Maxillofacial Radiology Research Articles

Bir Türk Diş Hekimliği Fakültesinde Çocuk Hastalarda Konik Işınlı Bilgisayarlı Tomografi Kullanımı

Objectives: The purpose of the present study was to provide information that might help in planning cone-beam computed tomography (CBCT) imaging in pediatric patients. This study focused on the evaluation of indications for CBCT in pediatric patients in a Turkish dental school. 
 Method: Six-hundred-seven CBCT scans belonged to patients under the age of 16 were included in this study. The following data were recorded from an electronic patient database: age, gender, indication for referral (impacted teeth, supernumerary teeth, trauma, cysts/tumors, clefts, temporomandibular joint, and other reasons), dispersion of referrals by departments, external or internal referral.
 Results: Mean age was 12.39 years [range: 4-16; 260 females (42.8%) and 347 males (57.2%)]. The most frequent and largest age group (54.2%) was 13- to 16-years old. The most frequent request was to assess an impacted tooth and its localization (38.2%). Examining the FOVs, the maxilla was the most frequently imaged area (27.2%). Four-hundred sixty-six patients (76.8%) had been referred from departments of the dental school while 141 (23.2%) patients were referred from external clinics. Re-exposure was required in 52 cases (8.6%) due to patient-motion artefacts. 
 Conclusion: The results of the present study can help dental professionals make the decision to refer for CBCT when extra three dimensional imaging is necessary for a pediatric patient. It might be proper that an oral and maxillofacial radiologist decides when CBCT is necessary and then supervises the CBCT-scanning protocol to minimize the radiation dose to pediatric patients.

Normal Variants of the Oral and Maxillofacial Region: Mimics and Pitfalls.

A normal variant is defined as an incidental, often asymptomatic, imaging finding that mimics a true pathologic condition. Given the complex anatomy and wide variety of normal variants in the oral and maxillofacial region, a thorough understanding of commonly encountered normal variants in this region is essential to avoid misinterpretation and unnecessary further imaging or interventions. Moreover, familiarity with normal variants that are known to become symptomatic at times is necessary to facilitate further workup and guide the treatment plan. Intraoral radiography and panoramic radiography, which are unique to oral and maxillofacial radiology, provide two-dimensional (2D) images. Hence, the overlapping of structures or the displacement of the tomographic layer on images can confuse radiologists. It is crucial to understand the principle of 2D imaging to avoid being confused by ghost images or optical illusions. In addition, understanding the normal development of the maxillofacial region is essential when interpreting maxillofacial images in children or young adults because the anatomy may be quite different from that of mature adults. Knowledge of changes in the jaw bone marrow and each tissue's growth rate is essential. It is also necessary to know when the tooth germ begins to calcify and the tooth erupts for diagnostic imaging of the maxillofacial region. The authors describe imaging findings and clinical manifestations of common normal variants in the oral and maxillofacial region, divided into four parts: the maxilla, mandible, tooth, and temporomandibular joint, and discuss the imaging approach used to differentiate normal variants from true pathologic conditions. Online supplemental material is available for this article. ©RSNA, 2022.

Trainable WEKA (Waikato Environment for Knowledge Analysis) Segmentation Tool: Machine-Learning-Enabled Segmentation on Features of Panoramic Radiographs

Introduction: Segmentation of dental radiographs is a comprehensive subject in oral care and diagnosis. It is the process of delineating anatomical structures to simplify the diagnostic process for oral and maxillofacial radiologists.Purpose: This paper will provide an in-depth analysis of the latest benchmarks in oral imaging by studying the segmentation of panoramic radiographs using Trainable WEKA (Waikato Environment for Knowledge Analysis) Segmentation (TWS). The aim of this research is to accurately automate segmentation where it can be implemented on a large scale of clients in order to simplify radiological diagnosis.Methods and Materials: The experimentation was conducted by modifying open-source radiographs from UFBA UESC DENTAL IMAGES dataset. In order to simulate realistic conditions such as noise affecting regions of interest, panoramic radiographs were degraded and blurred with Gaussian noise. Accuracy was quantified by measuring the difference between the automated image and the dentist-annotated image using MorphoLibJ. To ensure the precision in results, automated predicted segmentations were observed by an oral maxillofacial radiologist and compared with the dentist-renditioning annotations of the panoramic radiographs (orthopantomograms).Results: The TWS classifier on radiographs with an average of 32 teeth and greater (Dice value of 0.66) and an average of less than 32 teeth (F1 score of 0.59) was significant. The calculated t-value for the Jaccard index is 2.78 and the t-value for the Dice score is 2.81. The results, considering the statistical scores, were due to the independent variable. The radiographs with 32 teeth and greater had higher Intersection over Union scores and F1 scores because of less discrepancy in tooth alignment.Conclusions: Segmentation of dental radiographs can be conducted by machine learning instead of manual segmentation.

