Intraoral Radiographic Techniques Research Articles

VISUALIZATION OF INCISIVE FORAMEN USING TWO INTRAORAL PERIAPICAL RADIOGRAPHIC TECHNIQUES

Background: Intraoral periapical radiographs are reported to show the incisive foramen as a typical anatomical landmark. In order to assess the visibility of the incisive foramen in the bisecting angle and paralleling angle approaches, as well as how visible it is in routine periapical radiographs, the current study was conducted. Methods: This descriptive cross-sectional study evaluated 90 intraoral periapical radiographs of maxillary central incisors. These were scored for visibility of incisive foramen by a radiographic expert using two intraoral radiographic techniques. The data was entered in Microsoft Office Excel sheet 2007 and calculated using SPSS version 20. Results: In both the paralleling and bisecting radiographs, the incisive foramen could be seen in a total of 63.8% and 36.2% of the images, respectively. Conclusions: The dentist must have a thorough awareness of how the incisive foramen appears on standard intraoral radiographs. Our research demonstrates that when compared to the bisecting angle technique, the paralleling technique delivers superior visibility of the incisive foramen. Therefore, it is recommended to use the paralleling technique approach to see the foramen.

Impact of a modified preclinical teaching methodology in intraoral radiographic technique to reduce radiographic technique errors in a dental school amidst COVID-19

Impact of a modified preclinical teaching methodology in intraoral radiographic technique to reduce radiographic technique errors in a dental school amidst COVID-19

3D-printed model for preclinical training in oral and maxillofacial radiology

<h3>Objective</h3> 3D printing is experiencing significant growth in the teaching and learning process. Therefore, this study aimed to present a 3D-printed skull model for preclinical intraoral radiographic practice. <h3>Study Design</h3> Two 3D-printed mannequins were created. The first was created using an STL file of a skull and was edited using two 3D modeling softwares (Meshmixer and Netfabb). The second mannequin was designed directly from segmentation of a patient's CBCT data and then converted into an STL file. Both mannequins were printed using fused deposition modeling (FDM) technology and polylactic acid (PLA) filament. The printed skull bones were attached, and the mandible was articulated to the articular fossa of the temporal bone. The teeth were inserted into the alveoli. Intraoral radiographs of both mannequins were acquired using a digital sensor (Carestream RVG 5100). <h3>Results</h3> Both 3D-printed mannequins showed satisfactory radiographic appearance, allowing geometric representation of each intraoral radiographic projection, regardless of STL file origin. Anatomical structures, such as the periodontal ligament space, zygomatic process of the maxilla, and intermaxillary suture, were represented. The material cost of the printed prototype was $34.00. <h3>Conclusions</h3> The use of 3D-printed models is presented as an alternative to artificial commercial phantoms for the preclinical training of intraoral radiographic techniques, combining the radiographic projection's quality, the possibility of model manipulation, and an affordable price. <b>Statement of Ethical Review</b> Ethical review was sought and study was exempted from ethical review

Three-Dimensional printed model for preclinical training in oral radiology.

3D printing is experiencing significant growth in the teaching and learning process. This study aims to present a 3D printed skull model for preclinical intraoral radiographic practice. Two 3D printed mannequins were created. One mannequin used an STL file of a skull that was edited using two 3D modelling software (Meshmixer and Netfabb). The second mannequin was designed directly from a patient's segmented CBCT data and then converted into an STL file. Both mannequins were printed using fused deposition modelling (FDM) technology and polylactic acid (PLA) filament; teeth for the second mannequin were also printed using digital light processing (DLP). The printed skull bones were attached, the mandible was articulated to the articular fossa of the temporal bone, and the teeth were inserted into the alveoli. Intraoral radiographs of both mannequins were taken using a digital sensor (RVG 5100, Carestream). Both 3D printed mannequins showed satisfactory radiographic appearance, allowing geometric representation of each intraoral radiographic projection, regardless of STL file origin. Anatomical structures, such as the periodontal ligament space, zygomatic process of the maxilla and intermaxillary suture, were represented. The material cost of the first and second printed prototype was $34.00 and $39.00, respectively. The use of 3D printed models is presented as an alternative to artificial commercial phantoms for the preclinical training of intraoral radiographic techniques through the combined benefits of superior radiographic projection quality, the possibility of model manipulation and an affordable price.

