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Abdinian M, Keshani F, Sadeghi F, Soltani P, Spagnuolo G, Rengo C. Evaluation of the effects of postprocessing settings in digital bitewing radiographs on proximal caries detection. Clin Exp Dent Res 2024; 10:e889. [PMID: 38712390 DOI: 10.1002/cre2.889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/25/2024] [Accepted: 04/22/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVE Radiographs are an integral part of detecting proximal caries. The aim of this study was to evaluate the effect of contrast, brightness, noise, sharpness, and γ adjustment of digital intraoral radiographs on the diagnosis of proximal caries. MATERIALS AND METHODS In this in vitro study, 40 extracted teeth including 20 premolars and 20 molars with enamel lesions (white spot or dentin discoloration seen through the enamel) were mounted together in groups of eight inside the skull. Bitewing radiographic images of each dental group were obtained by a photostimulable phosphor plate sensor with exposure conditions of 8 mA, 70 kV, and 0.2 s. The images were reconstructed by the built-in software and examined by two oral and maxillofacial radiologists in various settings of contrast, brightness, sharpness, noise, and γ. The teeth were then cut mesiodistally and the presence or absence of caries was confirmed by an oral and maxillofacial pathologist using a stereomicroscope. The data were then analyzed using the κ agreement coefficient, sensitivity, specificity, and accuracy (α = .05). RESULTS Adjustment of brightness and contrast led to higher diagnostic performance with an accuracy of 82.5% and 83.8 (for observers 1 and 2, respectively) and 82.5% (for both observers), respectively. Noise adjustment was the least helpful approach for diagnosis of proximal dental caries among other adjustments, with an accuracy of 78.8% and 77.5% for observers 1 and 2, respectively. CONCLUSION Brightness and contrast setting was more efficient in improving the diagnostic potential of bitewing radiographs compared to other adjustments.
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Affiliation(s)
- Mehrdad Abdinian
- Department of Oral and Maxillofacial Radiology, Dental Implants Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Forooz Keshani
- Department of Oral and Maxillofacial Pathology, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fateme Sadeghi
- Students Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parisa Soltani
- Department of Oral and Maxillofacial Radiology, Dental Implants Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Gianrico Spagnuolo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
- Therapeutic Dentistry Department, Institute for Dentistry, Sechenov University, Moscow, Russia
| | - Carlo Rengo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
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Amasya H, Alkhader M, Serindere G, Futyma-Gąbka K, Aktuna Belgin C, Gusarev M, Ezhov M, Różyło-Kalinowska I, Önder M, Sanders A, Costa ALF, de Castro Lopes SLP, Orhan K. Evaluation of a Decision Support System Developed with Deep Learning Approach for Detecting Dental Caries with Cone-Beam Computed Tomography Imaging. Diagnostics (Basel) 2023; 13:3471. [PMID: 37998607 PMCID: PMC10669958 DOI: 10.3390/diagnostics13223471] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/12/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
This study aims to investigate the effect of using an artificial intelligence (AI) system (Diagnocat, Inc., San Francisco, CA, USA) for caries detection by comparing cone-beam computed tomography (CBCT) evaluation results with and without the software. 500 CBCT volumes are scored by three dentomaxillofacial radiologists for the presence of caries separately on a five-point confidence scale without and with the aid of the AI system. After visual evaluation, the deep convolutional neural network (CNN) model generated a radiological report and observers scored again using AI interface. The ground truth was determined by a hybrid approach. Intra- and inter-observer agreements are evaluated with sensitivity, specificity, accuracy, and kappa statistics. A total of 6008 surfaces are determined as 'presence of caries' and 13,928 surfaces are determined as 'absence of caries' for ground truth. The area under the ROC curve of observer 1, 2, and 3 are found to be 0.855/0.920, 0.863/0.917, and 0.747/0.903, respectively (unaided/aided). Fleiss Kappa coefficients are changed from 0.325 to 0.468, and the best accuracy (0.939) is achieved with the aided results. The radiographic evaluations performed with aid of the AI system are found to be more compatible and accurate than unaided evaluations in the detection of dental caries with CBCT images.