Clinical acceptance of advanced visualization methods: a comparison study of 3D-print, virtual reality glasses, and 3D-display

BackgroundTo compare different methods of three-dimensional representations, namely 3D-Print, Virtual Reality (VR)-Glasses and 3D-Display regarding the understanding of the pathology, accuracy of details, quality of the anatomical representation and technical operability and assessment of possible change in treatment in different disciplines and levels of professional experience.MethodsInterviews were conducted with twenty physicians from the disciplines of cardiology, oral and maxillofacial surgery, orthopedic surgery, and radiology between 2018 and 2020 at the University Hospital of Basel. They were all presented with three different three-dimensional clinical cases derived from CT data from their area of expertise, one case for each method. During this, the physicians were asked for their feedback written down on a pencil and paper questionnaire.ResultsConcerning the understanding of the pathology and quality of the anatomical representation, VR-Glasses were rated best in three out of four disciplines and two out of three levels of professional experience. Regarding the accuracy of details, 3D-Display was rated best in three out of four disciplines and all levels of professional experience. As to operability, 3D-Display was consistently rated best in all levels of professional experience and all disciplines. Possible change in treatment was reported using 3D-Print in 33%, VR-Glasses in 44%, and 3D-Display in 33% of participants. Physicians with a professional experience of more than ten years reported no change in treatment using any method.Conclusions3D-Print, VR-Glasses, and 3D-Displays are very well accepted, and a relevant percentage of participants with less than ten years of professional work experience could imagine a possible change in treatment using any of these three-dimensional methods. Our findings challenge scientists, technicians, and physicians to further develop these methods to improve the three-dimensional understanding of pathologies and to add value to the education of young and inexperienced physicians.

A U-Net Approach to Apical Lesion Segmentation on Panoramic Radiographs

The purpose of the paper was the assessment of the success of an artificial intelligence (AI) algorithm formed on a deep-convolutional neural network (D-CNN) model for the segmentation of apical lesions on dental panoramic radiographs. A total of 470 anonymized panoramic radiographs were used to progress the D-CNN AI model based on the U-Net algorithm (CranioCatch, Eskisehir, Turkey) for the segmentation of apical lesions. The radiographs were obtained from the Radiology Archive of the Department of Oral and Maxillofacial Radiology of the Faculty of Dentistry of Eskisehir Osmangazi University. A U-Net implemented with PyTorch model (version 1.4.0) was used for the segmentation of apical lesions. In the test data set, the AI model segmented 63 periapical lesions on 47 panoramic radiographs. The sensitivity, precision, and F1-score for segmentation of periapical lesions at 70% IoU values were 0.92, 0.84, and 0.88, respectively. AI systems have the potential to overcome clinical problems. AI may facilitate the assessment of periapical pathology based on panoramic radiographs.

Analysis of photostimulable phosphor image plate artifacts and their prevalence.

BACKGROUND Digital radiography has recently been used in dentistry as a substitute for conventional film radiography worldwide. Digital imaging has many advantages and provides new possibilities for recording and interpreting radiographic data. This system uses different types of digital receptors.AIMTo detect the frequency, type, and reasons behind the appearance of intraoral image artifacts acquired by photostimulable phosphor plates (PSP).METHODSThis retrospective descriptive study was conducted in the oral and maxillofacial radiology unit of the dental clinics of the College of Dentistry, Princess Nourah University (PNU). All intraoral digital radiographs were acquired using (Gendex Expert DC., United States) an intraoral X-ray machine with 7 -mA, 65-kVP using a PSP system (Soredex DIGORA Optime imaging plate) and laser scanners (Soredex DIGORA Optime), which can house all sizes of reusable intraoral PSP sensor plates with image acquisition software (MIPACS Dental Enterprise viewer 3.2.2). A total of 50000 intraoral radiographs were retrieved from the clinical database from April 2018 to April 2020 to evaluate the reason, type, and solutions to these image artifacts.RESULTSOverall, 50000 intraoral digital radiographs were acquired in a two-year-period; that is, from April 2018 to April 2020. Of these, 3550 (7.1%) retakes were performed due to the presence of image artifacts. Periapical radiographs were the most common image type of intraoral retakes (80.8%). Imaging artifacts were divided into three categories: operator, plate and scanning errors. Out of 3550 retakes, 5%, 1.37%, and 0.73% were related to operator, plate, and scanning errors, respectively. The cone cut was the most common operator error (988 images), Bite marks were the most common plate error (276 images), and delayed scanning artifacts were the most common scanning errors (145 images). The calculated kappa value for interobserver reliability was 0.99, indicating almost perfect interobserver agreement. CONCLUSIONOur study discussed intraoral image artifacts that were characteristic of PSP, where the most common artifacts were bitemarks, image size reduction, scratches, and delayed scanning.

