Intra-examiner Reproducibility Research Articles

Comparison of different methods used in the classification of maxillary gingival phenotype: A diagnostic accuracy study.

This study aimed to evaluate the reliability and applicability of novel methods for determining gingival phenotypes and compare them with currently recommended methods. Six maxillary anterior teeth from 50 systemically and periodontally healthy patients were evaluated using two conventional methods (periodontal probe translucency method [PP] and transgingival measurement with an endodontic file [EF]), and two novel methods (colored biotype probe translucency method [CBP] and transgingival measurement with a Florida probe [FP]). All data were statistically analyzed. Intra-examiner reproducibility and inter-examiner reproducibility for all methods were analyzed using 10 randomly selected patients who were re-evaluated for each analysis. Moderate agreement was found between EF and PP, with statistically significant differences between median gingival thickness (GT) values for thick 0.8 mm (0.5-1.1 mm) and thin 1 mm (0.6-1.7 mm) phenotypes, and a threshold GT value of ≤0.92 mm (p < .001). FP and PP also showed moderate agreement, with statistically significant differences between median GT values for thick and thin phenotypes (0.80 mm [0.40-1.60 mm] and 0.89 mm [0.40-1.60 mm], respectively), and a threshold GT value of ≤0.8 mm (p < .001). PP and CBP values showed a substantial agreement (p < .001). A statistically significant difference was found between median EF values and CBP categories (p < .001); however, paired comparisons showed that the distinction was applicable only between thin and other phenotypes. Although CBP was found to be successful in detecting the thin phenotype, it was not successful in distinguishing between medium, thick, and very thick phenotypes; moreover, it did not appear to offer any advantages over PP. Although FP may be preferable to EF in measuring gingival thickness, the cost of FP is a disadvantage.

A new alternative to the Ober test for evaluating the difference between right and left iliotibial band stiffness: A reliability study

IntroductionA dysfunctional stiffness of the iliotibial band can be related to pathologies of the pelvis/lumbar spine and the knee. The classic and modified Ober tests are the gold standard for assessing iliotibial band stiffness. However, to the authors’ knowledge, this test lacks adequate validation, and its specificity is questionable. A more reliable test is needed to better correlate iliotibial band stiffness to pathologies and to support treatment choices. MethodTwo examiners assessed the difference in stiffness (right vs. left limb) of the iliotibial band by direct fingertip palpation in 40 subjects (without clinically evident painful symptoms), before and after a specific 20-h training session. The difference in stiffness was evaluated with both a 3-level and a 7-level graduation. The intra- and inter-examiner (intra-day) reproducibility was calculated, and a validation of the manual assessment was performed with a myotonometric measurement of frequency and stiffness. ResultsThe test achieved post-training agreement consistently greater than 0.88 (weighted Cohen's K test) in intra-examiner assessment and 0.72 in inter-examiner assessment. Before training the agreement was less than 0.48 and 0.12, respectively. Manual versus instrumental agreement was fair to moderate (frequency 0.347; stiffness 0.470). ConclusionThe newly proposed manual test to assess ITB stiffness by direct palpation showed almost perfect intra-examiner reproducibility and good inter-examiner (intra-day) reproducibility. The specific training was fundamental. Comparison of manual vs instrumental stiffness assessment of the iliotibial band, as proposed in this study, is debatable.

Assessment of reproducibility and influence of different dental specialties on functional implant prosthodontic score: A prospective clinical study analyzing single-unit implant crowns.

