A comprehensive in vitro study of image accuracy and quality for periodontal diagnosis. Part 2: The influence of intra-oral image receptor on periodontal measurements

Radiographic diagnosis of periodontal diseases - Current evidence versus innovations

Accurate diagnosis of periodontal and peri-implant diseases relies significantly on radiographic examination, especially for assessing alveolar bone levels, bone defect morphology, and bone quality. This narrative review aimed to comprehensively outline the current state-of-the-art in radiographic diagnosis of alveolar bone diseases, covering both two-dimensional (2D) and three-dimensional (3D) modalities. Additionally, this review explores recent technological advances in periodontal imaging diagnosis, focusing on their potential integration into clinical practice. Clinical probing and intraoral radiography, while crucial, encounter limitations in effectively assessing complex periodontal bone defects. Recognizing these challenges, 3D imaging modalities, such as cone beam computed tomography (CBCT), have been explored for a more comprehensive understanding of periodontal structures. The significance of the radiographic assessment approach is evidenced by its ability to offer an objective and standardized means of evaluating hard tissues, reducing variability associated with manual clinical measurements and contributing to a more precise diagnosis of periodontal health. However, clinicians should be aware of challenges related to CBCT imaging assessment, including beam-hardening artifacts generated by the high-density materials present in the field of view, which might affect image quality. Integration of digital technologies, such as artificial intelligence-based tools in intraoral radiography software, the enhances the diagnostic process. The overarching recommendation is a judicious combination of CBCT and digital intraoral radiography for enhanced periodontal bone assessment. Therefore, it is crucial for clinicians to weigh the benefits against the risks associated with higher radiation exposure on a case-by-case basis, prioritizing patient safety and treatment outcomes.

The effect of different spatial resolutions and enhancement filters on radiographic detection of simulated furcation defects with intraoral digital radiography

OBJECTIVE

The objective of this study was to evaluate the effects of spatial resolution and the application of enhancement filters in the diagnosis of simulated furcation defects and image quality with intraoral radiographs.

STUDY DESIGN

Periapical images were acquired with photostimulable phosphor plates of molars in dry skulls (n = 8) and mandibles (n = 10) with 4 stages of furcation defect simulation. The plates were scanned in fast scan and high resolution modes to produce different spatial resolutions. Four image filters were applied. Six observers scored the detection of furcation defects. Mean values of area under the curve in receiver operating characteristic evaluation, accuracy, sensitivity, and specificity were calculated. Mean gray value (brightness), noise, and contrast-to-noise ratio (CNR) were calculated for enamel, dentin, and alveolar bone to evaluate image quality. Analysis of variance compared the values between the different spatial resolutions and filters. The significance of difference was established at P < .05.

RESULTS

There were no significant differences in overall diagnostic values comparing image spatial resolutions and filters. Diagnostic outcomes were significantly better for the largest defects than the smallest lesions but were generally poor in detecting lesions. All structures showed greater brightness in high resolution. . Noise was greater in all structures with all enhancement filters except inversion. Dentin and alveolar bone exhibited more noise and lower CNR in high resolution.

CONCLUSIONS

Varying spatial resolution and applying enhancement filters did not significantly affect the diagnosis of furcation defects.

Association of sleep bruxism and dental plaque factors on signs of periodontal disease in children in the mixed dentition

BACKGROUND

Periodontal disease has a multifactorial etiology; however, dental plaque and possible sleep bruxism (SB) have not been tested together in children as predictors of periodontal disease.

AIM

To assess the variation of SB, dental biofilm (DBF), gingival index (GI), and plaque index (PI) between localized and generalized pathological probing depth (PPD), crestal bone loss (CBL), and lack of delineation of lamina dura (LD) and to establish the association of DBF, GI, PI and SB with PPD, CBL, and LD in children with mixed dentition.

METHODS

Fifty children were assessed for SB and underwent a clinical and radiographic periodontal examination. anova and three multiple variable analysis were used to analyze the data.

RESULTS

One-way anova was found to be statistically significant for SB, between localized and generalized PPD (P = 0.03), CBL (P = 0.01), and LD (P = 0.005) and for DBF between localized and generalized CBL (P = 0.02). The three multiple variable analysis showed statistically and clinically significant associations of DBF with PPD (OR = 3.33); GI (OR = 2.37), and PI (OR = 1.46) with CBL and SB (OR = 7.66) and DBF (OR = 9.87) with LD. PI presented statistically significant association with CBL.

CONCLUSION

Significant associations of SB, DBF, GI, and PI with PD, CBL, and LD and the variations of the same factors between localized and generalized PPD, CBL, and LD suggest the necessity of evaluating SB, DBF, GI, and PI when children are screened in regular dental visits.

Quality assurance in digital dental imaging: a systematic review

OBJECTIVES

Doses induced by individual dental examinations are low. However, dental radiography accounts for nearly one third of the total number of radiological examinations in the European Union. Therefore, special attention is needed with regard to radiation protection. In order to lower patient doses, the staff performing dental examinations must have competence in imaging as well as in radiation protection issues. This paper presents a systematic review about the core competencies needed by the healthcare staff in performing digital dental radiological imaging quality assurance.