Intraoral Radiographic Processing Skills among Dentists in Saudi Arabia

AIM: The present study was designed to investigate use of intraoral radiographic techniques (conventional and digital) among general dental practitioners (GDP) in Saudi Arabia with focus on its availability in workplace, ease of the technique, and the recommended technique to be taught during undergraduate based on individual experience. METHODS: A questioner in form of a Google sheet was designed concerning demographic data, country, district, university, year of graduation, availability of radiographic technique available in workplace, which technique learned during undergraduate study, and which technique should teach during undergraduate study based on individual experience. A GDP list was developed from different dental groups on social media. The questioner was sent to the GDP list and to improve the response rate, telephone calls were made in advance to all expected participants. RESULTS: About 62.2% of participants were graduated within past 5 years, the most common dental X-ray processing technique learned during undergraduate study was the digital and conventional (both theoretical and practical) in 47.6% of participants followed by conventional (theoretical and practical) technique in 21% participants. Based on their work experience, 74.8% of participants preferred both digital and conventional techniques should be taught in dental Saudi Universities/Colleges while, the digital method was preferred by 21%. CONCLUSION: However, intraoral digital radiographic technique is widely available in most regions in Saudi Arabia; it is recommended to teach both intraoral digital and conventional radiographic techniques during undergraduate study.

Simulation of three intraoral radiographic techniques in pediatric dental patients: subjective comfort assessment using the VAS and Wong-Baker FACES Pain Raiting Scale

BackgroundPerception of pain associated with intraoral radiography in pediatric patients was evaluated through statistical comparisons of data obtained using the Wong-Baker FACES Pain Raiting Scale (WBFPRS) and visual analog scale (VAS) scoring.MethodsA total of 75 pediatric patients aged 6–12 years were included in this study. Simulations of each of three radiological methods (analog films, CCD sensor and phosphorus plates) were performed on 25 pediatric patients. Following the simulations, the meaning of each facial expression on the WBFPRS and the numbers on the VAS were explained to each child. For the comparison between groups, the homogeneity of the variances was tested with Levene’s test; because the variances were not homogeneous, Welch’s test was used. Tamhane’s T2 test was used because the homogeneity assumption was not provided to determine the source of the difference between the groups.ResultsWhen the conventional method was compared to the PSPL (photostimulable phosphor luminescence) method, no significant differences were noted in either the WBFPRS or VAS results (p >0.05). The results obtained from both of the scales were significantly different between the conventional method and the CCD sensor method (p < 0.05). When the PSPL and CCD sensors were compared, a significant difference was observed for the WBFPRS (p < 0.05). It was found the highest level of pain scores when used the CCD sensor method than the analog film and PSPL methods (p < 0.05).ConclusionsIt is expected that digital radiographic techniques will be improved in the future and that their disadvantages will be eliminated, resulting in imaging devices that are more comfortable for pediatric patients.

Comparative Evaluation of Intraoral and Extraoral Periapical Radiographic Techniques in Determination of Working Length: An In Vivo Study.