Implant therapy in partially edentulous patients has become the most adapted and predictable treatment modality. The success rate of implants has been measured in terms of esthetic, biological, and technical factors such as radiographic bone loss, prosthetic complications, and stability. Despite the existence of several indices for the esthetic assessment of implant crowns, a need for functional evaluation of the implant crown with an objective and reproducible score has arisen. The study aims to validate the reproducibility of the functional implant prosthodontic score (FIPS) and the influence exerted by different dental specialties while evaluating posterior single-unit implant crowns. This was a prospective clinical study. Fifteen patients with cement-retained single-implant crowns in the posterior region of the jaws were included. Eight examiners, two prosthodontists, two periodontists, two oral surgeons, and two orthodontists evaluated 15 photographs of single-unit implant crowns during the 1-year follow-up examination. The examiners assessed the photographs for FIPS, which includes five parameters for objectively evaluating the single-unit implant crowns. Assessments were performed twice at a gap of 4 weeks. Pearson's correlation with a 95% confidence interval was calculated for the intra-examiner and the Kruskal-Wallis test for inter-examiner reproducibility. The mean total FIPS scores for all included examiners were 7.133 for time T1 and 7.074 for time T2, showing a strong Pearson correlation coefficient for intra-examiner reproducibility. No significant difference was analyzed among different specialties with statistically significant values of the Kruskal-Wallis test. Intra- and inter-examiner analysis showed very consistent results during the reproducibility assessment of FIPS. The results validated the use of FIPS as a long-term predictive functional evaluation tool for the single-implant crowns in posterior sites irrespective of the effect of different dental specialties. It could be used for risk estimation and prognosis for long-term survival and performance of implant crowns.

Do the Various Indirect Bonding Techniques Provide the Same Accuracy for Orthodontic Bracket Placement? (Randomized Clinical Trial).

For orthodontic treatment to be effective, bracket placement must be precise to make the finishing stage easier, leading to an ideal occlusion with minimal intervention. This study aimed to evaluate the accuracy of manual and digital bracket positioning techniques utilizing computer-aided design and computer-aided manufacturing (CAD/CAM) jigs, 3D-printed indirect bonding trays (IBT), and double-layer vacuum-formed thermoplastic IBT. This study was done by scanning the dental arch of 30 orthodontic patients. The virtual setup and bracket positioning were performed with the Insignia™ system for ten patients, and 3D Maestro® software was used for the virtual setup of the remaining 20 patients. At the same time, the bracket positioning of 10 patients was done digitally by the 3D Maestro® software and the remaining 10 patients manually through the Ray Set® device. IBT were fabricated by CAD/CAM system, 3D printer, and vacuum-formed thermoplastic machine. A virtual bracket position was compared to the actual bracket position using the best-fit method of 3D digital superimposition in Geomagic® Control X™ (CX) software to determine how accurate it was in terms of linear and angular accuracy. Statistical analyses using SPSS 26.0 including Bland-Altman plots were used to assess the intra-examiner reproducibility. Shapiro-Wilk test was used to measure normality distribution. Wilcoxon matched-pairs signed rank test was used to analyze the differences between bracket positions within each group. Although there were obvious positional discrepancies between several readings, they were still within clinically acceptable ranges. All types of IBT would translate the planned position of the bracket from the digital and manual techniques to the teeth of patients with accepted precision in both linear and angular measurements; in addition, the error rate is about the same for all types of IBT. This trial is registered with NCT05549089.

Effect of craniofacial morphology on gingival parameters of mandibular incisors.

To investigate the association between the width of keratinized gingiva (WKG), gingival phenotype (GP), and gingival thickness (GT) with craniofacial morphology in sagittal and vertical dimensions. WKG, GP, and GT of mandibular anterior teeth in 177 preorthodontic patients (mean age 18.38 ± 5.16 years) were assessed clinically using a periodontal probe, a Colorvue Biotype Probe, and ultrasound by a single examiner. Patients were grouped into skeletal Class I, II, and III and hyperdivergent, normodivergent, and hypodivergent based on ANB and SN-MP angles. Mandibular incisor inclination (L1-NB) was also measured. Clinical and cephalometric measurements were repeated to assess inter- and intraexaminer reproducibility. A significant association was found between thin GP and skeletal Classes I and III for the left mandibular central incisor (MCI; P = .0183). In skeletal Class III patients, L1-NB angle demonstrated a decreasing trend as phenotype thickness decreased. A significant association was found between thin phenotype and normodivergent and hypodivergent groups for MCIs (left: P = .0009, right: P = .00253). No significant association between WKG or GT and craniofacial morphology was found. Thin GP is associated with skeletal Class I and III for the left MCI. Thin GP is associated with hypodivergent and normodivergent skeletal patterns for the MCIs. There was no association between WKG and GT and craniofacial morphology in both skeletal and vertical dimensions. Dental compensations that exist due to different craniofacial morphology may influence the GP.

