Intraoral Film Research Articles

Brief communication: Bone trabeculae are visible on periapical images.

It is traditionally believed that the radiographic image of bone striae is a reflection of the trabecular pattern of cancellous bone. Results of a 1999 paper by Cavalcanti et al. contradicted this paradigm, suggesting that the intraoral radiographic image of trabecular pattern in the mandible reflects the morphology of the endosteal surface of the cortical bone, rather than that of cancellous bone. Here, we conduct a simple experiment to assess the contribution of dry mandibular cancellous bone to the image of trabecular pattern seen on intraoral films. Standardized periapical-type radiographs centered on the same region of interest of a dry human mandible were acquired before and after removal of the buccal, then of both cortical plates, together with the endosteal cortical-trabecular bone interface. One oral and maxillofacial radiologist and 4 oral and maxillofacial radiology residents blindly assessed the presence or absence of bone striations on the acquired images. We find that bone striations are visible on periapical-type images of dry human mandibles in the absence of one or both cortical plates, and that their pattern is similar to that seen in the image of the intact specimen. We conclude that cancellous bone contributes significantly to the image of trabecular bone in dry human mandibles.

Managing silver and lead waste in dental offices

The heightened awareness within organized dentistry of environmental issues led the ADA Council on Scientific Affairs to develop recommendations on proper management of silver and lead wastes. This council report provides recommendations on managing silver waste (in used fixer solution) and lead waste (in used intraoral film packets, lead aprons and lead collars) through recycling. These recommendations are intended to provide guidance to practitioners in ensuring responsible disposal of wastes generated by dental offices and in minimizing the release of potential pollutants into the environment.

The effect of automated nonroller processing on the sensitometric characteristics of 3 intraoral film types.

We sought to compare the sensitometric characteristics of 3 intraoral film types processed in an automated roller solution with the characteristics of the films processed in 4 automated nonroller solutions. Eastman Kodak Ultra-Speed, Flow X-ray EV-57, and Eastman Kodak InSight films were exposed to varying levels of radiation and processed in 1 automated roller solution and in 4 nonroller solutions. Speed and contrast were measured at various density levels and ranges. With the exception of 1 nonroller solution, there was little difference in speed between roller and nonroller processing chemicals at various density levels. Some nonroller solutions were faster than the roller chemicals for all films. Nonroller processing mostly increased contrast compared with roller processing over various ranges. Sensitometric properties of films processed in automatic nonroller solutions are comparable in many cases to those in roller solutions, sometimes resulting in greater speed and contrast. Different adjustments in exposure factors are required for specific film/processing combinations.

Extraoral Radiographic Technique: An Alternative Approach

The inability of certain patient populations to accept intraoral films and/or sensors can cause complications in the performance of endodontic therapy. An alternative technique (extraoral film placement) can be used to obtain clinically diagnostic radiographs. This article describes the alternative technique.

Intra-oral and extra-oral digital imaging:: an overview of factors relevant to detector design

Since the introduction of the first intraoral detector system 15 years ago, major improvements have been achieved. Initially, fibre optic coupling was used between the entrance phosphor and the small CCD sensor, later sensors became available for direct exposure. Also the dimensions of the active area were increased to comply with the size of analogue dental films and the thickness of the sensor was decreased. Intraoral films are flexible, CCD-type sensors however, are stiff and therefore much more difficult to position in the mouth of the patient. The resolution of modern intraoral sensors is comparable or even higher than that of film, but with increasing resolution, noise is becoming a problem in some diagnostic tasks.Both imaging phosphor plates and CCD-based systems are also used in extra oral imaging. The procedures in phosphor plate technology are quite comparable to those of conventional film. As the width of CCD sensors is limited, a slit imaging technique is used in panoramic imaging and still images. Tomography, a radiographic method to display layers within an object is not possible with the present CCD sensors.