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Affiliation(s)
- Hakan Amasya
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Istanbul University-Cerrahpaşa, Istanbul 34320, Türkiye;
- CAST (Cerrahpasa Research, Simulation and Design Laboratory), Istanbul University-Cerrahpaşa, Istanbul 34320, Türkiye
- Health Biotechnology Joint Research and Application Center of Excellence, Istanbul 34220, Türkiye
| | - Mustafa Alkhader
- Department of Oral Medicine and Oral Surgery, Faculty of Dentistry, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Gözde Serindere
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Mustafa Kemal University, Hatay 31060, Türkiye; (G.S.); (C.A.B.)
| | - Karolina Futyma-Gąbka
- Department of Dental and Maxillofacial Radiodiagnostics, Medical University of Lublin, 20-093 Lublin, Poland; (K.F.-G.); or (I.R.-K.)
| | - Ceren Aktuna Belgin
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Mustafa Kemal University, Hatay 31060, Türkiye; (G.S.); (C.A.B.)
| | - Maxim Gusarev
- Diagnocat, Inc., San Francisco, CA 94102, USA; (M.G.); (M.E.); (A.S.)
| | - Matvey Ezhov
- Diagnocat, Inc., San Francisco, CA 94102, USA; (M.G.); (M.E.); (A.S.)
| | - Ingrid Różyło-Kalinowska
- Department of Dental and Maxillofacial Radiodiagnostics, Medical University of Lublin, 20-093 Lublin, Poland; (K.F.-G.); or (I.R.-K.)
| | - Merve Önder
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara 0600, Türkiye;
| | - Alex Sanders
- Diagnocat, Inc., San Francisco, CA 94102, USA; (M.G.); (M.E.); (A.S.)
| | - Andre Luiz Ferreira Costa
- Postgraduate Program in Dentistry, Cruzeiro do Sul University (UNICSUL), São Paulo 08060-070, SP, Brazil;
| | - Sérgio Lúcio Pereira de Castro Lopes
- Science and Technology Institute, Department of Diagnosis and Surgery, São Paulo State University (UNESP), São José dos Campos 01049-010, SP, Brazil;
| | - Kaan Orhan
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara 0600, Türkiye;
- Research Center (MEDITAM), Ankara University Medical Design Application, Ankara 06560, Türkiye
- Department of Oral Diagnostics, Faculty of Dentistry, Semmelweis University, 1088 Budapest, Hungary
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Mosavat F, Ahmadi E, Amirfarhangi S, Rafeie N. Evaluation of diagnostic accuracy of CBCT and intraoral radiography for proximal caries detection in the presence of different dental restoration materials. BMC Oral Health 2023; 23:419. [PMID: 37353807 PMCID: PMC10290356 DOI: 10.1186/s12903-023-02954-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/07/2023] [Indexed: 06/25/2023] Open
Abstract
PURPOSE This study aimed to assess the diagnostic accuracy of cone-beam computed tomography (CBCT) and digital intraoral radiography for the detection of proximal caries adjacent to amalgam, e.max porcelain, and metal-ceramic restorations (MCRs). MATERIALS AND METHODS Parallel intraoral radiographs were obtained from 40 posterior teeth using PSP sensors. To obtain CBCT scans, the teeth were first radiographed alone, and were then positioned next to a tooth with an amalgam restoration, MCR, and e.max porcelain crown, and radiographed again. Two blinded observers scored radiographs using a four-point scale (0: absence of proximal caries, 1: enamel caries, 2: carious lesion extending to the outer half of dentin, 3: carious lesion extending to the inner half of dentin). Tooth sections were made, and the grade of caries was determined under a light microscope at x12 magnification. The sensitivity, specificity, and accuracy of CBCT and intraoral radiographs were then calculated. RESULTS Artifact-free CBCT scans and intraoral radiographs had the highest diagnostic accuracy (0.826 and 0.657, respectively) while CBCT images of the teeth next to the amalgam restorations (0.526) had the lowest accuracy. The diagnostic accuracy of CBCT images of the teeth next to the porcelain crowns and MCRs was 0.613 and 0.601, respectively. CONCLUSION Artifact-free CBCT images had higher diagnostic accuracy than intraoral radiography for the detection of all grades of proximal caries. The diagnostic accuracy of CBCT images of teeth adjacent to amalgam, porcelain, and MCRs was lower compared to intraoral radiographs and artifact-free CBCT images.