Secondary Caries Detection and Treatment Decision according to Two Criteria and the Impact of a Three-Dimensional Intraoral Scanner on Gap Evaluation

This study aimed to evaluate the in vitro performance in detecting caries around composite restorations in permanent posterior teeth and the impact of treatment decisions of two visual criteria: International Dental Federation (FDI) criteria and the Caries Associated with Restorations and Sealants (CARS) system. The correlation among secondary caries and the presence of gap measured with a three-dimensional (3D) intraoral scanner was also aimed. One hundred sixteen teeth were assessed by a trained and calibrated examiner according to the FDI criteria or CARS system. A second examiner measured the gap on the 3D models using specific software. The reference standard was the histological examination performed by a third examiner blind to the other evaluations. Other 30 extracted permanent teeth were used only to assess the reproducibility of the methods. The same random sample was selected for re-examination by all three methods, and there were 7 days between the examinations. Unweighted and weighted kappa tests were conducted to assess intra-examiner reproducibility. Spearman’s correlation coefficient (Rho) and 95% confidence intervals (95% CI) were calculated between the histological examination and scores obtained with FDI criteria, CARS system, and treatment decisions. Spearman’s correlation between the visual and scanner evaluation with the reference standard was performed. Spearman’s rank correlation analyses were conducted independently between the gap evaluated and measured by the visual inspection with the gap assessed using the scanner. The reproducibility of the visual score systems reached high values. Spearman’s correlation coefficients (Rho; 95% CI) between the following variables versus histology were the FDI presence of caries (0.65; 0.53–0.74); CARS scores (0.65; 0.52–0.74); FDI treatment decision (0.46; 0.31–0.59); and CARS treatment decision (0.62; 0.49–0.72). Rho (95% CI) between histology and the gap assessment by the visual inspection was 0.59 (0.45–0.70), the gap measurement by the visual inspection was 0.49 (0.33–0.62), and the gap measured by the scanner was 0.37 (0.18–0.53). Both visual criteria present similar performance in detecting caries. The correlation among treatment decisions is moderate for the FDI and CARS criteria, and both are moderately correlated with lesion depth, with a slight CARS superiority. However, visual examination presents better performance than the 3D intraoral scanner on gap size assessment.

Influence of CBCT parameters on image quality and the diagnosis of vertical root fractures in teeth with metallic posts: an ex vivo study.

The aim of this study was to evaluate the influence of peak kilovoltage (kVp) and a metal artifact reduction (MAR) tool on image quality and the diagnosis of vertical root fracture (VRF) in cone-beam computed tomography (CBCT). Twenty single-rooted human teeth filled with an intracanal metal post were divided into 2 groups: control (n = 10) and VRF (n = 10). Each tooth was placed into the socket of a dry mandible, and CBCT scans were acquired using a Picasso Trio varying the kVp (70, 80, 90, or 99), and the use of MAR (with or without). The examinations were assessed by 5 examiners for the diagnosis of VRF using a 5-point scale. A subjective evaluation of the expression of artifacts was done by comparing random axial images of the studied protocols. The results of the diagnoses were analyzed using 2-way analysis of variance and the Tukey post hoc test, the subjective evaluations were compared using the Friedman test, and intra-examiner reproducibility was evaluated using the weighted kappa test (α = 5%). The kVp and MAR did not influence the diagnosis of VRF (p > 0.05). According to the subjective classification, the 99 kVp protocol with MAR demonstrated the least expression of artifacts, while the 70 kVp protocol without MAR led to the most artifacts. Protocols with higher kVp combined with MAR improved the image quality of CBCT examinations. However, those factors did not lead to an improvement in the diagnosis of VRF.

Can the detection of second mesiobuccal canals be enhanced based on the volume of adjacent canals?