Prevalence of Incidental Findings in Maxillary Sinus Using Cone Beam Computed Tomography – A Retrospective

Maxillary sinus pathologies and normal variations in the sinus anatomy can result in complications during surgical interventions. Hence, maxillofacial radiologists should be knowledgable regarding thes radiographic findings poiting to pathologies/variations. To study the prevalence of various incidental findings in the maxillary sinus region using cone beam computed tomography (CBCT). This was a retrospective- cross sectional study. CBCT scans of sixty patients who have been advised radiographs

Evaluation of paranasal sinus anatomic variations and mucosal changes with cone beam computed tomography

Background/Aim: Anatomical variations of paranasal sinuses are common and play an role in disrupting the drainage of the sinuses, which often causes chronic sinusitis. In this article, anatomical variations of the paranasal sinuses and its relationship with mucosal changes were evaluated retrospectively by cone beam computed tomography (CBCT) which is also known as dental volumetric tomography. Material and Methods: CBCT data of 500 patients who applied to Cukurova University Faculties of Dentistry for any reason were retrospectively evaluated by maxillofacial radiologist. Anatomical variants of paranasal sinuses were included in the study. Mucosal thickening greater than 2 mm in the maxillary sinus was considered pathological. Results: The most common anatomic variation in the study was the nasal septal deviation, found in 302 (60.4%) patients. The least common anatomic variation in the study was lower concha pneumatization found in 3 (0.6%) patients. Mucosal thickening of the maxillary sinus was observed in 271 (54.2%) cases in the right sinus and 260 (52%) cases in the left sinus (p>0.05). Conclusions: Nasal septum deviation was the most common variation in the study. According to the results of our study, concha bullosa, haller cell and the uncinate process had no definite effect on mucosal thickening in the maxillary sinus.

Wavelet Guided 3D Deep Model to improve Dental Microfracture Detection.

Epidemiological studies indicate that microfractures (cracks) are the third most common cause of tooth loss in industrialized countries. An undetected crack will continue to progress, often with significant pain, until the tooth is lost. Previous attempts to utilize cone beam computed tomography (CBCT) for detecting cracks in teeth had very limited success. We propose a model that detects cracked teeth in high resolution (hr) CBCT scans by combining signal enhancement with a deep CNNbased crack detection model. We perform experiments on a dataset of 45 ex-vivo human teeth with 31 cracked and 14 controls. We demonstrate that a model that combines classical wavelet-based features with a deep 3D CNN model can improve fractured tooth detection accuracy in both micro-Computed Tomography (ground truth) and hr-CBCT scans. The CNN model is trained to predict a probability map showing the most likely fractured regions. Based on this fracture probability map we detect the presence of fracture and are able to differentiate a fractured tooth from a control tooth. We compare these results to a 2D CNN-based approach and we show that our approach provides superior detection results. We also show that the proposed solution is able to outperform oral and maxillofacial radiologists in detecting fractures from the hr-CBCT scans. Early detection of cracks will lead to the design of more appropriate treatments and longer tooth retention.

A Deep Learning Model for Idiopathic Osteosclerosis Detection on Panoramic Radiographs

Objective: The purpose of the study was to create an artificial intelligence (AI) system for detecting idiopathic osteosclerosis (IO) on panoramic radiographs for automatic, routine, and simple evaluations. Subject and Methods: In this study, a deep learning method was carried out with panoramic radiographs obtained from healthy patients. A total of 493 anonymized panoramic radiographs were used to develop the AI system (CranioCatch, Eskisehir, Turkey) for the detection of IOs. The panoramic radiographs were acquired from the radiology archives of the Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Eskisehir Osmangazi University. GoogLeNet Inception v2 model implemented with TensorFlow library was used for the detection of IOs. Confusion matrix was used to predict model achievements. Results: Fifty IOs were detected accurately by the AI model from the 52 test images which had 57 IOs. The sensitivity, precision, and F-measure values were 0.88, 0.83, and 0.86, respectively. Conclusion: Deep learning-based AI algorithm has the potential to detect IOs accurately on panoramic radiographs. AI systems may reduce the workload of dentists in terms of diagnostic efforts.