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Affiliation(s)
- Farzaneh Mosavat
- Oral and Maxillofacial Radiology Department, School of Dentistry, Tehran University of Medical Science, Tehran, Iran
| | - Elham Ahmadi
- Department of Operative Dentistry, Dental Research Center, Dentistry Research Institute, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Saba Amirfarhangi
- Department of Prosthodontics, Dental Faculty, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Niyousha Rafeie
- Dental Research center, Dentistry research institute, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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Vijayan A, Jo S, Mathew B, Vidyadharan M, Nair A. Comparison of diagnostic ability of conventional film and storage phosphor plate in detecting proximal caries with direct measurements by stereomicroscope: A diagnostic test evaluation. Contemp Clin Dent 2022; 13:156-161. [PMID: 35846590 PMCID: PMC9285835 DOI: 10.4103/ccd.ccd_858_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/05/2021] [Indexed: 11/08/2022] Open
Abstract
Background: Radiography plays an important role in detection of interproximal caries. The aim of study is to compare diagnostic ability of conventional film and photostimulable phosphor (PSP) with direct measurement using stereomicroscope in detecting proximal caries. Methodology: In this descriptive study – diagnostic test evaluation, 200 proximal surfaces of 100 extracted human posterior teeth were radiographed with dental X-ray unit. Evaluation of conventional and digital radiographs was performed twice by three observers. Carious lesions were classified based on a four-point scale (R0–R3) suggested by Abesi et al. Weighted kappa coefficients were calculated to assess intra- and interobserver agreement for each image set. Indices of diagnostic ability calculation were based on the first readings of the three observers. The scores were compared with the histological gold standard using receiver operating characteristic (ROC) analysis to evaluate diagnostic ability. Results: Intraobserver kappa coefficients calculated for each observer for each method of detecting caries ranged from 0.914 to 0.956. Interobserver kappa coefficients for each image set ranged from 0.8788 to 0.9583. The sensitivity and specificity of film for the first observer were 77.5% and 78.3% and for PSP were 77.5% and 80%, respectively. ROC analysis revealed that there were no statistically significant results (P > 0.05) between Az values for the two detection methods. Conclusion: PSP plate should be preferred over conventional films in detecting cavitated proximal caries. Further studies with more noncavitated proximal surfaces are required to conclusively establish the diagnostic ability of PSP over conventional film.
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Abu El-Ela WH, Farid MM, Abou El-Fotouh M. The impact of different dental restorations on detection of proximal caries by cone beam computed tomography. Clin Oral Investig 2021; 26:2413-2420. [PMID: 34601634 DOI: 10.1007/s00784-021-04207-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To evaluate the effects of different types of restorations on observer ability to detect proximal caries in CBCT images. MATERIALS AND METHODS Forty human premolars and molars with artificial proximal caries were placed proximal and distal to 5 molars having different restorations (amalgam, composite, resin-modified glass ionomer cement (RMGIC) fillings, zirconia, and lithium disilicate crowns) and a non-restored molar. CBCT scans were obtained using i-CAT® Next Generation. Images were rated twice by 2 observers. The exact depth of artificial caries was histologically established. Sensitivity, specificity, and area under the receiver operating characteristic curve (Az) values were calculated. RESULTS Caries detection in teeth surfaces mesial and distal to amalgam showed compromised specificity and accuracy. Moreover, caries detection in teeth surfaces mesial to zirconia crown showed low sensitivity, specificity, and accuracy. Capability of CBCT in detection of proximal caries in teeth adjacent to composite, RMGIC, and lithium disilicate was comparable to those adjacent to non-restored molar. CONCLUSIONS CBCT scans performed for tasks other than caries detection should be assessed for proximal caries in absence of any restorations as well as in presence of composite, RMGIC fillings, and lithium disilicate crowns. However, CBCT should not be used for proximal caries detection in teeth adjacent to amalgam and teeth surfaces mesial to zirconia crowns. CLINICAL SIGNIFICANCE It is important to investigate the influence of artifacts produced by various restorations on CBCT-based caries detection to optimize CBCT benefits, caries diagnosis and avoid unnecessary treatment of sound surfaces.
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Affiliation(s)
- Walaa Hussein Abu El-Ela
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ain Shams University, Monazamet El Wehda El Afriqeya St, Cairo, Egypt.
| | - Mary Medhat Farid
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ain Shams University, Monazamet El Wehda El Afriqeya St, Cairo, Egypt
| | - Mona Abou El-Fotouh
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ain Shams University, Monazamet El Wehda El Afriqeya St, Cairo, Egypt
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Wenzel A. Radiographic modalities for diagnosis of caries in a historical perspective: from film to machine-intelligence supported systems. Dentomaxillofac Radiol 2021; 50:20210010. [PMID: 33661697 PMCID: PMC8231685 DOI: 10.1259/dmfr.20210010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/03/2021] [Accepted: 02/16/2021] [Indexed: 01/17/2023] Open
Abstract
Radiographic imaging for the diagnosis of caries lesions has been a supplement to clinical examination for approximately a century. Various methods, and particularly X-ray receptors, have been developed over the years, and computer systems have focused on aiding the dentist in the detection of lesions and in estimating lesion depth. The present historical review has sampled accuracy ex vivo studies and clinical studies on radiographic caries diagnosis that have compared two or more receptors for capturing the image. The epochs of film radiography, xeroradiography, digital intraoral radiography, panoramic radiography and other extraoral methods, TACT analysis, cone-beam CT and artificial intelligence systems aiding in decision-making are reviewed. The author of this review (43 years in academia) has been involved in caries research and contributed to the literature in all the mentioned epochs.