ObjectivesThe purpose of this study was to evaluate whether the presence of the second mesiobuccal (MB2) canal is related to volumetric differences on the adjacent canals of maxillary molars. DesignForty-seven maxillary first and second molars with and without the MB2 canal were individually scanned using microcomputed tomography (micro-CT). The volume of each canal was measured by an evaluator with experience in micro-CT analysis. The intraclass correlation coefficient (ICC) was obtained. Multiple logistic regression and odds ratio was calculated. To compare the volume of canals in molars with and without MB2, the Mann-Whitney test was applied (α = 0.05). ResultsThe intra-examiner reproducibility was almost perfect (ICC=0.97). Multiple logistic regression demonstrated that the volume of the mesiobuccal (MB1) canal can possibly act as a predictor of the presence of the MB2 canal. It was also found that the MB1 canal volume is larger in molars without the MB2 canal (p = 0.01). No statistically significant difference was observed in the adjacent canals (p > 0.05). ConclusionsDespite the challenging detection of the presence of MB2 canals, clinicians should be aware that MB1 canals of reduced volume are highly suggestive of their presence.

Pupil assessment with a new handheld pupillometer in healthy subjects.

To assess the pupil response with a new handheld pupillometer in healthy subjects. Sixty-four eyes of 32 healthy subjects (mean age 21.2years) were tested. After dark adaptation for 10min, pupil responses to 1s red and blue light stimuli at 100cd/m2 were measured in the order from right to left eyes with a 1min interval. The initial pupil size (D1, mm), minimum pupil size (D2, mm), and constriction rate (CR, %) were obtained. Intra-examiner reproducibility was examined using the coefficient of variation (CV, %) and the Bland-Altman plot. Inter-examiner consistency was examined using the interclass correlation coefficient (ICC) and the agreements with a conventional device, by Pearson's correlation coefficient (r). The CV of all parameters have high reproducibility in the red (11.0-20.7%) and blue (5.5-12.1%) light stimuli. Bland-Altman plot analysis showed no bias with both light stimuli. "Almost perfect" and "substantial" correlations between the examiners were obtained in the red (ICC = 0.78-0.94) and blue (ICC = 0.71-0.89) light stimuli. "Excellent" and "good" correlations between the devices were obtained, except for the CR parameter in the red (D1: r = 0.90; p < 0.001, D2: 0.72; p < 0.001, and CR: 0.08; p = 0.631, respectively) and blue (D1: r = 0.87; p < 0.001, D2: 0.70; p < 0.001, and CR: 0.19; p = 0.274, respectively) light stimuli. The novel pupillometer is useful for assessing pupil response. However, because of their different constructions, the CR values cannot be compared directly between the devices.

Investigating Type B Basilar Invagination Through Cephalic Indices

We sought to compare the diagnostic accuracy of cephalic indices for type B basilar invagination (BI). This retrospective study examined head and neck magnetic resonance imaging sequences of 31 Group B BI cases and 96 controls. Two examiners blinded to diagnostic data evaluated the cephalic indices of each magnetic resonance imaging sequence, described as width/length (WLI) and height/width (HWI). The distance of the odontoid process apex to Chamberlain line and clivus canal angle were measured. The interexaminer and intraexaminer reproducibility of the cephalic indices was calculated using intraclass correlation coefficient. The diagnostic accuracy was discerned by the receiver operating characteristic (ROC) curve. All analyses were scrutinized with a 95% confidence interval. Cephalic indices showed interexaminer and intraexaminer reproducibility ≥94%. The areas under the ROC curve were 0.639 (WLI) and 0.874 (HWI) (95% confidence interval: P < 0.05). The HWI showed a sensitivity of 74.7% and a specificity of 85.5% for the cutoff criterion ≤58. The WLI presented a sensitivity of 53.3% and a specificity of 66.7% for the cutoff criterion ≥86. The HWI showed the largest area under the ROC curve in comparison with the WLI, with robust sensitivity and specificity values, indicating that the proportions between cranial height and width can help clinicians in investigating type B BI.

Diagnostic Validity in Occlusal Caries Detection of ICDAS II, DIAGNOdent, Radiography and a Combination of the Three Methods: An In Vitro Study.