ABSTRACTObjectives/aimsThis study was designed to determine the endodontic working length (WL) of root canals using digital extraoral periapical radiography (EOPAR) technique and comparing its accuracy with the standard digital intraoral periapical radiography (IOPAR).Materials and methodsSixty single-rooted mandibular first premolars indicated for orthodontic extraction were radiographed preoperatively to ensure closed apices. After gaining endodontic access, WL was determined by IOPAR using paralleling technique, followed by EOPAR, by placing a cone at +35° from the contralateral side. Accessed tooth was then extracted to obtain the actual root canal length and was compared with the radiographic lengths. Data were subjected to statistical analysis using paired t test.ResultsThe actual length and the extraoral radiographic length showed no statistical significant difference (p = 0.326). The difference between the mean WL obtained by IOPA and EOPA was also not statistically significant (p = 0.096). The accuracy of IOPA technique was 97.87 ± 0.91% and that of EOPA technique was 94.65 ± 2.57%.ConclusionThe EOPA technique with an angulation of +35° can be used as an alternative to IOPA for mandibular premolars in apprehensive children, dental phobic patients with low pain threshold, neurological difficulties, and exaggerated gag reflex.How to cite this articleSridhara A, Konde S, Noojadi SR, et al. Comparative Evaluation of Intraoral and Extraoral Periapical Radiographic Techniques in Determination of Working Length: An In Vivo Study. Int J Clin Pediatr Dent 2020;13(3):211–216.

A Letter Regarding Recently Published Original Article: Comparative Evaluation of Intraoral and Extraoral Periapical Radiographic Techniques in Determination of Working Length: An In Vivo Study.

How to cite this article: Aps JKM. A Letter Regarding Recently Published Original Article: Comparative Evaluation of Intraoral and Extraoral Periapical Radiographic Techniques in Determination of Working Length: An In Vivo Study. Int J Clin Pediatr Dent 2020;13(5):576–577.

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

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

Digital dental radiology in Belgium: a nationwide survey.

The aim of this study is to analyse the use of digital dental radiology in Belgium, by focussing on the use of extraoral and intraoral radiographic techniques, digitalisation and image communication. A nationwide survey has been performed amongst Belgian general dentists and dental specialists. Questionnaires were distributed digitally via mailings lists and manually on multiple refresher courses and congresses throughout the country. The overall response rate was 30%. Overall, 94% of the respondents had access to an intraoral radiographic unit, 76% had access to a panoramic unit, 21% has an attached cephalometric arm. One in five Belgian dentists also seem to have direct access to a cone beamCT. 90% of all intraoral radiography unit worked with digital detectors, while this was 91% for panoramic units (with or without cephalometrics). In 70% of the cases, general dental practitioners with a digital intraoral unit used a storage phosphor plate while in 30% of the cases they used sensor technology (charge-coupleddevice or complementarymetal-oxide-semiconductor). The most common method for professional image transfer appeared to be email. Finally, 16% of all respondents used a calibrated monitor for image analysis. The survey indicates that 90% of the respondents, Belgian dentists, make use of digital image techniques. For sharing images, generaldental practitioners mainly use methods such as printout and e-mail. The usage of calibrated monitors, however, is not well established yet.

Diagnostic accuracy of 4 intraoral radiographic techniques for misfit detection at the implant abutment joint

Statement of problemA misfit or gap at the implant–abutment joint (IAJ) requires detection as it may compromise the health of the peri-implant tissue. However, which radiographic technique provides the most orthogonal relationship between the central beam and the implant/image receptor is unclear. PurposeThe purpose of this in vitro study was to evaluate the diagnostic accuracy of 4 intraoral radiographic techniques on misfit detection at the IAJ. Material and methodsTwenty implants were placed in polyamide jaws, and customized dental implant abutments with a metal collar were installed. Different gaps were simulated by placing one or three 50-μm-thick polyester strips at the IAJ; the absence of the strip represented the control group (no gap). The 4 radiographic techniques were evaluated by using different film holders: a periapical with bisecting angle (PBA), a bitewing interproximal (BI), a periapical with standard paralleling (PSP), and a periapical with modified paralleling (PMP) holder (with a custom-made paralleling index). A total of 240 digital radiographs were evaluated by 4 clinicians experienced with dental implants. Differences were evaluated by using receiver operating characteristic (ROC) curves (Az) and Fisher tests (α=.05). Diagnostic values (sensitivity, specificity, accuracy, and positive and negative predictive values) were also obtained. The Kappa test was used to assess intra- and interevaluator reproducibility, which ranged from moderate to almost perfect. ResultsAll diagnostic values, except specificity, were lower for the PBA technique for both the 50- and 150-μm gaps. Az values for the PBA technique were significantly lower than those obtained for the other 3 techniques (P<.05), which did not differ from each other. The 150-μm gaps were more easily detected than the 50-μm gaps only for PBA (P<.05). ConclusionsThe BI, PSP, and PMP techniques detected misfits at the IAJ most accurately. The PBA technique is not recommended for this purpose.