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Affiliation(s)
- Ann Wenzel
- Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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Motoki O, Fergus DH, Yusuke T, Nanako K, Matsumoto S, Mikako H. Partial Pulpotomy to Successfully Treat a Caries-Induced Pulpal Micro-Abscess: A Case Report. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.678632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Vital pulp treatment (VPT) is a therapeutic strategy aimed at conservatively managing deep carious lesions and the exposed pulp. VPT has recently expanded through the use of hydraulic-calcium-silicate cement (HCSC), cone-beam CT, and dental operating microscopy (DOM), as well as an improved understanding of pulpal repair mechanisms. Consensus documents have concluded that non-selective removal of caries is not necessary in the absence of clinical symptoms, as partial or non-selective caries removal techniques reduce the likelihood of pulp exposure. Alternatively, others suggest that leaving carious tissue may help sustain pulpal inflammation and lead to failure of VPT. The presence of a purulent discharge from the exposed pulp is considered indicative of an irreversible damage and a need for pulpectomy. This report documents the successful VPT in a symptomatic molar with deep caries that exhibited purulent discharge from the pulp after exposure. A female patient presented with spontaneous pain in the maxillary left second molar. One year before, she had received a cast-metal restoration over a resin-based-composite (RBC) restoration. The tooth had been largely asymptomatic since; however, after experiencing spontaneous pain, she consulted the hospital clinic. Radiographs indicated that the restoration was not deep with visible dentin between the restoration and the pulp. Pulp sensibility tests yielded a positive response. There was no pain on percussion and no periodontal problems. Removal of the restoration and carious dentin using a DOM resulted in a pulpal exposure with purulent discharge and bleeding. A partial pulpotomy using HCSC was performed. Six months later, the clinical symptoms had completely resolved; however, due to concerns of partial necrosis, the patient was re-assessed. DOM examination revealed an incomplete hard-tissue barrier; moreover, there were also signs of residual tissue with inflammation. As a result, the defected area was enlarged, the pulp tissue debrided, and the HCSC reapplied. After review at 1 year, the tooth remains symptomless, with no apical radiolucency. Notably, this report visually illustrates that exposed pulp tissue containing limited region pus can maintain vitality after VPT. This finding raises two questions: (1) whether leaving infected dentin in situ and avoiding visualization of the pulp exposure is appropriate; and (2) whether the presence of purulent tissue in the pulp warrants a pulpectomy.
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Walsh T, Macey R, Riley P, Glenny AM, Schwendicke F, Worthington HV, Clarkson JE, Ricketts D, Su TL, Sengupta A. Imaging modalities to inform the detection and diagnosis of early caries. Cochrane Database Syst Rev 2021; 3:CD014545. [PMID: 33720395 PMCID: PMC8441255 DOI: 10.1002/14651858.cd014545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The detection and diagnosis of caries at the earliest opportunity is fundamental to the preservation of tooth tissue and maintenance of oral health. Radiographs have traditionally been used to supplement the conventional visual-tactile clinical examination. Accurate, timely detection and diagnosis of early signs of disease could afford patients the opportunity of less invasive treatment with less destruction of tooth tissue, reduce the need for treatment with aerosol-generating procedures, and potentially result in a reduced cost of care to the patient and to healthcare services. OBJECTIVES To determine the diagnostic accuracy of different dental imaging methods to inform the detection and diagnosis of non-cavitated enamel only coronal dental caries. SEARCH METHODS Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 31 December 2018); Embase Ovid (1980 to 31 December 2018); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 31 December 2018); and the World Health Organization International Clinical Trials Registry Platform (to 31 December 2018). We studied reference lists as well as published systematic review articles. SELECTION CRITERIA We included diagnostic accuracy study designs that compared a dental imaging method with a reference standard (histology, excavation, enhanced visual examination), studies that evaluated the diagnostic accuracy of single index tests, and studies that directly compared two or more index tests. Studies reporting at both the patient or tooth surface level were included. In vitro and in vivo studies were eligible for inclusion. Studies that explicitly recruited participants with more advanced lesions that were obviously into dentine or frankly cavitated were excluded. We also excluded studies that artificially created carious lesions and those that used an index test during the excavation of dental caries to ascertain the optimum depth of excavation. DATA COLLECTION AND ANALYSIS Two review authors extracted data independently and in duplicate using a standardised data extraction form and quality assessment based on QUADAS-2 specific to the clinical context. Estimates of diagnostic accuracy were determined using the bivariate hierarchical method to produce summary points of sensitivity and specificity with 95% confidence regions. Comparative accuracy of different radiograph methods was conducted based on indirect and direct comparisons between methods. Potential sources of heterogeneity were pre-specified and explored visually and more formally through meta-regression. MAIN RESULTS We included 104 datasets from 77 studies reporting a total of 15,518 tooth sites or surfaces. The most frequently reported imaging methods