In this study, we compare the efficacy and diagnostic concordance of the ICDAS, the radiographic criterion and the instrument known as the DIAGNOdent fluorescence laser pen on occlusal caries lesions using a histological section as the gold standard. Of 100 teeth that did not present cavitated occlusal lesions or occlusal fillings, 80 were chosen through a randomization program and examined by two previously trained and calibrated researchers. Subsequently, the teeth were sectioned with a diamond disk and observed under an optical microscope. The results were studied for caries with a limit established in enamel and caries with extension to dentin. The intra-examiner (0.821–0.933) and inter-examiner (0.817–0.924) reproducibility obtained for both ICDAS and DIAGNOdent for the diagnosis of borderline enamel caries was high. Similarly, intra-examiner (0.686–1.000) and inter-examiner (0.809–0.944) reproducibility for diagnosis of caries with dentin extension was also high for both methods. The sensitivity obtained was 0.76 (ICDAS), 0.87 (DIAGNOdent) and 0.58 (Rx), whereas the specificity obtained was 0.66 (ICDAS), 0.4 (DIAGNOdent) and 0.77 (Rx) for lesions limited to enamel. For lesions with extension to dentin, the sensitivity obtained was 0.73 (ICDAS), 0.82 (DIAGNOdent) and 0.09 (Rx), and the specificity obtained was 0.79 (ICDAS), 0.52 (DIAGNOdent) and 0.97 (Rx). Sensitivity increases in both cases by combining diagnostic methods. In conclusion, ICDAS and DIAGNOdent are better diagnostic methods than Rx for the detection of occlusal caries, and the combination of these methods helps to obtain a better diagnosis.

Three-dimensional analysis of the maxillary sinus according to sex, age, skin color, and nutritional status: A study with live Brazilian subjects using cone-beam computed tomography

ObjectiveTo perform three-dimensional measurements (volume and area) of the maxillary sinus, from cone-beam computed tomography (CBCT) images, and to assess potential differences between the left and right sides and a correlation of the measurements to sex, age, skin color, and nutritional status. DesignCBCT images of 161 living Brazilian subjects of both sexes (89 women and 72 men) were used, and three-dimensional measurements of volume and area were made with the beta version of the DDS-Pro™ 2.14.2_2022 software (DPP Systems, Czestochowa, Poland). The inter- and intra-examiner reproducibility of measurements was evaluated with TEM, rTEM, and R. ResultsBoth maxillary sinus volume and area did not show significant differences between the left and right sides and between the sexes. Volume and area were significantly lower in the age group from 6 to 11 years than in the other two groups (p < 0.05). The measurements obtained for maxillary sinus volume and area were significantly higher in white individuals (p < 0.05), but they did not show significant differences (p > 0.05) regarding nutritional status (considering the body mass index - BMI). ConclusionThere were no statistically significant differences between the sexes, which does not allow recommending the use of maxillary sinus volume and area measurements to analyze sexual dimorphism, and the same occurs for BMI. However, such measures can help to estimate the age and skin color of individuals.

Are facial, maxillary arch and incisor dimensions related in patients with a unilaterally impacted palatal canine? A prospective investigation

Abstract Objective To identify and determine the relationship between facial, maxillary arch and incisor dimensions of patients presenting with a unilaterally impacted palatal canine. Methods Prospective referrals over one calendar year of patients identified with a unilaterally impacted palatal canine were compared with prospectively recruited control subjects. Canine location was determined radiographically and re-confirmed two weeks later. Facial, maxillary arch and incisor dimensions were assessed. Intra-examiner reproducibility was re-assessed using randomly selected images (20%, n = 40). General linear models were applied for inter-group comparisons incorporating Bonferroni adjustment with categorical parameters assessed using Fisher’s exact test (SAS®, Version 9.4, SAS.com). Inter-class correlation coefficients were calculated for relationships between the variables. Results Fifty-four patients (37 females; 17 males) presenting with a unilaterally impacted palatal canine [mean age 14.5 (SD 1.7) years] and 54 control subjects (37 females, 17 males) [mean age 14.3 (SD 2.2) years] were recruited. Measurement error was small for landmark data (0.58 mm), palatal depth (0.09 mm), palatal area (0.42 mm²) and Bolton ratio (0.14%). For facial, maxillary arch and tooth shape assessments, landmark error was 0.05 mm with complete agreement for classification. The mean nasal basal width was smaller in the unilaterally impacted palatal canine group compared with the control group (P &lt; 0.0001) but face shape distribution and face ratio were similar (both P &gt; 0.05). The mean anterior Bolton ratio was larger in the impacted canine group (P &lt; 0.01). No differences were recorded between groups for other parameters (all P &gt; 0.05). No positive correlations were identified between the variables. Conclusions Patients with a unilaterally impacted palatal canine had a narrower mean nasal basal width and a larger mean anterior Bolton ratio compared to a control group but the clinical significance of the differences was considered minor. Facial, maxillary arch and incisor dimensions were neither individually nor collectively correlated with a palatal canine which may lend support to a genetic aetiology.