Comparison between RVG UI sensor and Kodak InSight film for detection of incipient proximal caries

The purpose of this study was to compare the efficacy of the four combination modes of Trophy RadioVisioGraphy UI sensor (Trex-Trophy Radiology Inc., Marne-la-Valee, France) and Kodak InSight film (Eastman Kodak Co., Rochester, NY) for detecting proximal dental caries. Thirty extracted human upper premolars were selected. Of 60 surfaces, 25 had carious lesions in the form of small cavities, and the rest showed no evidence of caries as verified by a micro computed tomogram (micro CT; XCT Research SA+, Stratec Medizintechnik GmbH, Pforzheim, Germany). All teeth were radiographed with the paralleling technique (60kV, 40 cm focus-to-sensor distance). Four combination modes (high-resolution caries mode—HRC; high-sensitivity caries mode—HSC; high-resolution periodontal mode—HRP; and high-resolution endo mode—HRE) were used. Exposure was set at 0.12 sec for HRC, 0.08 sec for HSC, 0.16 sec for HRP, 0.12 sec for HRE, and 0.16 sec for the Kodak InSight film. The resulting images were evaluated by three oral radiologists. The same three observers evaluated the digital images, and were allowed to use the contrast and brightness controls in doing so. Possible differences in ROC curve areas among image modalities were assessed by the Friedman test. The mean ROC curve areas were 0.66±0.11 for HRC, 0.78±0.02 for HSC, 0.76±0.04 for HRE, 0.77±0.04 for HRP, and 0.71±0.09 for the Kodak InSight film. There were no statistically significant differences between HRC, HSC, HRE, HRP and the Kodak InSight film in terms of proximal caries detection. The four modes of RVG UI system are each a viable alternative to intraoral film for the detection of incipient dental caries.

The Use of Radiation Dose‐Reduction Techniques in the Practices of Dental Faculty Members

X-ray exposure to dental patients has been significantly reduced by the introduction of speed group E intraoral film, rectangular beam limitation, long position indicating devices (PIDs), and rare-earth intensifying screens for extraoral radiography. Research indicates that many dentists do not use these techniques. However, schools of dentistry have implemented them to varying degrees for many years, so this investigation was conducted to determine the extent to which dental school faculty members use these materials and techniques in their own practices. Comparisons were made between full- and part-time instructors, those in practice for fifteen years or less and those in practice for more than fifteen years, and those with postgraduate education versus those with no formal education beyond dental school. The significance of differences was measured with chi-square analysis. The results indicate that dentists with faculty appointments utilize dose-reducing techniques to degrees that are comparable to or greater than reported usage by non-dental faculty practitioners. Faculty dentists in practice fifteen years or less are more likely than their older colleagues to use E-speed film (p = 0.001), whereas those in practice more than fifteen years are more likely to use longer PIDs (p = 0.049). Greater acceptance of these practices by faculty may lead to reinforcement of their use in the clinical education of dental students.

Radiation dose-reduction techniques in North American dental schools.

The purpose of this investigation was to describe the extent to which dental schools use materials, equipment, and quality-assurance protocols that reduce radiation exposure to patients. Questionnaires soliciting information regarding intraoral and extraoral radiographic practices and quality-assurance procedures were sent to the directors of oral and maxillofacial radiology (OMR) at the 65 schools of dentistry in the United States and Canada. The response rate was 100%. E-speed film is used at 86% of institutions. Direct digital radiography is used at 58% of institutions for intraoral imaging and 11% for extraoral radiography. Other dose-reducing techniques include long source-film distances (88%), rectangular beam limitation (47%), leaded aprons (95% for extraoral films; 85% with thyroid collars for intraoral films), and rare earth intensifying screens (100%). The most commonly used tube potential is 70 kVp (88%). The director of OMR is solely responsible for radiographic policies at approximately 75% of institutions. Regular tests for film fog, speed, and contrast are done at roughly 75% of schools, while over 90% test darkroom lighting and x-ray equipment. Some dose-reducing strategies are commonly used in dental schools, while others have not gained wide acceptance.

Comparative study of digital and conventional radiography for the diagnostic ability of artificial proximal surface caries