Growing bone assessment made easy at chairside

Various intraoral radiographic techniques have been utilized to study bone changes following periodontal therapy, for example, digital subtraction radiography, computer-assisted densitometric image analysis, computed tomography (CT), and cone bean CT. This short communication provides an insight about a novel yet simple technique which utilizes a user-friendly software (Adobe Photoshop CS3) and provides the clinician a quick, objective economical tool to assess periodontal regeneration (bone fill) radiographically. The use of this software is recommended in any clinical trial, wherein bone is target tissue to be assessed at different time intervals. It can find clinical applications include endodontic periapical cyst therapy, implant, oral and maxillofacial surgery, and orthopedics surgeries. This method is simple, reliable, and reproducible and helps in objective assessment of radiographic changes of the periodontal osseous defects following periodontal therapy.

Intraoral Radiology in General Dental Practices – A Comparison of Digital and Film-Based X-Ray Systems with Regard to Radiation Protection and Dose Reduction

The purpose of this study was to gain insight into the distribution and application of digital intraoral radiographic techniques within general dental practices and to compare these with film-based systems in terms of patient dose reduction. 1100 questionnaires were handed out to general dental practitioners. Data was analyzed with respect to the type of system by using descriptive statistics and nonparametric tests, i.e. Kruskal-Wallis, Mann-Whitney and chi-square test (SPSS 20). 64% of the questioned dentists still use film-based radiology, 23% utilize storage phosphor plate (SPP) systems and 13% use a charge-coupled device (CCD). A strong correlation between the number of dentists working in a practice and the use of digital dental imaging was observed. Almost 3/4 of the film users work with E- or F-speed film. 45% of them refuse to change to a digital system. The use of lead aprons was popular, while only a minority preferred thyroid shields and rectangular collimators. A fourfold reduction of exposure time from D-speed film to CCD systems was observed. Due to detector size and positioning errors, users of CCD systems take significantly more single-tooth radiographs in total. Considering the number of radiographs per patient, there is only a slight tendency towards more X-rays with CCD systems. Up to image generation, digital systems seem to be as or even more difficult to handle than film-based systems, while their handling was favored after radiographic exposure. Despite a slight increase of radiographs taken with CCD systems, there is a significant dosage reduction. Corresponding to the decrease in exposure time, the patient dose for SPP systems is reduced to one half compared to film. The main issues in CCD technology are positioning errors and the size of the X-ray detectors which are difficult to eliminate. The usage of radiation protection measures still needs to be improved. ► Responsible use of digital intraoral radiology results in a significant dose reduction in everyday practice. ► The ALARA principle is only achieved by strict implementation of dose-reducing methods. ► The efforts to use dose-reducing devices must be increased.

Choice of diagnostic and therapeutic imaging in periodontics and implantology

Imaging forms an integral component for diagnosis of dental and in specific periodontal diseases. To date, intra-oral radiographic techniques are the main non-invasive diagnostic aids for the detection and assessment of internal changes in mineralized periodontal tissues like alveolar bone. These analog radiographic techniques suffer from inherent limitations like: Two dimensional projection, magnification, distortion, superimposition and misrepresentation of anatomic structures. The evolution of novel imaging modalities, namely cone beam computed tomography, tuned aperture CT empowered dental researchers to visualize the periodontium three dimensionally. This improves interpretation of structural and biophysical changes, ensures densitometric assessments of dentoalveolar structures including variations in alveolar bone density, and peri-implant bone healing more precisely. This detailed review, highlights current leading edge concepts, envisions a wide range of imaging modalities which pave the way for better understanding and early intervention of periodontal diseases.

