow-up. The analysis aims how occlusal loads may affect the peri-implant bone years after insertion through two-dimensional analysis using intraoral digital radiographs. Twelve hybrid T3 implants (Biomet 3i) were placed in 9 healthy patients with the 2-stage surgical approach. Standardized digital Rx were taken after early loading (6-8 weeks) after placement (T0); after 12 months (T1); after 30 months (T2); after 4 years follow-up (T3), after 5 years follow-up (T4), after 6 years follow-up (T5), after 7 years follow-up (T6). The marginal bone gain and loss was digitally measured. From T2 to T4 (5 years follow-up) there was a new bone formation demonstrating that well-balanced load forces can ensure good maintenance, with a crestal bone gain during the 2.7 to 7-year follow-up period.

Radiographic Outcomes of Mineral Trioxide Aggregate (MTA) with and Without Platelet-Rich Fibrin (PRF) In Direct Pulp Capping: A Clinical Pilot Study

Aim: The purpose of the current investigation was to determine by radiographic means if a calcific dentinal bridge had formed following direct pulp capping (DPC) with calcium hydroxide (CH), mineral trioxide aggregate (MTA), or a combination of platelet-rich fibrin (PRF) and MTA. Materials and Methods: In the beginning, 45 systemically healthy patients who needed DPC and had pulpal exposure were enrolled in the trial. They were then randomly assigned to one of three groups: CH (control, n = 15), MTA ( n = 15), or PRF + MTA ( n = 15). To determine the radiographic density of the dentin immediately underneath the location of pulpal exposure, pre-operative intraoral digital radiographs of the afflicted teeth were acquired. Through sequential imaging, the radiographic evaluation of dentinal bridge formation was performed. All images were studied carefully, keeping the reference point constant. Results: Out of the 45 patients, finally 10 per group were analysed. According to an analysis of variance, difference in mean density values among the various groups was found to be significant [( p = .001). On bi-group comparison (using post-Tukey HSD), difference between CH and PRF + MTA was significant ( p = .001), between MTA and PRF + MTA was significant ( p = .022), and between CH and MTA not significant ( p = .347)]. The PRF + MTA group showed the highest increase in mean density values. Conclusion: The results of the present study suggest that PRF and MTA when used in combination have better radiographic outcomes compared to MTA alone when used as DPC agents.

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.

Intraoral digital radiography- A way forward or risk of overexposure: A questionnaire-based study

: Digitization of intraoral radiography has revolutionized dentistry. It comes with plethora of advantages, such as quick image production elimination of processing chemicals, reduced patient exposure. With easy and instant image acquisition, the number and frequency of radiographs as well retakes have also increased. Therefore, making us think is there an actual reduction in the radiation exposure or not.: To assess clinical utilisation of intraoral digital radiography among practicing dental surgeons.It is a questionnaire-based study. Questionnaire was curated using google forms and divided into two sections. First section included personal data and second section was focused on the clinical practice. Questionnaire link was circulated through various social media platform. 112 responses were collected.Out of all responses, 78.6% are using intraoral digital radiography, among them 53.4% are using CCD sensors. Maximum number of practitioners (54.5%) take on an average 0-5 intraoral digital radiographs and 98.9% of them take 1-6 retakes per day. Errors in positioning the receptor and PID were the most common reasons for taking repeats.: It appears that there is an increase in number and frequency of radiographs and number of retakes which might be nullifying the dose reduction from intraoral digital radiography. Practitioners should not neglect the radiation exposure from intraoral digital radiography as it may have a cumulative effect in long run and should abide by the radiation protection protocol and ALADA principle.

Evaluation of diagnostic accuracy of CBCT and intraoral radiography for proximal caries detection in the presence of different dental restoration materials