Conventional intraoral radiography continues to be the most widely used image modality for the diagnosis of dental caries. But, conventional intraoral radiography has several shortcomings, including the difficulty of exposing and processing intraoral film of consistently acceptable quality. In addition, radiographic retaking that was the result of processing errors, may result in increased discomfort and radiation dose to the patient. Recently, various digital radiographies substitute for conventional intraoral radiography to overcome these disadvantages. The advantages of digital radiography are numerous. One of advantages Is the elimination of processing errors. In addition, the radiation dose for digital system is approximately 20% to 25% of that required for conventional intraoral radiography Another potential advantage of digital imaging is the ability to perform image quality enhancements such as contrast and density modulation, which may increase diagnostic accuracy. The purpose of this study was to compare the diagnostic ability of artificial proximal defects to conventional intraoral radiography, direct digital image(CDX2000HQ) and indirect digital image(Digora). Artificial defects were made in proximal surfaces of 60 extracted human molars using #1/2, #1, #2 round bur. Five dentists assessed proximal defects on conventional intraoral radiography, direct digital image(CDX2000HQ) and indirect digital image(Digora). ROC(Receiver Operating Characteristic) analysis and Two-way ANOVA test were used for the evaluation of detectability, and following results were acquired. 1. The mean ROC area of conventional intraoral radiography, direct digital image(CDX2000HQ) and indirect digital Image(Digora) were 0.6766, 0.7538, 0.6791(Grade I), 0.7176, 0.7594, 0.7361(Grade II), and 0.7449, 0.7608, 0.7414(Grade III), respectively. 2. Diagnostic ability of direct digital image was higher than other image modalities. But, there was no statistically significant difference among other imaging modalities for Grade I, II, III lesion(p>0.05). In conclusion, when direct and indirect digital system are comparable with conventional intraoral radiography. these systems may be considered an alternative of conventional intraoral radiography for the diagnosis of proximal surface caries.

Role of radiology in forensic dentistry

There are various methods for the identification of human remains; most of them are based on comparisons between available ante- and post-mortem data. Although fingerprinting is the most accurate and precise method, in many cases, such as in mutilated, decomposed, burned or fragmented bodies, it cannot be used, and the dental methods become of the utmost importance, since teeth and dental restorations are very resistant to destruction by fire--they keep numerous characteristics, which are quite unique, and offer the possibility of accurate and legally acceptable identification of remains. This brief review describes the progress of forensic dentistry during the last 25 years, regarding the procedures and techniques that use ante-mortem and post-mortem radiographs. Among the discussed progresses one can point out: a specially designed self-supporting film holder that retains intra-oral films in the mouths of deceased persons whose mandibular musculature has been fixed in rigor mortis; positioning devices suitable for reproducing the geometry of ante-mortem radiographic images; methods involving digital radiographs, which can be easily stored in a central archive, retrieved and transmitted, via modem, to mass casualty sites; age estimation procedures; identification of edentulous individuals comparing radiographs of the maxilla; and studies of validation of dental radiographs taken with ante-mortem and post-mortem intervals of up to 30 years.

Fractal dimension analysis of weight-bearing bones of rats during skeletal unloading

Fractal analysis was used to quantify changes in trabecular bone induced through the use of a rat tail-suspension model to simulate microgravity-induced osteopenia. Fractal dimensions were estimated from digitized radiographs obtained from tail-suspended and ambulatory rats. Fifty 4-month-old male Sprague-Dawley rats were divided into groups of 24 ambulatory (control) and 26 suspended (test) animals. Rats of both groups were killed after periods of 1, 4, and 8 weeks. Femurs and tibiae were removed and radiographed with standard intraoral films and digitized using a flatbed scanner. Square regions of interest were cropped at proximal, middle, and distal areas of each bone. Fractal dimensions were estimated from slopes of regression lines fitted to circularly averaged plots of log power vs. log spatial frequency. The results showed that the computed fractal dimensions were significantly greater for images of trabecular bones from tail-suspended groups than for ambulatory groups ( p < 0.01) at 1 week. Periods between 1 and 4 weeks likewise yielded significantly different estimates ( p < 0.05), consistent with an increase in bone loss. In the tibiae, the proximal regions of the suspended group produced significantly greater fractal dimensions than other regions ( p < 0.05), which suggests they were more susceptible to unloading. The data are consistent with other studies demonstrating osteopenia in microgravity environments and the regional response to skeletal unloading. Thus, fractal analysis could be a useful technique to evaluate the structural changes of bone.

A simple method for estimating effective dose in dental CT. Conversion factors and calculation examples for a clinical low dose protocol

An easily applicable method to estimate effective dose including in its definition the high radiosensitivity of the salivary glands from dental computed tomography is presented. Effective doses were calculated for a markedly dose reduced dental CT protocol as well as for standard settings. Data are compared with effective doses from the literature obtained with other modalities frequently used in dental care. Conversion factors based on the weighted Computed Tomography Dose Index were derived from published data to calculate effective dose values for various CT exposure settings. Conversion factors determined can be used for clinically used kVp settings and prefiltrations. With reduced tube current an effective dose for a CT examination of the maxilla of 22 microSv can be achieved, which compares to values typically obtained with panoramic radiography (26 microSv). A CT scan of the mandible, respectively, gives 123 microSv comparable to a full mouth survey with intraoral films (150 microSv). For standard CT scan protocols of the mandible, effective doses exceed 600 microSv. Hence, low dose protocols for dental CT should be considered whenever feasable, especially for paediatric patients. If hard tissue diagnoses is performed, the potential of dose reduction is significant despite the higher image noise levels as readability is still adequate.

