Posterior Bitewing Research Articles

Progression of posterior approximal carious lesions in Norwegian teenagers from 1982 to 1986

The purpose of the present study was to assess the progression rate of approximal carious lesions in Norwegians aged 14-18 years. Sixty-five subjects whose average age at base line was 14.9 years had one pair of posterior bitewing radiographs taken annually from 1982 to 1986. One examiner assessed all radiographs in chronologic order, recording degree of approximal caries. When a surface changed from one state to another, it was assumed to have changed at the midpoint between the two examinations. A total of 590 lesions were observed. Uncensored lesions took on average nearly 3 years to penetrate the enamel. Inclusion of right censored lesions by the Kaplan-Meier approach increased the uncensored estimate by approximately 20%. The average for doubly censored lesions was about 6.5 years. Low average rate of caries progression coupled with wide variations between lesions and among subjects suggests a need for individually prescribed recall routines.

Comparison between panoramic and posterior bitewing radiography in the diagnosis of periodontal bone loss

A study is reported comparing the diagnostic yield of panoramic and posterior bitewing radiographs when used to image periodontal bone disease. It is concluded that there is a high concordance between the findings from the two types of radiographs but that the concordance varies with the degree of bone loss and tooth type. Consequently when panoramic radiography is used in clinical practice, the examination should be supplemented by intraoral radiographs in regions when image quality is poor in the panoramic image and where there are structures of special interest.

Marginal bone in periodontal disease: an evaluation of image quality in panoramic and intra-oral radiography.

Five observers assessed the panoramic and full-mouth (14 periapical and four posterior bitewing) radiographs of 20 patients each for the ability to interpret and measure the marginal bone level. The image quality of each site was classified as excellent, acceptable or unacceptable. Depiction errors affecting interpretability and measurability were also noted. In the upper arch, the frequency of uninterpretable and non-measurable sites was almost equal for panoramic and periapical radiography. Image quality was better with periapical radiography in the lower arch. In the posterior regions of both arches, more sites could not be measured from panoramic compared with bitewing radiographs. Due to overlapping the distal surface of the maxillary canine and the mesial surface of the first maxillary premolar could often not be interpreted in either panoramic or periapical radiographs, but infrequently in the bitewings. In the lower arch, the most frequent depiction error was inadequate density in the incisor region of panoramic radiographs. On the basis of these results, we proposed that in clinical practice the panoramic radiograph can be supplemented with individually selected periapicals. In epidemiological studies, the panoramic radiograph should be combined with a premolar bitewing radiograph.

Effect of x‐ray beam vertical angulation on radiographic alveolar crest level measurement

Utilizing intraoral radiographs of human skulls taken at known vertical angulation, we have demonstrated that expression of the crest level as a distance between cej and the crest is as accurate as a ratio of bone height to root length. The degree of inaccuracy of either of these measures is related to the magnitude of the angular deviation of the x-ray beam from 90 degrees. Angular deviation can be estimated from calculation of a cusp height score (ratio of lingual cusp height to buccal cusp height x 100). Based on the analysis of cusp height scores it was determined that the x-ray beam angulation for posterior bitewings ranged between 90 degrees and 80 degrees whereas for posterior periapicals the angulation range was between 90 degrees and 70 degrees. Therefore, it is recommended that, for longitudinal studies of bone height, measurements of the crest to cej distance, particularly in the region of the molars, be made utilizing bitewing radiographs. For the premolar and incisor regions, deviation of the vertical angulation of an x-ray of up to 20 degrees from a 90 degrees baseline resulted in little, if any, change in crest level by either one of the two measures used. An appendix is provided for the theoretical modeling of the types and magnitude of change in crest level observed for projection images of different anatomical configurations.

Clinical indicators of radiographically detectable dental diseases in the adult patient

A comprehensive analysis of the relationship between clinical observations in dental patients without symptoms and oral disease as detected by full-mouth and panoramic dental radiographs in a large population of patients has never been reported. Knowledge of these relationships is necessary in the design of a diagnostic decision process (clinical algorithm) that can predict which patients require dental radiographs for the diagnosis of dental caries or periodontal disease to be confirmed or refined. An accurate clinical algorithm could reduce the number of radiographs that are taken of certain routinely seen dental patients without symptoms, thus reducing unnecessary exposure x-radiation as well as potentially reducing health care costs for these patients. A sample of 602 adult men on whom a complete series of panoramic, posterior bitewing, and periapical dental radiographs and an independent oral examination were performed provided the opportunity to evaluate the relationship between clinically observed oral disease indicators and independent radiographic evidence of dental caries and periodontal disease. The analysis suggests that combinations of several clinical indicators can predict with some success which patients without symptoms will benefit most from oral radiographs. The presence of several carious lesions on oral examination was the best predictor of radiographic detection of dental caries. Clinical indicators that appear to predict radiographic evidence of periodontal disease are clinical measures of pocket depth, mobility, and the patient's denture status. An important finding is that because of the high prevalence of gingivitis and plaque, these indicators were not related to radiographic evidence of periodontal disease. Certain clinical indicators may be more or less important, depending on whether the clinician is attempting to diagnose dental caries alone, periodontal disease alone, or both disease simultaneously. The findings suggest that a thorough clinical examination can help the clinician recognize clinical indicators capable of identifying patients who will or will not exhibit additional radiographic findings on their dental radiographs.