Artificial Intelligence in Oral and Maxillofacial Radiology: It is Here

Artificial Intelligence in Oral and Maxillofacial Radiology: It is Here

Prevalence of incidental maxillary sinus pathology in asymptomatic patient during routine dental examination by Cone beam computed tomography(A Retrospective Study).

Abstract: Objective: The aim of the present study was to assess and to record the prevalence of incidental maxillary sinus pathologies in asymptomatic patients presenting with dental problems using the cone-beam computed tomography (CBCT) scans. Method: This retrospective study included 53 patients (106 maxillary sinus) underwent cone beam CT for various dental procedure, which included dental implants, maxillofacial surgery, orthodontics, endodontics, oral pathology, etc. Both male and female included in this study with age range from (18-45). Individuals with known sinus pathology were excluded in this study. The CBCT scans were evaluated and the maxillary sinuses ware examined by an experienced maxillofacial radiologist for the presence or absence of the any pathology. The images were analyzed in three planes (axial, sagittal and coronal) with a slice of (0.15 mm) thickness. Result: Among total of fifty-three cases included in the current study 35 (66.1%) of them had lesion with 47.2% they get their lesion on both sides followed by (13.2%,5.7%) on the left and right side respectively. while 18 individuals were free from any documented lesion. Regarding gender distribution in our study the females were predominant 54.7%. Conclusion: Oral radiologist should be aware of these incidental findings and thoroughly evaluate the whole captured CBCT volume in all 3 views (axial, coronal, and sagittal) to exclude any pathologic changes in the maxillary sinus, which can help in early diagnosis and refer the patient to a specialist if necessary for treatment. Keywords: Cone beam computed tomography, asymptomatic sinuses, pathology.

Retrospective Study: Evaluating the Positioning Errors in Digital Panoramic Radiographs

To produce a panoramic cardiograph with a constant image quality common errors must be kept to a minimum.This study is conducted with an objective to analyse the most prevalent positioning and technical errors inpanoramic radiographs.300 Orthopantomograms(OPGs) were taken from January 2020 to December 2021 in the Maxillofacial Imagingcentre and they were assessed by three maxillofacial radiologists for analysing positional errors.Using the OHP sheet, all radiographs were viewed on a computer monitor to demarcate the ‘’6’’ Zones. Resultsshowed that around 52 radiographs were error free (17.3%) and 248 radiographs had errors (82.6%). Theradiographs having single positional error were 205(82.66%). The radiographs having two positional errors were35(14.1%). The radiographs having three positional errors were 8(3.2%).The outcome of analysis reveals that percentage of positioning errors in panoramic radiographs is fairly highwhich reduces its diagnostic value. The Technicians are made aware of the errors and are instructed to doublecheck the patient’s position before taking radiographs.

Konik Işınlı Bilgisayarlı Tomografi ile Stafne Kemik Kavitelerinin Retrospektif Değerlendirilmesi

Objective: The aim of this study is to evaluate demographic and radiographic characteristics of Stafne bone cavity (SBC) in detail in a large group of cases. Material and Methods: 6,758 conebeam computed tomography (CBCT) images taken in İstanbul University Faculty of Dentistry, Oral and Maxillofacial Radiology Department between 2015-2018 were included in the study. Cases were evaluated and recorded with regard to age, gender, localization of the lesion, location (right-left), dimensions of the lesion (depth, height ,and width), cortical types of the lesion and newly modified cortical types, edge border types of the lesion and margin types. Results: Twenty seven cases (0.39%) of SBC were detected among 6,758 images. The average age of the patients with SBC was 48.56±10.577 (minimum 26, maximum 70). Among 27 patients with SBC, 23 (85.2%) were male and 4 (14.8%) were female. A statistically significant positive correlation was found between cases' the depth, height and width (p=0.000; r>0.7). A statistically significant positive correlation was found between the size of the cases and the cavity types (p=0.000; r>0.4). There was no statistically significant correlation between the mandibular canal relationship and all other parameters (p>0.05). Conclusion: Diagnosis and follow-up of SBC cases are often carried out by CBCT images; therefore, it is crucial to know the radiographic features and current classifications in detail.