were analogue radiographs (55 datasets from 51 studies) and digital radiographs (42 datasets from 40 studies) followed by cone beam computed tomography (CBCT) (7 datasets from 7 studies). Only 17 studies were of an in vivo study design, carried out in a clinical setting. No studies were considered to be at low risk of bias across all four domains but 16 studies were judged to have low concern for applicability across all domains. The patient selection domain had the largest number of studies judged to be at high risk of bias (43 studies); the index test, reference standard, and flow and timing domains were judged to be at high risk of bias in 30, 12, and 7 studies respectively. Studies were synthesised using a hierarchical bivariate method for meta-analysis. There was substantial variability in the results of the individual studies, with sensitivities that ranged from 0 to 0.96 and specificities from 0 to 1.00. For all imaging methods the estimated summary sensitivity and specificity point was 0.47 (95% confidence interval (CI) 0.40 to 0.53) and 0.88 (95% CI 0.84 to 0.92), respectively. In a cohort of 1000 tooth surfaces with a prevalence of enamel caries of 63%, this would result in 337 tooth surfaces being classified as disease free when enamel caries was truly present (false negatives), and 43 tooth surfaces being classified as diseased in the absence of enamel caries (false positives). Meta-regression indicated that measures of accuracy differed according to the imaging method (Chi2(4) = 32.44, P < 0.001), with the highest sensitivity observed for CBCT, and the highest specificity observed for analogue radiographs. None of the specified potential sources of heterogeneity were able to explain the variability in results. No studies included restored teeth in their sample or reported the inclusion of sealants. We rated the certainty of the evidence as low for sensitivity and specificity and downgraded two levels in total for risk of bias due to limitations in the design and conduct of the included studies, indirectness arising from the in vitro studies, and the observed inconsistency of the results. AUTHORS' CONCLUSIONS The design and conduct of studies to determine the diagnostic accuracy of methods to detect and diagnose caries in situ are particularly challenging. Low-certainty evidence suggests that imaging for the detection or diagnosis of early caries may have poor sensitivity but acceptable specificity, resulting in a relatively high number of false-negative results with the potential for early disease to progress. If left untreated, the opportunity to provide professional or self-care practices to arrest or reverse early caries lesions will be missed. The specificity of lesion detection is however relatively high, and one could argue that initiation of non-invasive management (such as the use of topical fluoride), is probably of low risk. CBCT showed superior sensitivity to analogue or digital radiographs but has very limited applicability to the general dental practitioner. However, given the high-radiation dose, and potential for caries-like artefacts from existing restorations, its use cannot be justified in routine caries detection. Nonetheless, if early incidental carious lesions are detected in CBCT scans taken for other purposes, these should be reported. CBCT has the potential to be used as a reference standard in diagnostic studies of this type. Despite the robust methodology applied in this comprehensive review, the results should be interpreted with some caution due to shortcomings in the design and execution of many of the included studies. Future research should evaluate the comparative accuracy of different methods, be undertaken in a clinical setting, and focus on minimising bias arising from the use of imperfect reference standards in clinical studies.
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Affiliation(s)
- Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Richard Macey
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Philip Riley
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Anne-Marie Glenny
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Heatlh Research Services, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Janet E Clarkson
- Division of Oral Health Sciences, Dundee Dental School, University of Dundee, Dundee, UK
| | | | - Ting-Li Su
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Anita Sengupta
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Bardal R, Mobini M, Mirzaee M. In vitro comparison of two photostimulable phosphor plate systems for early detection of occlusal dentin caries with and without a sharpening filter. J Dent Res Dent Clin Dent Prospects 2021; 14:223-227. [PMID: 33575011 PMCID: PMC7867687 DOI: 10.34172/joddd.2020.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 07/07/2020] [Indexed: 11/14/2022] Open
Abstract
Background. Dental caries is the most important reason for tooth loss. Clinical examination is the most commonly used technique for occlusal caries diagnosis. The diagnostic power of digital systems is a matter of controversy in this field. The present study aimed to determine the diagnostic accuracy of two photostimulable phosphor plate (PSP) systems for early occlusal dentin caries in vitro.
Methods. Sixty-nine extracted molar and premolar teeth were used in this study. The teeth were mounted in triple blocks, and standard radiographs were taken by the Digora and Acteon digital radiographic systems. The original and filter 1-enhanced radiographs were evaluated by two experienced observers twice at an interval of two weeks, and dentin caries was recorded in Tables prepared for the study. The teeth were then sectioned in a buccolingual direction and evaluated under a stereomicroscope. The observers’ reports were compared with microscopic findings as the gold standard. SPSS 23 was used to calculate the kappa coefficient, sensitivity, specificity, and area under the ROC curve (AUC). Statistical significance was set at P<0.05.