Characteristics of Kodak Insight, an F-speed intraoral film

Objectives. This study reports film speed, contrast, exposure latitude, resolution, and response to processing solution depletion of Kodak Insight intraoral film. Methods. Densitometric curves were generated by using International Standards Organization protocol. Additional curves were generated for Ultra-speed, Ektaspeed Plus, and Insight films developed in progressively depleted processing solutions. Eight observers viewed images of a resolution test tool for maximum resolution assessment. Images of an aluminum step-wedge were reviewed to determine useful exposure latitude. Results. Insight’s sensitivity in fresh automatic processor solutions places it in the F-speed group. An average gradient of 1.8 was found with all film types. Insight provided 93% of the useful exposure latitude of Ektaspeed Plus film. Insight maintained contrast in progressively depleted processing solutions. Like Ektaspeed Plus, Insight was able to resolve at least 20 line-pairs per millimeter. Conclusions. Under International Standards Organization conditions, Insight required only 77% of the exposure of Ektaspeed Plus film. Insight film provided stable contrast in depleted processing solutions. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:120-29)

Resorption of incisors after ectopic eruption of maxillary canines: a CT study.

The purpose of the study was to analyze the extent and prevalence of resorption of maxillary incisors after ectopic eruption of the maxillary canines in a sample of subjects referred to an orthodontic specialist clinic for consultation. The subjects consisted of 107 children, 39 boys and 68 girls, between 9 and 15 years of age (mean 12.5 years), with 156 ectopically and 58 normally erupting maxillary canines. All children were subjected to a basic clinical and intraoral radiographic investigation. These radiographs were supplemented with computerized tomography (CT) of the upper alveolar bones in order to get more precise information on the positions and relationships between the maxillary canines and adjacent incisors and to evaluate resorptions on the roots of the incisors. The results showed that, relative to the roots of the adjacent incisors, the crowns of 21% the ectopically positioned canines were located to the buccal, 18% to the distobuccal, 27% to the lingual, 23% to the distolingual, 5% apically and 6% between the central and lateral incisors. Ninety-three percent of the ectopically positioned canines were in contact with the roots of the adjacent lateral incisor and 19% were in contact with the central incisor. The corresponding figures for the normally erupting canines were 49%. Resorptions on the roots of the incisors adjacent to the ectopically positioned canine occurred in 38% of the laterals and in 9% of the centrals. The resorptions were graded and tended to be extensive. Among the 58 resorbed lateral incisors, resorptions were slight in 31%, moderate in 9%, and severe with pulpal involvement in 60%. The corresponding figures for the 14 resorbed centrals were 36%, 21%, and 43%, respectively. About 60% of the resorptions involved the middle and apical thirds, the tip of the apex not included. On the sides with normally erupting canines, 3 lateral maxillary incisors were slightly or moderately resorbed distally. In all, 51 of the 107 subjects with ectopically erupting maxillary canines (48%) had resorbed maxillary incisors during the eruption of the maxillary canines. There were statistically significant correlations between ectopic eruption of the maxillary canine, contacts between the teeth and resorptions on the adjacent incisors. It was concluded that resorption on maxillary incisors after ectopic eruption of the maxillary canines is a more common phenomenon than previously reported and has to be considered in all cases with seriously diverging eruption of maxillary canines. It was also concluded that the resorptions of the roots of the incisors were caused by pressure during the eruption of the adjacent, aberrant canine. Finally, it was shown that CT scanning substantially increased the detection of root resorptions on incisors adjacent to ectopically erupting maxillary canines (about 50%). The sensitivity of intraoral films was low when diagnosing the resorptions, being calculated to 0.68.

Digitisation and display of intra-oral films

Digitisation and display of intra-oral films

Digitisation and display of intra-oral films.