Prevalence and anatomical variations of maxillary sinus septa: A cone-beam computed tomography analysis.

BackgroundDetailed understanding the anatomy and variations of maxillary sinus septa is necessary. We aimed to investigate prevalence and various anatomical variations of maxillary sinus septa using cone-beam computed tomography (CBCT) images. Material and MethodsIn this retrospective cross-sectional study, CBCT scans of 809 patients referred to a specialist dental and maxillofacial radiology clinic in Babol, northern Iran, during 2014-2020 were evaluated. Location, morphology, height, and direction of septa in different planes were recorded. ResultsSinus septa were observed in 37.9% (n=307) of the participants. There were 117 cases with septa only in left sinus, 83 cases with septa only in right sinus, and 107 cases with septa in both sinuses. Totally, 414 septa were seen in the subjects. Prevalence of partial septa was considerably higher than complete septa (77.5% versus 22.5%). Regarding septa location, middle area with a prevalence rate of 58.7% was found more prevalent than other sinus areas. The mean septum height on the left and right sinuses was 6.0±3.1 mm 5.7±3.9, respectively (p<0.001). Regarding left sinus, directions of vertical (63.8%), oblique (30.8%), and straight (63.8%) were the most prevalent compared with other directions in sagittal, frontal, and axial planes, respectively. In relation to right maxillary sinus, direction of vertical in sagittal and frontal planes (72.6% and 24.2%, respectively), and direction of straight in axial plane (58.4%) were the most prevalent directions compared with others in the same planes. ConclusionsSepta prevalence in maxillary sinus was relatively high, with various directions, locations, heights, and shapes. It is recommended to use CBCT for a careful evaluation of toothless area prior to surgeries on the sinus (especially sinus lift) in three plans, in order to take careful measures and prevent postoperative complications in case septa exist. Key words:Maxillary sinus septa, anatomical variation, cone-beam computed tomography, dental implant.

Root canal morphologies of mandibular premolars in Southeast Anatolian population: Evaluation of CBCT

Background/Aim: This study aimed to evaluate the root canal morphology of mandibular first and second premolars with the aid of cone-beam computed tomography (CBCT) in the Southeast Anatolian population. Material and Methods: The study examined a total of 1258 mandibular first and second premolars using cone-beam computed tomography images of 370 randomly selected patients who applied to the Department of OralDental and Maxillofacial Radiology of Faculty of Dentistry, Dicle University due to various indications. The total number of roots and root canals, canal symmetry and correlations between the right and left side of the mandible, and the prevalence in men and women were recorded. Data was analzyed using the Chi-Square and Fisher's Exact tests. Canal configurations were evaluated based on the Vertucci classification. Results: The evaluation of CT images of a total of 370 individuals showed that 88.89% of the first premolars and 98.45% of the second premolars were symmetrical. The canal anatomy of the first premolars suggested that 85.98% of the premolars were of Type I, 12.02% were of Type V, and 2% were of Type III based on the Vertucci classification. On the other hand, the canal anatomy of the second premolars revealed that 98.83% were of Type I, 0.67% were of Type V, and 0.5% were of Type III. Conclusions: The prevalent morphology of the multiple canals was Type V, except for the Vertucci classification Type I in the mandibular first premolars. Limited number of canal variations were observed in the mandibular second premolars.

Evaluation of the morphology of the nasopalatine canal using cone beam computed tomography

High precise evaluation of the nasopalatine canal morphology is essential to perform detailed diagnosis and treatment plans in implantology and the orthodontic field. We aimed to study morphometric analysis measurements of the nasopalatine canal. In this cross-sectional study, maxillary CBCT images from 125 patients were evaluated in the Maxillofacial Radiology department between 2014-2021. Sagittal views were assessed to determine nasopalatine canal morphology and dimensions. The difference in canal diameter and length between genders was evaluated using an One Way ANOVA test. There was no significant sex difference among all 125 cases in nasopalatine canal diameter, length, anterior bone plate width. The average length of the nasopalatine canal was 16.49±2.8 mm in male, 16.20±2.9 mm in female, incisive foramen diameter in the sagittal plane was 4.04±0.9 mm in male, 4.02±0.9 mm in female, nasopalatine foramen diameter was 4.63±1.4 mm in male, 4.75±1.2 mm in female. The width of the bone anterior to the canal was 5.89±1.4 mm in males, 5.69±1 mm in females. 16-48 aged Mongolian average length of the nasopalatine canal was 16.3 mm, and average incisive foramen width was 4.08 mm, the average width of the bone anterior to the canal was 5.76 mm. Anterior retraction treatment for upper incisor root can be done safely without root resorption around 5.5 mm in the premaxillary alveolar bone.