Insufficient evidence on diagnostic accuracy of radiographic methods in periapical tissues

The Cochrane Central register of controlled trials, Medline and Embase databases were searched. Clinical studies that compared methods against a reference standard were included. Studies also needed to have sensitivity, specificity, likelihood ratio, odds ratio or receiver operator curve (ROC) data or data reported so this could be calculated. Two reviewers independently assessed abstracts and full text articles. Study quality was assessed using the GRADE criteria (www.gradeworkinggroup.org/). A qualitative summary was conducted. Twenty-six studies were included, none was considered to be of high quality, 11 were of moderate quality. There was insufficient evidence that the digital intraoral radiographic technique is diagnostically as accurate as the conventional film technique. The same applies to Cone beam computed tomography (CBCT). No conclusions can be drawn regarding the accuracy of radiological examination in identifying various forms of periapical bone tissue changes or about the pulpal condition.

Tumor odontogénico queratoquístico: Hallazgo radiográfico y resolución quirúrgica de un caso clínico

We present a clinical case of odontogenic keratocyst in a 26-year-old female patient. Both extraroal and intraoral radiographic techniques were used with the purpose of locating and attempt a presumptive diagnosis of this pathology. A biopsy was performed, confirming our earlier diagnostic presumption and then, surgical intervention was carried out, with the complete enucleation of the tumor. Short-, mid- and long-term controls were also performed, not showing any signs of a possible recurrence of the lesion. Based on our findings, we study the keratocystic odontogenic tumor according to location, gender, age and jaw affected, after reviewing the current literature on this issue.

Radiological diagnosis of periapical bone tissue lesions in endodontics: a systematic review

This systematic review evaluates the diagnostic accuracy of radiographic methods employed to indicate presence/absence and changes over time of periapical bone lesions. Also investigated were the leads radiographic images may give about the nature of the process and the condition of the pulp in nonendodontically treated teeth. Electronic literature search included the databases PubMed, Embase and CENTRAL from January 1950 to June 2011. All languages were accepted provided there was an abstract in English. The MeSH terms were 'Cone beam computed tomography (CBCT)', 'Radiography, panoramic', 'Periapical diseases', 'Dental pulp diseases', 'Sensitivity and specificity', 'receiver operating characteristics (ROC) curve', 'Cadaver', 'Endodontics' and 'Radiography dental'. Two reviewers independently assessed abstracts and full text articles. An article was read in full text if at least one of the two reviewers considered an abstract to be potentially relevant. Altogether, 181 articles were read in full text. The GRADE approach was used to assess the quality of evidence of each radiographic method based on studies of high or moderate quality. Twenty-six studies fulfilled criteria set for inclusion. None was of high quality; 11 were of moderate quality. There is insufficient evidence that the digital intraoral radiographic technique is diagnostically as accurate as the conventional film technique. The same applies to CBCT. No conclusions can be drawn regarding the accuracy of radiological examination in identifying various forms of periapical bone tissue changes or about the pulpal condition.

Adaptive panoramic tomography with a circular rotational movement for the formation of multifocal image layers

Panoramic radiography with which only structures within a certain image layer are in focus and others out of focus on the panoramic image has become a popular imaging technique especially in dentistry. However, the major drawback to the technique is a mismatch between the structures to be focused and the predefined image layer mainly due to the various shapes and sizes of dental arches and/or to malpositioning of the patient. These result in image quality typically inferior to that obtained using intraoral radiographic techniques. In this paper, to overcome these difficulties, we suggest a new panoramic reconstruction algorithm, the so-called adaptive panoramic tomography (APT), capable of reconstructing multifocal image layers with no additional exposure. In order to verify the effectiveness of the proposed algorithm, we performed systematic simulation studies with a circular rotational movement and investigated the image performance.