Clinical efficacy of dental radiography in the detection of dental caries and periodontal diseases

This article reports the ability of dental radiographs to correctly detect evidence of dental caries and periodontal disease (sensitivity) and to correctly establish the absence of these diseases (specificity). The analysis used a unique data set that was collected as part of the Veterans Administration Dental Longitudinal Study in Boston. Periapical, panoramic, and posterior bitewing radiographs were independently compared with a consensus radiographic standard of all three radiographs read simultaneously. Findings showed that the sensitivities of all three radiographs to detect dental caries were lower than expected, at approximately 60%, whereas the sensitivities to detect evidence of periodontal disease averaged approximately 85%. Panoramic radiographs were substantially less sensitive for detecting dental caries than periapical and posterior bitewing radiographs, but no difference between these modalities was observed in the analysis of sensitivity to periodontal disease. The proportion of false-negative and false-positive readings from dental radiographs was substantial and requires further investigation.

A study of selection criteria for intraoral dental radiography

This study was undertaken to determine whether adequate diagnostic information could be obtained from a thorough clinical examination supplemented with a limited number of intraoral radiographs, the exact number of films determined in each case by applying a set of historical and/or clinical selection criteria. The 100 patients in this study required an average of 8.2 periapical radiographs (range, 0 to 18), in addition to posterior bitewing films to complete the diagnostic process. Later evaluation of complete-mouth surveys on these patients revealed that no cases of periodontitis, no periapical lesions, and no impacted teeth were overlooked when selection criteria were used. Forty-two unsuspected abnormalities were found, but only three of these required treatment—a root tip close to the surface and enlarged follicular spaces distal to two clinically erupted third molars.

The use of panoramic radiography in the evaluation of asymptomatic adult dental patients

This article examines the efficacy of panoramic radiography alone and in combination with intraoral films as part of the “full-mouth” radiographic evaluation of asymptomatic dental patients in the diagnosis of dental caries and periodontal disease. Three full-mouth radiographic surveys—the panoramic alone, the panoramic plus posterior bitewing, and the periapical plus posterior bitewing—are compared. Two forms of measurement—comparative and incremental—were used to identify the radiographic survey with the highest single diagnostic yield when measured against the consensus standard. The findings show that the panoramic radiograph alone exhibits very low sensitivities to dental caries, ranging from 0.6% on anterior teeth to 25.6% on premolars. Even when posterior bitewing radiographs are added to the panoramic films, the sensitivities are significantly below those of the full-mouth periapical and bitewing survey. In contrast, the sensitivities of all three radiographic surveys in the diagnosis of periodontal disease are quite high, ranging from 87% to 96%, so that differences are not clinically significant. However, specificities tended to be low for periodontal disease and high for caries. Thus, for dental caries and (to a lesser extent) periodontal disease, the panoramic radiograph was inferior to the full-mouth intraoral series in its ability to correctly detect evidence of the disease.

低年齢児における乳臼歯隣接面う蝕の発生と進行について

Incidence and Progression of Approximal Caries in Deciduous Molars of Preschool Children, Okiuji TAKAGI, Katsuhiko TAURA, Noriko TAKAHASHI and Yoshihiro SHIMADA. Posterior bitewing radiographs of 161 nursery school children in Sendai, initially aged 3 to 4 years in May to July, 1980, were taken every six-months for 2 years to investigate the incidence and progression rate of approximal carious lesions in deciduous molars.At the initial examination, 1038 caries-free surfaces (X0), 224 surfaces with carious lesions in the enamel (X1) and 17 surfaces with dentinal carious lesions up to halfway through the dentine (X2) were radiographically defined. These were reexamined every 6 months over a 2-year period, and the cumulative progression rate of the X0, X1 and X2 was calculated. The following results were obtained.1. In the study period, 77.6 % of the X1 progressed into dentinal caries, and the rest were unchanged. Approximately 34.6 % of the X1 progressed to possible pulpitis (X3).2. In comparing the progression rate between the X1 of different tooth types, the rate for the mesial surface of the lower first deciduous molars was greater than others.3. 75.6 % of the X2 progressed into more advanced involvement.4. The X1 had a tendency to progress quickly in the first year, and the X2 showed this tendency in the second year. The X0 showed a similar progression rate in both years.From these results, dentinal carious lesions detected by a bitewing radiograph should be filled immediately, but it is questionable whether radiological lesions defined in the enamel should be treated immediately. Moreover, we think that bitewing radiographs at yearly intervals should be used to define approximal lesions in preschool children, because a relatively large number of carious surfaces are detected by this method.