PurposeThis study aimed to assess the diagnostic accuracy of cone-beam computed tomography (CBCT) and digital intraoral radiography for the detection of proximal caries adjacent to amalgam, e.max porcelain, and metal-ceramic restorations (MCRs).Materials and methodsParallel intraoral radiographs were obtained from 40 posterior teeth using PSP sensors. To obtain CBCT scans, the teeth were first radiographed alone, and were then positioned next to a tooth with an amalgam restoration, MCR, and e.max porcelain crown, and radiographed again. Two blinded observers scored radiographs using a four-point scale (0: absence of proximal caries, 1: enamel caries, 2: carious lesion extending to the outer half of dentin, 3: carious lesion extending to the inner half of dentin). Tooth sections were made, and the grade of caries was determined under a light microscope at x12 magnification. The sensitivity, specificity, and accuracy of CBCT and intraoral radiographs were then calculated.ResultsArtifact-free CBCT scans and intraoral radiographs had the highest diagnostic accuracy (0.826 and 0.657, respectively) while CBCT images of the teeth next to the amalgam restorations (0.526) had the lowest accuracy. The diagnostic accuracy of CBCT images of the teeth next to the porcelain crowns and MCRs was 0.613 and 0.601, respectively.ConclusionArtifact-free CBCT images had higher diagnostic accuracy than intraoral radiography for the detection of all grades of proximal caries. The diagnostic accuracy of CBCT images of teeth adjacent to amalgam, porcelain, and MCRs was lower compared to intraoral radiographs and artifact-free CBCT images.

The effect of different spatial resolutions and enhancement filters on radiographic detection of simulated furcation defects with intraoral digital radiography

The objective of this study was to evaluate the effects of spatial resolution and the application of enhancement filters in the diagnosis of simulated furcation defects and image quality with intraoral radiographs. Periapical images were acquired with photostimulable phosphor plates of molars in dry skulls (n=8) and mandibles (n=10) with 4 stages of furcation defect simulation. The plates were scanned in fast scan and high resolution modes to produce different spatial resolutions. Four image filters were applied. Six observers scored the detection of furcation defects. Mean values of area under the curve in receiver operating characteristic evaluation, accuracy, sensitivity, and specificity were calculated. Mean gray value (brightness), noise, and contrast-to-noise ratio (CNR) were calculated for enamel, dentin, and alveolar bone to evaluate image quality. Analysis of variance compared the values between the different spatial resolutions and filters. The significance of difference was established at P < .05. There were no significant differences in overall diagnostic values comparing image spatial resolutions and filters. Diagnostic outcomes were significantly better for the largest defects than the smallest lesions but were generally poor in detecting lesions. All structures showed greater brightness in high resolution. . Noise was greater in all structures with all enhancement filters except inversion. Dentin and alveolar bone exhibited more noise and lower CNR in high resolution. Varying spatial resolution and applying enhancement filters did not significantly affect the diagnosis of furcation defects.

Association of selective serotonin reuptake inhibitor use with marginal bone level changes around osseointegrated dental implants: A retrospective study.

Selective serotonin reuptake inhibitors (SSRIs) are used for the management of anxiety and depression. Existing evidence shows their negative impact on implant osseointegration, survival rates, and peri-implant health. Currently, there are limited data on their effect on peri-implant marginal bone levels. The primary goal of this retrospective study is to evaluate the association between SSRIs use and marginal bone level (MBL) changes around osseointegrated dental implants over time. Records from patients who received at least one dental implant between 2010 and 2021 were reviewed. Information related to medical history, SSRI use, and the implant site was obtained from patients' electronic charts. Mesial and distal MBLs were measured relative to the implant platform on digital intraoral radiographs, taken at the time of prosthesis installation and at the most recent follow-up visit. MBL changes were calculated. A total of 152 dental implants from 105 patients were included. The mean follow-up period was 46.97±21.87 months. The mean MBL change was significantly greater for SSRI users (0.41±0.76mm) compared to non-users (0.04±0.65mm) [MD=0.37mm, p=0.00, 95% CI: (-0.61)-(-0.15mm)]. Mesial MBL change of 0.42±0.84mm and 0.02±0.71mm was noted for SSRI users and non-users, respectively. The distal MBL change was 0.4±0.93mm and 0.07±0.73mm, respectively. Smoking, sex, and implant location did not seem to influence the MBL differences between groups. Use of SSRIs is associated with greater marginal bone loss around osseointegrated dental implants in function for a mean period of 3.8 years.

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&lt;0.05). The mean distal enamel thickness was significantly greater than the mean mesial enamel thickness for both the IOPA and SM methods (p&lt;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.