Results. The internal and the external agreements in both imaging systems were good to excellent. The means of sensitivity, specificity, and AUC in the Acteon system were 34.1, 92.9, and 0.674, with 30.8, 94.8, and 0.659, respectively, in the Digora system.
Conclusion. The accuracy of early occlusal caries diagnosis was poor on both systems, and no significant difference was observed between the two systems at a 95% confidence interval. Although the AUC was slightly higher in the original images, there was no significant difference between them; however, due to their high specificity, they can prevent unnecessary treatments in the clinic.
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Affiliation(s)
- Roghieh Bardal
- Department of Oral and Maxillofacial Radiology, Dental Caries Prevention Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mahshid Mobini
- Department of Oral and Maxillofacial Radiology, Dental Caries Prevention Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Matin Mirzaee
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
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10
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GalvÃo NS, Nascimento EHL, GaÊta-Araujo H, Freitas DQ, Haiter-Neto F, Oliveira ML. Automatic exposure compensation and subjective image enhancement in the radiographic diagnosis of caries. Braz Oral Res 2020; 34:e082. [PMID: 32785477 DOI: 10.1590/1807-3107bor-2020.vol34.0082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/23/2020] [Indexed: 11/22/2022] Open
Abstract
This study aims to assess the influence of high-density material on the radiographic diagnosis of proximal caries in digital systems with automatic exposure compensation, and to evaluate the effect of subjective adjustment of brightness and contrast to undertake this diagnostic task. Twenty bitewing radiographs of forty posterior human teeth with non-cavitated carious lesions, confirmed by micro-CT, were obtained with two digital systems. A porcelain-fused-to-metal crown attached to a titanium implant was inserted into the exposed area, and all the radiographs were repeated. Five radiologists assessed the radiographs and diagnosed proximal carious lesions. Afterwards, the observers were asked to adjust image brightness and contrast, based on their subjective perception, and to reassess the images. Thirty percent of each experimental group was reassessed to test intraobserver reproducibility, totaling 208 images per observer. Intraobserver and interobserver agreements ranged from fair to substantial. Sensitivity, specificity, predictive values, and area under the ROC curve were calculated and compared for each radiographic system, using ANOVA (α = 0.05). Overall, presence of high-density material and adjustment of brightness and contrast did not significantly influence the radiographic diagnosis of proximal caries (p ≥ 0.05). Regarding Digora Optime, adjustment of brightness and contrast significantly increased (p < 0.05) the diagnostic accuracy of proximal carious lesions in the presence of high-density material. In conclusion, the presence of high-density material in the X-rayed region does not influence radiographic diagnosis of proximal caries. However, when it is present in the X-rayed area, subjective adjustment of brightness and contrast is recommended for use with the Digora Optime digital system.
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Affiliation(s)
- Neiandro Santos GalvÃo
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | | | - Hugo GaÊta-Araujo
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Francisco Haiter-Neto
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Matheus Lima Oliveira
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, SP, Brazil
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KURŞUN ÇAKMAK EŞ, BAYRAK S, ATAKAN C. PREVALENCE AND CHARACTERISTICS OF SOFT TISSUE CALCIFICATIONS IN CBCT IMAGES OF MANDIBULAR REGION. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2020. [DOI: 10.33808/clinexphealthsci.606139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Comparison of Two-Dimensional and Three-Dimensional Radiographs Using Clinically Relevant Parameters. Dent J (Basel) 2019; 7:dj7020050. [PMID: 31052379 PMCID: PMC6630924 DOI: 10.3390/dj7020050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/17/2019] [Accepted: 04/22/2019] [Indexed: 11/17/2022] Open
Abstract
This work compared the assessment of clinically relevant parameters by two-dimensional, that is, full-mouth intraoral radiograph (I-O) and panoramic radiograph (OPT), and three-dimensional, that is, cone beam computed tomography (CBCT), imaging methods. Different radiographic images (CBCT, I-O and OPT) were available for a 53-year-old female patient with dental and periodontal problems. A total of 14 dental and periodontal parameters were assessed by two independent examiners and compared among the three radiographic imaging modalities. For 10 parameters (71%), the CBCT images were superior to both I-O and OPT images. In contrast, CBCT demonstrated an inferior performance compared to I-O and OPT in the assessment of caries and dental restorations. Compared to OPT, I-O provided more clinically relevant findings for 10 out of 14 parameters (71%). Agreement between I-O and OPT was found with respect to dehiscence, fenestration, the number of bone walls and the root canal cross-section. Differences between the radiographic images were more likely to be detected when maxillary teeth rather than mandibular teeth were assessed with regard to furcation involvement, root proximity and root fusion.