Reverse Intra-oral Periapical Radiography For Mandibular Posterior Teeth

Aims: To satisfy the newly reverse modified intra-oral periapical projection, in order to reduce the pa-tient discomfort and eliminate gagging reflex during periapical radiography of the lower posterior teeth. Materials and methods: Twenty voluntaries patients have been used in this research aged between 20-25 years, each patient subjected for two intra-oral periapical radiographic examinations for lower posterior teeth (premolars and molars). The first radiographic exami-nation has been made with ordinary principles of intra-oral periapical radiographic projec-tion, while the second radiograph has been made with reverse modified principles of intra-oral periapical radiographic projection. Five independent examiners (two oral radiographer, oral surgeon, oral diagnosis and oral medicine), rated the two radiographic images obtained from both radiographic examination methods. Image quality was assessed by rating the visi-bility of five anatomical landmarks: tooth structures identification (enamel, dentin and root can-al system), bone trabiculation, mental foramen borders, inferior dental canal borders and lamina du-ra. Results: The data collected from the evaluation of the radiographic images obtained from both radiographic projections were analyzed by paired samples chi-square test, which shown no significant difference (P>0.05) in image quality obtained from both techniques for five selected structures. The bone trabeculae and the lamina dura given higher rating of total score with ordinary technique (54, 49 points respectively) when compared with reverse radi-ographic technique (47, 41 points respectively). The highest percentage of unrecognized shadow of mental foramen and the inferior dental canal with use of ordinary radiographic technique (40%, 30% respectively), while the other examined anatomic structures (tooth structure, bone trabeculae and lamina dura) can be identified clearly with both radiographic techniques. Higher percentage of gag reflex and pain discomfort was observed with ordinary technique projection (45%, 40% respectively) in comparison with reverse technique projec-tion (0%, 5% respectively). Conclusion: the reverse intra-oral periapical radiographic technique can be used accurately in the radiographic projection of the mandibular posterior teeth; with minimal pain discomforted and with eliminated gagging reflex initiation.

Interpretation of chemically created periapical lesions using 2 different dental cone-beam computerized tomography units, an intraoral digital sensor, and conventional film

To assess the diagnostic potential of 2 different cone-beam computerized tomography (CT) units and compare this with intraoral digital and conventional film in the detection of chemically created periapical lesions. Periapical lesions were created chemically in 27 intact roots of 23 teeth (6 incisors, 4 canines, 6 premolars, and 7 molars). Cone-beam CT and digital and film images of the teeth were obtained before and after the lesions were created. Three observers separately used a 5-point scale to rate the images for the presence or absence of periapical pathology. Images were scored twice by each observer, with an interval of 4 weeks. Kappa values were calculated to assess intra- and interobserver agreement. Data were analyzed using repeated-measures analysis of variance for nested designs. R(2) values were used to assess the models for each observer for each method. Differences between observers and methods were tested for statistical significance with the paired t test. Kappa coefficients for intraobserver agreement ranged from 0.196 to 0.542 for the 2-dimensional (2D) images and from 0.533 to 0.699 for the cone-beam CT images, whereas kappa coefficients for interobserver agreement ranged from 0.223 to 0.302 for the 2D images and from 0.417 to 0.461 for the cone-beam CT images. The R(2) values for each observer showed that cone-beam CT images were superior to 2D intraoral images. There was no difference between the 2 cone-beam CT units tested (P > .05), and no difference was found between the 2 intraoral radiographic techniques tested (P > .05). The 2 cone-beam CT units tested performed similarly, and both performed better than intraoral digital and film radiography in detecting chemically created periapical lesions.