A comparison of combinations of clinical and radiographic examinations in evaluation of a dental clinic population

Panoramic periapical anterior and posterior bitewing radiographic, mirror-explorer, and transillumination clinical examinations were performed on 300 patients. Various combinations of the radiographic and clinical examination techniques were compared in terms of their ability to diagnose caries, alveolar bone loss, calculus, periapical bone lesions, impacted teeth, root tips, and miscellaneous conditions. A mirror-explorer clinical examination with panoramic and posterior bitewing radiographs and either anterior bitewing radiographs or transillumination proved to be as efficient in the initial examination of patients as the mirror-explorer clinical examination with periapical and posterior bitewing radiographs.

Detection of proximal carious lesions: Two-film versus four-film bitewing radiography

The use of four posterior bitewing radiographs was compared with the use of two bitewing radiographs in fifty patients. The radiographs were evaluated with regard to the number of proximal carious lesions that could be detected and the number of technical errors in each technique. It was concluded that the four-bitewing radiographic technique is easier to perform, produces fewer technical errors, and provides the clinician with more diagnostic information than the two-bitewing radiographic method, and it is therefore recommended for routine radiographic examination.

Intraoral or Panoramic Radiography?

When panoramic radiographs are used to replace full-mouth radiographic series for the pediatric patient, certain advantages and disadvantages of this technique should be understood. The panoramic exposure offers ease of operation, shorter working time, and greater coverage than does the intraoral full-mouth series. However, certain shortcomings are noted. Rotations of maxillary premolars appear where there are none, and confusion exists in the anterior region about rotated teeth. Supernumerary teeth are frequently missed on the panoramic film in the anterior region. Because of this it is wise to supplement the panoramic image with anterior periapical films. Posterior bitewing films are a necessary supplement to the panoramic examination and with them interproximal caries, periapical lesions, and other details not visualized on the panoramic film are noted. It is imperative that the dentist understand confusing panoramic images that result from motion, superimposed structures, and apparent rotations, so that missed diagnoses do not occur.

Study of tooth loss in an adolescent Brazilian population.

Data concerning tooth loss in developing countries may indicate the dental health status in young people and serve as baseline data for evaluation of future dental health programs. The study population consisted of 304 schoolchildren (145 males, 159 females) from Belo Horizonte, M.G. Brazil. The mean age was 14.5, ranging from 13 to 16 yr. The number of teeth already lost and teeth indicated for extraction were assessed from two posterior bitewing radiographs and one frontal color photo which were obtained from all participants. The results showed that 2/3 of the studied population had lost one or more permanent teeth. The average number of missing teeth was 1.8 in both males and females. Of the various teeth, the mandibular first molars had most frequently been lost. Differences between the sexes concerning amount and pattern of lost teeth were small.

Errors on dental bitewing radiographs.

The prevalence of common errors on posterior bitewing radiographs was assessed on 2409 pairs of films collected from different public dental clinics in the county of Buskerud, Norway. Only 4.6% fulfilled the criteria for correct bitewing radiographs. Incorrect position of the film was found in 42.7%. Exposures with wrong horizontal angulation of the central beam constituted 10.6%, and under/overaxial exposures 2.2%, of the sample. Cone cutting occurred in 4.3%. Disturbing spots were found on most of the films (88.1%); 7.7% of the films had been insufficiently washed. Other errors due to wrong darkroom procedures or equipment failures were more rarely observed. The present study has shown that unnecessary errors, reducing the readability of bitewing radiographs, are frequently found. Steps should be taken to improve the standard of the radiographs used for diagnosis.

Observations of dental disease and anomalies in 9- to 11-year-old Norwegian children.

Sets of intraoral radiographs consisting of ten periapicals and, in most cases, two posterior bitewings, from 99 girls and 101 boys aged 9-11 years were examined by four dentists. The study was undertaken to quantitate the disease and anomalies present in the sample and investigate the inter-examiner variability of the diagnosis. Each of the examiners independently recorded the disease and anomalies from the radiographs. Knowledge of previous dental treatment and abnormalities noted by the community dental officers were obtained from the children's dental records. The prevalence of disease and anomalies in the sample was low. Considerable examiner variability revealed a need for more objective criteria for the radiographic diagnosis of some of the dental anomalies. Girls had a significantly higher DMFT than boys. Hypodontia was found in 13 children, and dens invaginatus class III/IV (9) was observed on radiographs from 5 children.