Dentists ' perceptions and Methods regarding the radiographic examinations and radiation protection: A 2022 research in Thessaloniki, Greece

Background/Aim: Dentistry has made major progress due to modern advancements in radiology. It would be interesting to examine the correlation of dental science with the labor market, as well as to assess dentists' adaption to nowadays' scientific and financial circumstances. This research aims to investigate the opinions of dentists in Thessaloniki, Greece, with regard to choosing the appropriate radiographic examinations in various clinical cases, and to canvass their knowledge of radiation protection. Material and Methods: Our sample was comprised of 7% of private dentists working in the urban complex within the borders of Thessaloniki, Greece. Self-referential multiple choice questionnaires were distributed via email. For the statistical analysis, GoogleForms was utilized, and objectivity was guaranteed by ensuring participants' anonymity. Results: The replies underwent statistical analysis with the use of Google Forms, and through this process charts have been produced. Orthopantomograph is the most usual radiographic examination for new patients and for the evaluation of complications. Dentists' age and gender seem to affect their radiographic choices in everyday clinical practice. Regarding intraoral radiography, the paralleling technique is more usually applied. Moreover, the findings suggest the need for dentists' constant education on radiation protection. Last but not least, most participants choose digital intraoral radiography. Conclusions: Dentists tend to seek assistance from radiological laboratories for special radiographies, such as cone-beam computed tomography, as well as in cases of diagnostic dilemma. They also recognize digitalization's contribution to keeping health records. Consequently, clinicians' additional education, financial motives for the upgrade of radiological equipment and records' digitalization are fundamental prerequisites for modern dentistry.

Improvements in image quality after optimization in digital intraoral radiographs

BackgroundDigital intraoral radiographic exposures are optimized largely on the basis of subjective assessment of diagnostic image quality. This study presents an objective approach to optimize radiographic exposure settings for digital intraoral radiographic systems. MethodsSeven size 2 digital intraoral systems were assessed for image quality and determination of optimal exposure following the protocol specified in American National Standard Institute/American Dental Association Standard No. 1094: Quality Assurance for Digital Intra-Oral Radiographic Systems. A ProX radiograph unit (Planmeca) at 63 kVp and 6 mA was used to obtain radiographs of the Dental Digital Quality Assurance phantom. ImageJ software (National Institutes of Health) was used to quantify dynamic range and spatial resolution, and contrast perceptibility was evaluated visually. Optimal exposure is the setting with the maximal contrast perceptibility and spatial resolution while displaying the full dynamic range. After image optimization, a custom phantom consisting of an endodontically prepared tooth was imaged to evaluate the file position relative to the apex for each system. Differences in distances between file position relative to the root apex at the optimal exposure as well as 1 increment above and below were measured. ResultsRadiographic images obtained at the optimal exposure yielded better visualization and more accurate measurements of the file tip relative to the apex. ConclusionsOptimizing radiographic exposures improves image quality and accuracy in clinical decisions. Practical ImplicationsImprovement in image quality and better accuracy in actual distance of the endodontic file to the radiographic apex coupled with complete cleaning, shaping, and obturation of the canal should lead to better endodontic treatment outcomes.

Relationship between image information content and observer performance in digital intraoral radiography.

This study conducted a receiver operating characteristic (ROC) analysis by applying improved cluster signal-to-noise (CSN) analysis to digital intraoral radiographs and develop an observer-free method of analyzing image quality related to the observer performance in the detection task. Two aluminum step phantoms with a thickness interval of 1.0mm were used for this study. One phantom had holes of increasing depth (from 0.05 to 0.35mm) and the other had no holes. Phantom images were obtained under various exposure dose and image capture modes using a dental X-ray unit, a photostimulable phosphor imaging plate, and scanner system. These phantom images were analyzed using the FindFoci plugin in ImageJ software. Subsequently, true positive rates (TPRs) and false positive rates (FPRs) were calculated by analyzing phantom images with and without holes. We constructed ROC curves by plotting the TPRs against the FPRs and calculated the area under the ROC curve (AUC). Using the same phantom images with holes, eight observers assessed the number of detectable holes. Correlations between observer detection performance and AUC values were evaluated. AUC values increased as the exposure dose increased and showed different tendencies depending on the image capture mode. The AUC values showed a high correlation with observer detection performance (r = 0.76). AUC values obtained from CSN analysis reflect image quality and replace the observer detection performance test of image quality.

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.