Validity and reproducibility of the PPLP score in the follow-up of anterior cruciate ligament reconstruction in athletes

Objectives:In a context where psychological scores appear to have an increasing influence on the resumption of sports, it would also appear to be essential to evaluate the relevance of global scores with multiple criteria. The PPLP score (Psychological Physical Ligament Predictive score) enables an analysis of subjective, clinical and isokinetic muscle assessment items.Methods:We prospectively followed anterior cruciate ligament (ACL) reconstructions in several series for which we analyzed the validity of the score (763 patients), the reproducibility, the sensitivity to change, the relevance in the follow-up of ligamentoplasty (3,296 ligamentoplasties followed postoperatively) as well as the predictive nature in the resumption of sports (258 patients). The PPLP score has two parts: one (PPLP1) based on 100 points for postoperative follow-up and the other also based on 100 points (PPLP2) which is added to the first score for follow-up at a certain period of time after surgery to determine a new score of 200 points. We also tried to identify correlations with other scores in the literature (OAK, Lysholm, Tegner, KOOS, Arpeggio, IKDC Subjective and the Psychovitality Test).Results:We demonstrated the distinction of the items (r coefficient of 0.20) for construct validity. Intra-examiner and extra-examiner reproducibility was excellent, ranging from 0.92 to 1. The PPLP score changed in a statistically significant way during hospitalization and according to the operating lead time with phases of higher variation. Complicated clinical changes manifested in a low score, in particular neuro-algodystrophies (1.9%) with a mean PPLP1 of 80.33 while changes without complications (80.8%) had a mean score of 94.28 with a significant difference (p < 0.0001). The PPLP2 score correlated significantly with the resumption of competition (p = 0.012). A high score was associated with faster recovery. The optimal cut-off score was 176 (sensitivity 79.7% and specificity 49.3%). The results of the PPLP score were correlated with the other scores.Conclusion:The PPLP score was validated in terms of construction, reproducibility, and sensitivity in the follow-up of ACL ligamentoplasties. It provides indications on the quality of change and the possibilities of resuming sports. It is the only score that incorporates isokinetic assessments.

A Radiographic Study of the Root-to-Crown Ratio of Natural Permanent Teeth in 81 Saudi Adults.

BackgroundThe ratio between a tooth root and its crown is an essential diagnostic parameter that determines treatment options. This radiographic study used panoramic dental radiographs or orthopantograms to measure the mean root (R)-to-crown (C) ratios (R/C) of the permanent teeth in 81 Saudi adults.Material/MethodsA total of 81 panoramic radiographs of Saudi adult patients (40 males and 41 females) previously treated in the College of Dentistry, Saudi Arabia, aged 16–35 years, were selected. The crown height and root length for each tooth were measured on the digital panoramic radiographs. The correlation coefficient (intra-class) was calculated to assess the intra-examiner reproducibility and a good agreement was achieved (ICC=0.79–0.89).ResultsFor both males and females, the highest mean R/C ratio was for maxillary canine (1.91) and for mandibular second premolar (2.0) while the lowest R/C ratio was for maxillary first molar (1.64) and for mandibular central incisor (1.59). Except for the maxillary second premolar, no significant differences in R/C ratios were observed for maxillary arch. In the mandibular arch, the R/C ratio for lateral incisor, both premolars, and molars differed significantly (P<0.05). Among males, statistically significant differences between teeth existed in R/C ratios for central and lateral incisors, second premolar, and both molars (P>0.05). For females, significant differences between teeth in R/C ratios were observed for both premolars and both molars (P>0.05).ConclusionsThis study supports the findings from previous studies that orthopantograms can be used to calculate root/crown ratios, which varies between males and females and the dental arch among Saudi adults.