MATERIALS AND METHODS

The following databases were searched: Pubmed, Cinahl, Pro Quest and IEEXplore digital library. Also volumes of some dental imaging journals and doctoral theses of the Finnish universities educating dentists were searched. The search was performed using both MeSH terms and keywords using the option 'search all text'. The original keywords were: dental imaging, digital, x-ray, panoramic, quality, assurance, competence, competency, skills, knowledge, radiographer, radiologist technician, dentist, oral hygienist, radiation protection and their Finnish synonyms.

RESULTS

Core competencies needed by the healthcare staff performing digital dental radiological imaging quality assurance described in the selected studies were: management of dental imaging equipment, competence in image quality and factors associated with it, dose optimization and quality assurance.

CONCLUSIONS

In the future there will be higher doses in dental imaging due to increasing use of CBCT and digital imaging. The staff performing dental imaging must have competence in dental imaging quality assurance issues found in this review. They also have to practice ethical radiation safety culture in clinical practice.

The Effects on Absorbed Dose Distribution in Intraoral X-ray Imaging When Using Tube Voltages of 60 and 70 kV for Bitewing Imaging

Objectives

Efforts are made in radiographic examinations to obtain the best image quality with the lowest possible absorbed dose to the patient. In dental radiography, the absorbed dose to patients is very low, but exposures are relatively frequent. It has been suggested that frequent low-dose exposures can pose a risk for development of future cancer. It has previously been reported that there was no significant difference in the diagnostic accuracy of approximal carious lesions in radiographs obtained using tube voltages of 60 and 70 kV. The aim of this study was, therefore, to evaluate the patient dose resulting from exposures at these tube voltages to obtain intraoral bitewing radiographs.

Material and Methods

The absorbed dose distributions resulting from two bitewing exposures were measured at tube voltages of 60 and 70 kV using Gafchromic^® film and an anatomical head phantom. The dose was measured in the occlusal plane, and ± 50 mm cranially and caudally to evaluate the amount of scattered radiation. The same entrance dose to the phantom was used. The absorbed dose was expressed as the ratio of the maximal doses, the mean doses and the integral doses at tube voltages of 70 and 60 kV.

Results

The patient receives approximately 40 - 50% higher (mean and integral) absorbed dose when a tube voltage of 70 kV is used.

Conclusions

The results of this study clearly indicate that 60 kV should be used for dental intraoral radiographic examinations for approximal caries detection.

Effect of combined digital imaging parameters on endodontic file measurements

INTRODUCTION

This study assessed the effect of the combination of a dedicated endodontic filter, spatial resolution, and contrast resolution on the determination of endodontic file lengths.

METHODS

Forty extracted single-rooted teeth were x-rayed with K-files (ISO size 10 and 15) in the root canals. Images were acquired using the VistaScan system (Dürr Dental, Beitigheim-Bissingen, Germany) under different combining parameters of spatial resolution (10 and 25 line pairs per millimeter [lp/mm]) and contrast resolution (8- and 16-bit depths). Subsequently, a dedicated endodontic filter was applied on the 16-bit images, creating 2 additional parameters. Six observers measured the length of the endodontic files in the root canals using the software that accompanies the system. The mean values of the actual file lengths and the measurements of the radiographic images were submitted to 1-way analysis of variance and the Tukey test at a level of significance of 5%. The intraobserver reproducibility was assessed by the intraclass correlation coefficient.

RESULTS

All combined image parameters showed excellent intraobserver agreement with intraclass correlation coefficient means higher than 0.98. The imaging parameter of 25 lp/mm and 16 bit associated with the use of the endodontic filter did not differ significantly from the actual file lengths when both file sizes were analyzed together or separately (P > .05). When the size 15 file was evaluated separately, only 8-bit images differed significantly from the actual file lengths (P ≤ .05).

CONCLUSIONS

The combination of an endodontic filter with high spatial resolution and high contrast resolution is recommended for the determination of file lengths when using storage phosphor plates.

Accuracy of enhancement filters in measuring in vitro peri-implant bone level

OBJECTIVES

To identify the accuracy of enhancement filters of an intraoral phosphor-plate system for measuring the simulated peri-implant bone level.

MATERIALS AND METHODS

A total of 20 titanium implants (Titamax(®) ) were placed into six fragments of bovine ribs and defects simulating bone loss were created. Periapical radiographs were taken with a phosphor-plate system (Vista Scan(®) ) according to the paralleling standard technique, and nine enhancement filters were applied: fine, caries 1, caries 2, perio, endo, noise reduction, invert, emboss, and sculpture. The Friedman test compared the radiographic measurements of the defects to those obtained on the bovine ribs with a digital caliper. Intra- and interobserver agreement was calculated with the intra-class correlation coefficient (ICC).

RESULTS

The ICC values showed excellent intra- and interobserver agreement. The caries1, caries2, endo, and perio filters resulted on measurements statistically different from both the original images and the measurements of the digital caliper (P < 0.05). The other filters did not show statistically significant differences from the original images nor from the measurements of the digital caliper.

CONCLUSION

In addition to the original images, the fine and emboss filters resulted on the most precise measures. The caries1, caries2, endo, and perio filters were the less accurate for measuring the peri-implant bone level.