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Nascimento EH, Gaêta-Araujo H, Vasconcelos KF, Freire BB, Oliveira-Santos C, Haiter-Neto F, Freitas DQ. Influence of brightness and contrast adjustments on the diagnosis of proximal caries lesions. Dentomaxillofac Radiol 2018; 47:20180100. [PMID: 29851369 DOI: 10.1259/dmfr.20180100] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To assess the influence of brightness and contrast adjustments of digital radiographs on the diagnosis of proximal caries lesions, and to compare with observers' preferences for subjective image quality. METHODS 80 proximal surfaces of posterior teeth were radiographed using an intraoral digital system (Digora Toto, Soredex, Finland). Initial images and four different combinations of brightness and contrast for each radiography were analysed. Five observers scored the images for the presence and extension of caries lesions. Micro-CT images were used as gold standard. In a second stage, the observers were asked which of the radiographs they preferred for the assessment of caries lesions. RESULTS No differences were found between the original and adjusted radiographic images regarding the area under the receiver operating characteristic curve, sensitivity, and specificity (p > 0.05). There was a significant difference between the micro-CT and the intraoral radiographs (p < 0.0001). Images with high brightness and low contrast presented higher number of true negative cases, but also a decrease in caries detection. On the other hand, there were more cases of overestimation of the presence and extension of caries lesions in images with low brightness and high contrast. The subjective evaluation of image quality showed that radiographs with lower brightness and higher contrast tended to be preferred by observers. CONCLUSIONS Brightness and contrast adjustments in digital intraoral radiographs within the range tested in this study do not significantly influence the diagnosis of proximal caries lesions, although observers tend to prefer lower brightness and higher contrast images.
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Affiliation(s)
- Eduarda Hl Nascimento
- 1 Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP) , São Paulo , Brazil
| | - Hugo Gaêta-Araujo
- 1 Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP) , São Paulo , Brazil
| | - Karla F Vasconcelos
- 1 Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP) , São Paulo , Brazil
| | - Bernardo B Freire
- 1 Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP) , São Paulo , Brazil
| | - Christiano Oliveira-Santos
- 2 Division of Oral Radiology, Department of Stomatology, School of Dentistry of Ribeirao Preto, University of Sao Paulo (USP) , São Paulo , Brazil
| | - Francisco Haiter-Neto
- 1 Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP) , São Paulo , Brazil
| | - Deborah Q Freitas
- 1 Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP) , São Paulo , Brazil
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Glória JCR, Martins CC, Armond ACV, Galvão EL, Dos Santos CRR, Falci SGM. Third Molar and Their Relationship with Caries on the Distal Surface of Second Molar: A Meta-analysis. J Maxillofac Oral Surg 2018; 17:129-141. [PMID: 29618876 PMCID: PMC5878171 DOI: 10.1007/s12663-017-1032-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 07/01/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The aim of this meta-analysis was to determine which characteristics of mandibular third molars (MTMs) are more often associated with an increase in the prevalence/incidence of caries on the distal surface of mandibular second molars (MSMs). METHODS Three electronic databases were analyzed: PubMed; OVID and the Virtual Health Library. Observational studies were included, and the risk of bias was assessed using The Newcastle-Ottawa Scale. The Comprehensive Meta-Analysis software program was used for meta-analysis. RESULTS Fifteen studies were included in this systematic review, and five were included in the meta-analysis. The distal surface of MSMs were more likely to exhibit caries in the following scenarios: when MTMs were found in the A position, rather than the C position (OR: 3.45, 95% CI: 2.28-5.22, p<0.001); when the horizontal position was compared with the vertical (OR: 8.12, 95% CI: 3.75-17.58, p<0.001) and distoangular (OR: 9.75, 95% CI: 3.49 - 27.25, p<0.001) positions; and when the mesioangular position was compared with the vertical (OR: 7.25, 95% CI: 3.48-15.10, p<0.001) and distoangular (OR: 9.54, 95% CI: 3.47 - 26.21, p<0.001) positions. CONCLUSION The results of this study suggest that the presence of MTMs increases the incidence of caries on the distal surface of MSMs. Furthermore, caries on the distal surface of MSMs is more commonly associated with position A and horizontal and mesioangular mandibular molars.