Proximal Caries Increment in Connection with Orthodontic Treatment with Removable Appliances

The progression of proximal caries on canines, premolars and molars has been studied among 129 children treated with removable orthodontic appliances. The registration of carious lesions was performed on posterior bitewing radiographs taken before and after the orthodontic treatment. The children in this investigation showed a higher proximal caries progression than children treated with fixed orthodontic appliances where bands had been used. However, in comparison with caries data from epidemiological investigations in children of similar ages from the same area no difference was noted.

Quality of intraoral radiographs from 9-11-year-old Norwegian children.

The quality of intraoral radiographic series consisting of 10 periapical and two posterior bitewing radiographs from 200 children were examined by six dentists. The radiographs were evaluated both without and, subsequently, with specified criteria. In the absence of specified criteria, no general agreement between the examiners was found when they were asked to state the quality of a radiograph. Using specified criteria much better agreement was obtained. The radiographic images of the maxillary and mandibular incisors were generally found acceptable using the criteria set up for the present study while the images of the canines, premolars and especially molars frequently were found unacceptable. Only a small proportion of the approximal surfaces on the posterior bitewings were found to be unreadable for caries of dentin while approximately 20% of the approximal surfaces were unreadable for caries of enamel. Approximately half the bitewing films had been placed wrongly in the mouth. Considering the available knowledge about prevalence of disease and anomalies in children of this age, quality of the radiographs, examiner variability and a possible harmful effect of radiography, screening with full-mouth intraoral radiographs in the actual age group does not seem to be justified in the population studied.

Dental health and parental attitudes in Finnish immigrant preschoolchildren in the north of Sweden.

The aim of the present study was to investigate the dental health of 100 Finnish 4-6-year-old children in Luleå, in the north of Sweden, and to compare data with those from a matched control group of Swedish children of the same age, sex and social background. The study also included attitudes to dental health among the parents. The clinical examination included registration of decayed, extracted and filled teeth and surfaces (deft and defs), gingival bleeding points (GBI) and presence of open bite or crossbite. Posterior bitewings were taken. Data concerning among other things oral habits, dietary habits and fluoride prophylaxis were taken. A questionnaire about the parents' attitudes to their own and their children's dental health as well as their opinion about the dental care received by their children was filled in. The results showed that the average defs in the Finnish group was 12.2 compared to 6.4 in the Swedish group. The percentage of children with a defs greater than 12 was 43% in the Finnish group and 19% in the Swedish. The mean GBI% was 11.2% in the Finnish and 8.2% in the Swedish group. The results showed a statistically significant difference in tooth brushing frequencies between the groups, and a tendency to better dietary habits in the Swedish group. There were no differences in the use of fluoride tablets or fluoridated toothpaste. Forty-seven percent of the Finnish parents were denture wearers compared to 10% of the Swedish. The attitudes to dental health among the Finnish parents differed from those in the Swedish group. This difference in attitudes together with language problems were the factors found that could explain the difference in dental health between the immigrant group and the Swedish group.

Frequency and distribution of proximal overlappings on posterior bitewing radiographs

4374 proximal surfaces on 791 posterior bitewing radiographs were classified according to overlappings. Six categories were used: 1) no overlapping, 2) blurred contact areas, 3) less than half of the enamel overlapped, 4) more than half of the enamel overlapped, 5) dentin overlapped, and 6) unclassifiable overlappings. Filled surfaces and surfaces not in contact were excluded. Only 19% of the surfaces did not have overlappings 65% exhibited mild overlappings (categories 2 and 3), and 16% severe overlappings (categories 4, 5 and 6). The frequencies of no overlappings varied from 7% to 40% for single tooth surfaces. The relationship between distribution of overlappings and tooth surfaces was statistically significant at the 0.05% level. Principles of excluding overlapping surfaces have been inconsistent in previous epidemiologic studies and clinical trials. The use of exact criteria for exclusion is recommended.

The construction and use of diagnostic standards for radiographic caries incidence scores

The aim was to construct and illustrate the use of diagnostic standards for recording of DFS incidence. Separate standards are presented for ranking of subjects; the mean "intermediate" DFS score per subject, which represented the majority decision of three dentists; and a certainty scale for individual tooth surfaces. The scores recorded for 40 sets of posterior bitewing radiographs of children between 13 and 15 years of age by two fourth year dental students and two dental hygienists were compared with the standards. Spearman's rank correlation coefficient reached the critical level of +0.70 in three of eight instances. Only one mean net DFS increment score differed significantly from the mean standard score (p less than 0.05). The level of agreement with the certainty scale for individual surfaces was low. Focusing attention on recording of DFS incidence gives a more severe test of examiners' diagnostic performance. The construction and use of control charts for monitoring the diagnostic level of examiners is suggested.