Impact of case complexity on paediatric dentists' ability to radiographically diagnose traumatic dental injuries

Being able to correctly interpret radiographs after a traumatic dental injury is an essential skill for providing appropriate and timely treatment. The aim of this study was to assess the impact of case complexity on paediatric dentists' performance when radiographically diagnosing traumatic dental injuries (TDI) and to investigate a possible added value of cone-beam computed tomography (CBCT) when compared with digital intra-oral radiography (2D vs 3D). A test panel of paediatric dentists was instructed to detect, identify and interpret radiographic findings using either 2D or 3D images. Intra-oral radiographs and CBCT images of 20 trauma cases were presented in random order, and the findings were recorded using structured scoring sheets. Case complexity was determined by two experienced benchmark scorers. Results were analysed using generalized linear mixed modelling. In general, performance for detection, identification and interpretation of findings was low, both with 2D and 3D images, with significantly lower values for difficult cases (p< 0.05). For easy as well as for difficult cases, 3D imaging resulted in a significantly better performance for detection and identification of findings (P < 0.001). This was not the case for correct interpretation, where significantly poorer performance was seen when using 3D images for difficult cases (p< 0.05). This study provides evidence that case complexity of traumatic dental injuries influences diagnostic performance. The use of CBCT enhanced detection and identification of findings but when case complexity increased, 3D imaging adversely affected correct interpretation.

Reduction of scratch or dirt artifacts on intraoral radiographs using dual imaging plates in image processing.

Artifacts including scratches and dirt artifacts on the digital intraoral radiographs finally contribute to making inaccurate diagnoses. The aim of this study was to reduce the incidence of artifacts using dual imaging plates (DIPs) in imaging processing. Conventional X-rays were taken of a porcine mandible embedded in acrylic resin using a DIP which consists of a front IP (FIP) and a back IP (BIP) with some scratches and dirt. The two images of the FIP and BIP were then synthesized and averaged to obtain a conventional DIP image. The following image processing method was used to make a DIP with artifact reduction (DIP+AR) image. A subtraction image of the FIP and BIP was constructed and the standard deviation (SD) was calculated. If the pixel value was over 3SD on the subtraction images, the pixel value of the DIP was swapped with the value on the opposite side of the non-artifact pixel. The conventional and DIP+AR images were also subjectively evaluated. Image processing to create a DIP+AR image was able to reduce the number of artifacts. Medians of number of artifacts evaluated were 2.00 [interquartile range (IQR), 2.50] in DIP images and 0.67 (IQR, 1.29) in DIP+AR images, indicating a significant reduction of number of artifacts in DIP+AR images. DIP+AR image processing can reduce the incidence of artifacts caused by scratches and dirt, and could extend the lifespan of the IP and contribute accurate diagnosis in oral radiology.

Detectability of simulated apical lesions on mandibular premolars and molars between radiographic intraoral and cone-beam computed tomography images: an ex vivo study

Adequate endodontic diagnostic is essential when making a therapy decision. Radiographic imagining acquisition methods (IAMs) are fundamental apical lesions of endodontic (ALE) origin diagnose tool. Thus, the aim of this research was to compare the simulated apical lesions (SALs) diagnose potential of digital intraoral radiography (DIR) and cone-beam computed tomography (CBCT), if there is a relationship between the IAMs, SALs-depth and their correct diagnose likelihood in human mandibular specimens’ datasets. 1024 SALs were prepared in cancellous and cortical bone with different penetration depths. The SALs-stages were radiographed with CBCT and DIR. The IAMs were randomly evaluated by 16 observers in two trials. Possible SAL findings were analyzed according to a five-point scale. The null hypothesis established that SALs detection accuracy does not differ between CBCT and DIR. Significantly differences (first 0.935 and second trial 0.960) were found for the CBCT area under the curve when compared with the DIR (first 0.859 and second trial 0.862) findings. SALs of smaller size were earlier detected by CBCT. In SALs without cortical involvement the probability of detection increased from 90 to 100%. The SALs-depth had the highest detectability influence on cancellous bone lesions and CBCT SALs detectability was 84.9% higher than with DIR images. The CBCT diagnose reproducibility was higher than the one of DIR (Kappa CBCT 75.7–81.4%; DIR 53.4–57.1%). Our results showed that CBCT has a higher SALs IAM diagnosing accuracy and that SALs detection accuracy incremented as the SALs-size increased.

Analysis of image defects in digital intraoral radiography based on photostimulable phosphor plates.