Light-based diagnostic methods for the in vivo assessment of initial caries lesions: Laser fluorescence, QLF and OCT.

To evaluate different light-based caries diagnostic methods for assessment of non-cavitated initial carious lesions on smooth surfaces. 39 participants were included. For each participant, three regions of interest (ROI) with ICDAS codes 0, 1 or 2 were defined. All ROIs (n = 117) were investigated/imaged with laser fluorescence (LF, DIAGNOdent 2095; KaVo dental GmbH), quantitative light-induced fluorescence (QLF; Biluminator 2+, Inspektor Research Systems B.V.) and spectral-domain optical coherence tomography (SD-OCT; Telesto II, Thorlabs GmbH). The values of LF, ΔF of QLF, and the lesion extent assessed by OCT were categorized. Frequency distribution of LF-/QLF- and OCT-scores was determined for each ICDAS code included. Inter- and intra-examiner reproducibility of QLF and OCT measurements were assessed by unweighted kappa coefficient (ĸ) and Wilcoxon test (α = 0.05). Compared with LF and QLF, OCT showed various manifestations of carious lesions for visually sound ROIs and a larger variation of caries extent in depth within the same ICDAS code groups. Intra-examiner reproducibility ranged between 0.49 and 1.00 for the QLF analysis and between 0.95 and 0.99 for the OCT analysis. Inter-examiner reproducibility ranged between 0.17 and 0.32 for the QLF analysis and between 0.65 and 0.79 for the OCT analysis. LF and QLF were insensitive to less pronounced smooth-surface lesions while OCT allowed differentiation based on the penetration depth of the carious lesions. This makes OCT a suitable method to complement conventional visual inspection in order to detect and assess (very) early lesions.

Evaluation of a multi-stage convolutional neural network-based fully automated landmark identification system using cone-beam computed tomographysynthesized posteroanterior cephalometric images.

ObjectiveTo evaluate the accuracy of a multi-stage convolutional neural network (CNN) model-based automated identification system for posteroanterior (PA) cephalometric landmarks.MethodsThe multi-stage CNN model was implemented with a personal computer. A total of 430 PA-cephalograms synthesized from cone-beam computed tomography scans (CBCT-PA) were selected as samples. Twenty-three landmarks used for Tweemac analysis were manually identified on all CBCT-PA images by a single examiner. Intra-examiner reproducibility was confirmed by repeating the identification on 85 randomly selected images, which were subsequently set as test data, with a two-week interval before training. For initial learning stage of the multi-stage CNN model, the data from 345 of 430 CBCT-PA images were used, after which the multi-stage CNN model was tested with previous 85 images. The first manual identification on these 85 images was set as a truth ground. The mean radial error (MRE) and successful detection rate (SDR) were calculated to evaluate the errors in manual identification and artificial intelligence (AI) prediction.ResultsThe AI showed an average MRE of 2.23 ± 2.02 mm with an SDR of 60.88% for errors of 2 mm or lower. However, in a comparison of the repetitive task, the AI predicted landmarks at the same position, while the MRE for the repeated manual identification was 1.31 ± 0.94 mm.ConclusionsAutomated identification for CBCT-synthesized PA cephalometric landmarks did not sufficiently achieve the clinically favorable error range of less than 2 mm. However, AI landmark identification on PA cephalograms showed better consistency than manual identification.

What diagnostic strategy performs better for caries lesion detection on proximal surfaces of adolescents?