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Affiliation(s)
- José Cristiano Ramos Glória
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, MG 39100-000 Brazil
| | - Carolina Castro Martins
- Department of Pediatric Dentistry and Orthodontics, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Anna Catharina Vieira Armond
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, MG 39100-000 Brazil
| | - Endi Lanza Galvão
- Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
| | - Cássio Roberto Rocha Dos Santos
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, MG 39100-000 Brazil
| | - Saulo Gabriel Moreira Falci
- Department of Dentistry, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua da Glória, 187, Diamantina, MG 39100-000 Brazil
- Hospital Santa Casa de Caridade de Diamantina, Dimantina, Brazil
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Rugg AL, Nelson LY, Timoshchuk MAI, Seibel EJ. Design and Fabrication of a Disposable Dental Handpiece for Clinical Use of a New Laser-Based Therapy-Monitoring System. J Med Device 2015. [DOI: 10.1115/1.4031800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Dental caries, the breakdown of tooth enamel by bacteria infection that causes cavities in the enamel, is the most common chronic disease in individuals 6–19 years of age in the U.S. Optical detection of caries has been shown to be sensitive to the presence of bacteria and the resulting demineralization of enamel. The scanning fiber endoscope (SFE) is a miniature camera system that can detect early stages of caries by performing high-quality imaging and laser fluorescence spectroscopy with 405 nm excitation. Because optical imaging of caries does not involve radiation risk, repeated imaging of the teeth is acceptable during treatment of the bacterial infection to monitor healing. A disposable handpiece was designed and fabricated to position the flexible fiber optic SFE probe for quantitative measurements. Plastic 3D-printed handpiece prototypes were tested with the SFE and a fluorescence calibration standard to verify mechanical fit and absence of signal contamination. Design feedback was provided by pediatric dentists and staff engineers to guide iterations. The final design configuration was based on the need to image interproximal regions (contact surfaces between adjacent teeth), ergonomics, and probe safety. The final handpiece design: (1) is safe for both the patient and the probe, (2) allows easy SFE insertion and removal, (3) does not interfere with spectral measurements, (4) standardizes the SFE's positioning during imaging by maintaining a consistent distance from the target surface, and (5) is significantly less expensive to produce and use than purchasing sanitary endoscope sheaths. The device will be used to help determine if new medicinal therapies can arrest caries and repair early interproximal demineralization under the clinical monitoring program. Ultimately, we anticipate that this handpiece will help us move closer toward widespread implementation of a dental diagnostic laser system that is safer and more sensitive than conventional methods for early caries detection.
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Affiliation(s)
- Amanda L. Rugg
- Department of Bioengineering, University of Washington, Seattle, WA 98195 e-mail:
| | - Leonard Y. Nelson
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195
| | | | - Eric J. Seibel
- Department of Bioengineering, University of Washington, Seattle, WA 98195
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195
- Human Photonics Lab, University of Washington, Seattle, WA 98195
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Safi Y, Shamloo Mahmoudi N, Aghdasi MM, Eslami Manouchehri M, Rahimian R, Valizadeh S, Vasegh Z, Azizi Z. Diagnostic accuracy of Cone Beam Computed Tomography, conventional and digital radiographs in detecting interproximal caries. J Med Life 2015; 8:77-82. [PMID: 28316670 PMCID: PMC5348938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
STATEMENT OF THE PROBLEM Presently, various imaging methods are available for the disclosure of proximal caries. Some recent studies have attempted to determine the diagnostic accuracy of available modalities, but they have shown variable results. Aim: This study was carried out to recognize and examine the correctness of cone-beam computed tomography (CBCT), regular radiographs and the nondirect digital system in the disclosure of interproximal caries. Materials and Method: In this observational tryout study, forty-two extracted non-cavitated, unrestored person molar and premolar teeth were placed in the blocks with proximal surfaces in touch. Then they were appraised by CBCT, formal radiographs and the nondirect digital system for the disclosure of interproximal caries. Four oral and maxillofacial radiologists used a 4-point scale to assess the pictures for the existence or absence of proximal caries. Caries depth was specified by histological examination. The gathered data were assessed by SPSS software using Weighted Kappa and Friedman test. Results: Statistics demonstrated that the accuracy of the indirect digital system was somewhat better than conventional systems. The accuracy of the indirect digital system was better than cone beam system, and this difference was statistically significant. Conclusion: The digital system was better than CBCT in the disclosure of proximal caries. The formal radiography fell in between the two other systems without a statistically significant deviation in detecting caries. Thus, CBCT is not advised to detect proximal caries because of the higher radiation dose.
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Affiliation(s)
- Y Safi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - N Shamloo Mahmoudi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - MM Aghdasi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Eslami Manouchehri
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - R Rahimian
- Department of Oral and Maxillofacial Radiology, School of Dentistry, International branch of Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Valizadeh
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Z Vasegh
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Z Azizi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, International branch of Shahid Beheshti University of Medical Sciences, Tehran, Iran
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