In digital intraoral radiography (DIR), images with defects caused by the digital process are sometimes produced. Hence, we analyzed DIR images with defects taken using the photostimulable phosphor (PSP) plate method and then classified these images based on the causes of the defect. The aim of this study was to classify defects in DIR using the PSP plate system, and to discuss the causes of each type of defect and the methods that can prevent their occurrence. Images with defects due to the two PSP plate systems (Arcana and Arcana Mira) were selected and classified according to the defect. Image defects caused by geometrical techniques that occur in both the film and PSP plate methods were excluded from this study. Moreover, changes in the rate of occurrence of images with defects over time were analyzed in this study. The defects in images obtained by the PSP plate system were classified into six types, which were further divided into those caused by machine error or human error. Both types of error could influence the diagnostic performance. Machine error accidentally and rarely occurred; thus, the prevention of such errors is difficult. However, human error, especially errors caused by photo-induced discharge, could be prevented using appropriate measures. In DIR systems using the PSP plate method, human error should be prevented by education and training to improve operation.

Accuracy of intraoral digital radiography in assessing maxillary Sinus-Root relationship compared to CBCT

Background and ObjectivesThe proper assessment of the relation between the roots of the maxillary posterior teeth and the maxillary sinus floor represents a real concern for dental practitioners when conducting any procedure in the involved region. Many imaging techniques have been employed to assess this relation. This study aimed to (1) compare the accuracy of digital periapical radiographs with that of cone-beam computed tomography images in assessing the relationship between the maxillary molar roots and the maxillary sinus floor and (2) determine periapical radiographic features (if present) that could indicate the actual protrusion of roots into the sinus cavity. Materials and MethodsThis observational analyticalin vivo study was carried out on 23 Egyptian patients. Cone-beam computed tomography and digital periapical images were obtained for each patient and assessed by three oral radiologists. Results were statistically analyzed in terms of accuracy, specificity, and sensitivity in addition to the McNemar-Bowker and Fleiss's Kappa test. ResultsDespite the presence of a significant difference between the results of both techniques, periapical radiography demonstrated 73% accuracy in displaying the sinus-root relation. Moreover, the continuity of the lamina dura suggests (with more than 70% accuracy) that the root is located outside the sinus and vice versa. ConclusionThe digital periapical technique is considered an accurate method of assessing the sinus-root relation especially when the root is located outside the sinus. One of the most indictive periapical features of root intrusion into the maxillary sinus is the discontinuity of the lamina dura.

Diagnostic consistency for observing endodontic files in digital radiographs displayed on different electronic devices

Objectives: To evaluate the diagnostic consistency of working lengths by observing endodontic files in root canals and periapical subtle structures in digital intraoral radiographs presented in two smartphones, a tablet and a laptop computer. Methods: A dried human skull embedded in an acrylic compound was used for exposing radiographs of the upper and lower second premolars and first molars with two endodontic files (Kerr files size 10 and 15) positioned to the full length of the roots or 1.5 mm short of apexes. A total of 100 radiographs were taken for each of the file sizes. Five observers were asked to assess all the 200 digital radiographs according to a 5-category scale in smartphone A (HUAWEI P9 Plus), smartphjone B (Apple iPhone 7), tablet (Apple iPad 2018) and laptop computer (Lenovo Thinkpad E480), respectively. The gold standard for receiver operating characteristic curve (ROC) analysis was determined with the endodontic Kerr file size 20. A total of 150 roots with files were radiographed, 75 of which with files reaching the radiographic apexes of the respective roots and 75 of which with files 1.5 mm short of the radiographic apexes for each endodontic file size. Results from ROC analysis was analyzed with one-way ANOVA and independent sample t test. Results: For the Kerr file size 10, the area under the ROC curve for laptop, tablet and two smartphones were 0.891±0.037, 0.869±0.037, 0.870±0.017 and 0.849±0.037, while for the Kerr file size 15 the ROC values were 0.957±0.02, 0.961±0.02, 0.961±0.01 and 0.961±0.02, respectively. There were no significant differences for diagnostic accuracy for observing endodontic file positions among digital radiographs presented in the two smartphones, one tablet and one laptop devices (endodontic file size 10: F=1.39, P=0.281; endodontic file size 15: F=0.05, P=0.985). A significant difference was found in the diagnostic accuracy of endodontic file positions between size 10 and 15 files in different display devices (t=-10.65, P<0.001). Conclusions: There was a high diagnostic consistency in the determination of working length and periapical subtle structures of roots by observing digital radiographs displayed on smartphones, tablet and laptop computer.