To evaluate the performance of visual inspection alone and associated to radiographic and laser fluorescence (LF) methods in detecting non-evident caries lesions at adolescents' proximal surfaces. Adolescents (12 to 17years old) were assessed for the presence of caries lesions through visual inspection, radiographic examination, and LF method (DIAGNOdent pen), at non-cavitated (NC) and cavitated lesion (CAV) thresholds. Temporary separation with orthodontic rubbers followed by direct visual inspection was the reference standard method. Two examiners conducted the examinations, and the first examiner reassessed around 20% of the sample, to evaluate inter- and intra-examiner reproducibility, respectively. Sensitivity, specificity, accuracy, and utility values were calculated for the methods alone and combined with visual inspection using two different strategies: simultaneous and sequential combination. A total of 834 proximal surfaces (51 adolescents) were included. Visual inspection presented higher reproducibility values (higher than 0.98). Moreover, visual inspection presented higher sensitivity (around 0.51) than those obtained with other diagnostic strategies (varying from 0.09 to 0.20) at the NC threshold. For CAV, visual inspection presented higher specificity (0.996) than the sequential association with adjunct methods (around 0.97), but with lower sensitivity. Accuracy and utility values for combined strategies were similar or lower than those achieved with the visual inspection performed alone. Visual inspection alone performs better for detecting caries lesions in premolars and molars of adolescents than other diagnostic strategies. The best diagnostic strategy for caries detection of proximal caries lesions in adolescents is the visual inspection alone.

Development and Reproducibility of a First Metatarsophalangeal Joint Osteoarthritis Magnetic Resonance Imaging Scoring System.

To develop a magnetic resonance imaging (MRI) atlas for the assessment of osteoarthritis (OA) of the first metatarsophalangeal (MTP) joint, and to assess its intra- and interexaminer reproducibility. MRI (proton density with and without fat suppression) was performed on the first MTP joint of 60 participants (30 participants with first MTP joint OA and 30 participants without first MTP joint OA). Characteristic MRI features of OA were then used to develop an MRI atlas of first MTP joint OA. The atlas assessed osteophytes (dorsal metatarsal head, plantar metatarsal head, dorsal proximal phalanx), bone marrow lesions (metatarsal head, proximal phalanx, sesamoids), cysts (metatarsal head, proximal phalanx), effusion-synovitis (dorsal, plantar), joint space narrowing (metatarsal-proximal phalanx, metatarsal sesamoids), and cartilage loss. To assess the reproducibility of the atlas, 2 examiners independently rated the MRIs of 30 participants on 2 occasions. Intra- and interexaminer reproducibility were determined using percentage agreement and Gwet's AC1. Observations using the atlas demonstrated fair-to-perfect intraexaminer reproducibility (percentage agreement from 67% to 100%, and Gwet's AC1 from 0.38 to 1.00) and fair-to-almost-perfect interexaminer reproducibility (percentage agreement from 67% to 98%, and Gwet's AC1 from 0.40 to 0.96). An MRI scoring system for the assessment of OA of the first MTP joint has been developed. The atlas demonstrates excellent intra- and interexaminer reproducibility. The atlas has the potential to allow for a better understanding of the cause(s) of pain in first MTP joint OA.

Does dose optimisation in digital panoramic radiography affect diagnostic performance?

To compare the overall diagnostic performance of digital panoramic radiographs obtained with low-dose protocols and to estimate the absorbed dose in the head and neck. Forty-eight panoramic radiographs were obtained from eight imaging phantoms using six exposure protocols of progressively lower tube voltages (kVp) and currents (mA), as follows: (1) 70 kVp and 12.5 mA, (2) 66 kVp and 10 mA, (3) 66 kVp and 8 mA, (4) 66 kVp and 5 mA, (5) 66 kVp and 4 mA and (6) 66 kVp and 3.2 mA. Five oral radiologists independently evaluated the images and reported all detectable radiographic findings. Intra-examiner reproducibility was assessed by re-evaluation of 25% of the images. The data were analysed using the McNemar and weighted Kappa tests. Absorbed doses of the six protocols were obtained from thermoluminescent dosimeters placed inside a Rando phantom and compared using one-way ANOVA with post hoc Tukey (α = 0.05). The overall diagnostic performance of panoramic radiographs obtained with low-dose protocols did not differ from that of panoramic radiographs obtained with the highest dose (p > 0.05). Moreover, substantial agreement was observed between all protocols. Protocol 1 resulted in the highest absorbed dose and protocols 4, 5 and 6 in the lowest absorbed doses, with the difference being significant (p ≤ 0.05). Although digital panoramic radiography is considered a relatively low-dose examination, the radiation dose can be further reduced without negatively affecting its overall diagnostic performance. Considering the risks associated with X-rays, digital panoramic radiographs can be obtained at even lower exposure levels.