Volumetric analysis of normal condyles and those with disc displacement with reduction in the Indonesian population: A CBCT study.

PurposeDisc displacement can cause resorption of the head of the condyle and affect its volume. This study analysed the volume of normal condyles and those with disc displacement with reduction (DDR) in cone-beam computed tomography (CBCT) scans from the Indonesian population.Materials and MethodsThis study analysed 56 condyles (26 normal and 30 with DDR) from patients who visited the Oral and Maxillofacial Radiology Unit after being referred from the Prosthodontics Unit at Dental Hospital Universitas Padjadjaran from December 2020 to February 2021. Samples were divided into 2 groups (normal and DDR left and right-side condyles) based on the DC/TMD Axis 1 form through the clinical examination results. Both sample groups were exposed to CBCT radiation. The CBCT imaging results in the Digital Imaging and Communications in Medicine format were exported to the open-source ITK-SNAP format to determine condyle volume. Volumetric data from the cortical and trabecular areas of the right or left side condyles were arranged by sex. The independent t-test was used to determine the significance of differences with IBM SPSS version 21.0. Intra- and inter-observer reliability and validity were tested before determining the volume of the condyles.ResultsNormal condyles and DDR condyles showed significant differences in volume (P<0.05). Significant differences were also seen in cortical (P=0.0007) and trabecular (P=0.0045) volumes. There was a significant difference in condylar volume based on sex.ConclusionThe normal condyle volume was significantly different from the DDR condyle volume in both sexes.

Prevalence of idiopathic osteosclerosis in the mandible: a cone beam computed tomography study

Objective: The aim of this study is to determine the prevalence of idiopathic osteosclerosis (IO) in the mandible in an Iranian subpopulation using cone beam computed tomography (CBCT). Methods: This cross-sectional study was performed on all CBCT images obtained in 2010-2014 from the archive of Oral and Maxillofacial Radiology Department at Isfahan Dental School. Images were evaluated by two observers in identical room and monitoring conditions. IO was defined as homogenous radiopacities with no particular etiology, ranging from 2 mm to 2 cm in size. Demographic information of all patients, as well as the lesion’s number, location, border, shape, and association with adjacent teeth were recorded. Results: From 377 CBCT images, 43 images (11.4%) had at least one IO lesion. Two separate IO lesions were detected in six patients; therefore, 49 IO lesions were found in total. No gender differences were observed in IO prevalence (P = 0.806). Although most common in patients who were in their 30s, IO prevalence was not statistically different among age groups (P = 0.369). IO was most frequent in the molar region, with 63.2% of lesions. Conclusion: IO prevalence was 11.4% in the studied population and was not statistically different between age groups or sexes. Most lesions were found in the mandibular molar region.

Revisiting dynamic range and image enhancement ability of contemporary digital radiographic systems.

To assess the dynamic range and enhancement ability of radiographs acquired with contemporary digital systems. Five repeated periapical radiographs of human mandibles with an aluminium step-wedge were acquired using two sensor-based and three photostimulable phosphor plate-based systems and an X-ray unit at ten exposure times 0.020, 0.032, 0.063, 0.080, 0.100, 0.200, 0.320, 0.400, 0.500, and 0.630 s. All images had their brightness and contrast enhanced by two experienced oral and maxillofacial radiologists in consensus and were exported as both the original and enhanced file formats. Mean grey values were obtained from the aluminium steps and tabulated with their corresponding thicknesses for each exposure time, digital radiographic system, and file format. Images with saturated steps were excluded and the mean grey values from the remaining images were averaged to assess image brightness and the angular coefficient of the linear trendlines was generated from the relationship between mean grey values and their corresponding aluminium thicknesses to assess image contrast. Brightness and contrast values were compared using two-way ANOVA with post-hoc Tukey (α = 0.05). Photostimulable phosphor plate-based digital radiographic systems had a broader dynamic range. Longer exposure times produced original images with lower brightness and variable contrast (p < 0.05). Subjective enhancement significantly increased or reduced brightness and/or contrast in some systems (p < 0.05). Contemporary digital radiographic systems present different dynamic ranges and exposure-related brightness and contrast. Image enhancement may be a valuable tool at slightly suboptimal exposure times.