To determine the optimal parameters for the digitisation and display of intra-oral radiographs. Six intra-oral radiographs (EP size 2 dental film, Eastman Kodak Co., Rochester, NY, USA) were digitised using an Arcus II image scanner (Agfa-Gevaert N. V., Mortsel, Belgium). Each film was digitised at 8 bits, with and without a film mask, using three scanner resolutions (200, 400 and 600 p.p.i.), resulting in six versions of each radiograph. Seven experienced observers were asked to evaluate the quality of the resulting images as they were displayed on a Nokia 445Xi monitor (Nokia Display Products, Helsinki, Finland). Monitor settings were varied by changing the colour palette and screen resolution. Digital images of masked films had a statistically significant (t-test with alpha 2 tail < or = 0.05) higher quality than those scanned without a mask. The best image quality was obtained at a resolution of 400 p.p.i. Display options were optimum with 256 colours and a screen size of 1152 x 864 pixels. Better results were obtained when intra-oral radiographs were digitised with a mask at a resolution of 200 or 400 p.p.i. and displayed using 256 colours and the largest screen size possible. Further studies are needed to extend these results to other makes and models of scanner and monitor.

Dental CT: examination method, radiation dosage and anatomy

Traditionally oral surgeons and dentists have evaluated the jaws using intraoral films and panoramic radiographs. The involvement of radiologists has been limited. In the past few years dedicated CT-software-programs developed to evaluate dental implant patients have provided a new look at the jaws. The complex anatomy is described and identified on human skulls and on axial, panoramic, and cross-sectional images. With this anatomic description Dental-CT-scans are used to demonstrate the anatomy of maxilla and the mandible. An overview of the technique of Dental-CT is provided, furthermore the radiation dose of different organs is explained. Suggestions to reduce these doses by simple modifications of the recommended protocols are given.

THE INFLUENCE OF STORAGE CONDITIONS ON FILM CHARACTERISTICS OF EKTASPEED PLUS AND ULTRA-SPEED FILMS

Dental professionals were reluctant to accept Ektaspeed (Eastman Kodak Co.) intraoral film despite its X-radiation dose-sparing advantages for patients. One reason may have been Ektaspeed film's known sensitivity to long-term storage as compared with that of Ultra-speed film (Eastman Kodak Co.). In 1995, Kodak replaced Ektaspeed with Ektaspeed Plus, claiming it had better resolution and higher stability than Ektaspeed, as well as equal exposure radiation. The authors compared film response to storage condition and time for Ultra-speed and Ektaspeed Plus films. The authors stored 10 boxes of newly produced Ultra-speed and Ektaspeed Plus film in five locations. They conducted 23 image trials over a 26-month period, exposing each film with an aluminum step-wedge under controlled conditions. After processing the film, they measured density to calculate the film's base + fog and contrast index values. The authors found significant differences in film type (P = .0002), processing status (P < .0001), storage location (P < .0001) and month of storage (P < .0001). They also found a film-type-by-location interaction (P < .0001) but did not find a film-type-by-processing interaction (P = .3271). Regression lines suggested that the optical density of base + fog levels rose more steeply for Ultra-speed film than they did for Ektaspeed Plus film. A significant association of decreasing contrast with increasing months of storage was seen with Ultra-speed film (P < .0001). There was a small increase in base + fog levels resulting from the use of used solutions over the course of the study. Ektaspeed Plus film compared favorably with Ultra-speed film under all conditions. The authors recommend the use of Ektaspeed Plus film for intraoral imaging, as its performance is comparable to that of Ultra-speed film while requiring half the X-radiation exposure to patients. Clinicians must ensure that the correct safelights and processing solutions are used before switching to the new film.

X-ray image detectors in stomatology

The paper analyzes the technical level of the intraoral tooth films made in Russia and foreign countries, the potentialities of use of screen-amplifying film sets for periapical survey.

A TECHNIQUE TO SIMPLIFY RADIOGRAPH DUPLICATION

Dentists need duplicate radiographs for insurance claims and to make referrals to other dentists. Several systems are available to duplicate radiographs in the conventional manner. Duplication machines range in size from 4 × 6 inches for duplication of a single intraoral film to 12 × 24 in. for duplication of a panoramic radiograph or full-mouth series of radiographs. The cost of the duplicator ranges from about $85 to $350. Radiograph duplication machines work by having a light source in a box covered by a translucent platform. Some of the more expensive machines also have a safelight in the box. The original film is placed on the platform, face down. The operator then places the duplicating film over the original film, also face down. The cover is closed and a timer exposes the duplicating film to the light source for eight to 15 seconds.