Detection of artificial occlusal caries in a phosphor imaging plate system with two types of LCD monitors versus three different films

Comparison of digital image displays performance in the detection of artificial internal root resorptions lesions

OBJECTIVE

To compare the diagnostic efficacy of different devices for visualizing digital images in detecting simulated internal root resorption (IRR).

METHODS

26 uniradicular human teeth were sectioned along its long axis and randomly divided into two groups. Then, they were submerged in hydrochloric acid (HCl) P.A 37% at different times to make two types of defects: Type 1 (2 hours), and type 2 (3 hours). Digital periapical radiographs were acquired in three moments: before section, after section and after immersion in acid. The images were evaluated on three different devices: 27-inch iMac Desktop, 8-inch Android Tablet, and 5.5-inch iPhone 8 Plus using a 5-point scale.

RESULTS

The sensitivity and accuracy values were higher with the use of the Android Tablet, for both types of defects. For the values of the area under ROC curve, higher results were observed with the Android Tablet and lower results with the iMac, showing a significant difference (p < 0.05) when comparing the use of the iMac with the Android Tablet and iPhone 8, for type 1 defects. When comparing the different devices, in the evaluation of images of type 2 defects, the values showed no statistical difference, regardless of the device evaluated (p > 0.05).

CONCLUSIONS

The size of the lesion interferes with the detection capacity in the image. However, the use of portable devices does not impair the diagnosis of IRR, regardless of size and the dental practioners may use different devices/display, under optimal viewing conditions, to detect IRR lesions, without jeopardizing the diagnostic ability.

The influence of image display systems on observers' preference for visualizing subtle dental radiographic abnormalities

OBJECTIVE

The objectives of this study were to assess observers' preference for standard screens (SSs) or medical displays (MDs) in visualizing difficult-to-diagnose radiographic dental abnormalities and their preference for dental filter tools when utilized with MD systems.

STUDY DESIGN

A retrospective data set of 60 in vivo radiographs consisting of intraoral (n = 20), panoramic (n = 20), and cone beam computed tomography (n = 20) images was created. Three image display monitors, including an SS, an MD, and an MD with 3 dental filter configurations (bone-low density enhancement filter, tooth-high density enhancement filter, and a combined filter representing regular MD), were utilized to assess 4 observers' monitor preferences in detecting radiographically subtle dental abnormalities. The data were analyzed by using binomial distribution. A P value ≤.05 was considered statistically significant.

RESULTS

Although observers expressed preference for MD for visualizing some abnormalities when examining intraoral and panoramic radiographs, MD was not preferred for detection of any abnormalities with cone beam computed tomography. There were no significant differences in preference for SS or MD overall (P ≥ .2024). Observers expressed significant preference for the filters in visualizing all but 2 abnormalities (P ≤ .0252).

CONCLUSIONS

The use of MD monitors enabled with dental filter tools may be preferred for visualizing certain subtle abnormalities.

Assessment of diagnostic accuracy of a direct digital radiographic-CMOS image with four types of filtered images for the detection of occlusal caries

BACKGROUND

Digital imaging has the potential to improve diagnostic accuracy and make quantitative diagnoses. In the recent decades, software for radiographic analysis has been investigated and developed for the detection of lesions and the quantitative assessment of the depth of a caries lesion. In addition, the accuracy of diagnosis may also be enhanced by programs that filter the images. These programs can adjust the brightness and contrast, determine the gray level, invert the shades of gray, and apply pseudocolors. Few studies compared different types of digital images in the diagnosis of changes in the tooth crown.

AIM

The main aim of this study was to assess the the diagnostic accuracy of a direct digital radiography (DDR)-CMOS image with four types of filtered images for the detection of occlusal caries.

MATERIALS AND METHODS

Fifty randomly selected patients' teeth were clinically examined and digitally radiographed. Radiographed images are converted into four filter images with the help of software. Filtered images were then selected for inter- and intraobserver examination and the result was subjected to statistical analysis.

CONCLUSION

DDR-CMOS and negative image were found to be more useful in diagnosing occlusal caries.

Assessing the Accuracy of Caries Diagnosis in Bitewing Radiographs Using Different Reproduction Media

STATEMENT OF THE PROBLEM

After introducing digital radiography, practitioners started reading radiographs from computer monitors; however, many still prefer hard-copy radiographs.

PURPOSE

This study aimed to assess the possible superiority of either type of radiograph recording media (computer monitor, film, or paper) in diagnosis and perception of the depth of the cariogenic lesions.

MATERIALS AND METHOD

Twenty digital bitewing radiographs, obtained from 200 posterior extracted teeth, were displayed on an LG monitor and printed on paper and film using Kodak printers. Two observers independently measured lesions depth on the images. Serial sections of teeth were obtained and the sections were evaluated by a stereomicroscope to determine the actual depth of cariogenic lesions. The efficacy of the each medium was assessed by determining its specificity and sensitivity in comparison with those of histological images. Weighted kappa coefficients and the ROC analysis were used for the statistical analysis.

RESULTS

Strong intra- and inter-observer agreements (0.818 to 0.958, 0.77 to 0.85) were found for all detection methods. The highest Az value was obtained with the monitor-displayed images (Az: 0.879); however, differences between detection methods were not statistically significant (p> 0.05).

CONCLUSION

Monitor-displayed bitewing radiographs, paper, and film prints used in our study performed similarly in the detection of proximal caries.

Diagnostic accuracy of different display types in detection of recurrent caries under restorations by using CBCT

OBJECTIVES

To assess the in vitro diagnostic ability of CBCT images using seven different display types in the detection of recurrent caries.

METHODS

Our study comprised 128 extracted human premolar and molar teeth. 8 groups each containing 16 teeth were obtained as follows: (1) Black Class I (Occlusal) amalgam filling without caries; (2) Black Class I (Occlusal) composite filling without caries; (3) Black Class II (Proximal) amalgam filling without caries; (4) Black Class II (Proximal) composite filling without caries; (5) Black Class I (Occlusal) amalgam filling with caries; (6) Black Class I (Occlusal) composite filling with caries; (7) Black Class II (Proximal) amalgam filling with caries; and (8) Black Class II (Proximal) composite filling with caries. Teeth were imaged using 100 × 90 mm field of view at three different voxel sizes of a CBCT unit (Planmeca ProMax(®) 3D ProFace™; Planmeca, Helsinki, Finland). CBCT TIFF images were opened and viewed using custom-designed software for computers on different display types. Intra- and interobserver agreements were calculated. The highest area under the receiver operating characteristic curve (Az) values for each image type, observer, reading and restoration were compared using z-tests against Az = 0.5. The significance level was set at p = 0.05.

RESULTS

We found poor and moderate agreements. In general, Az values were found when software and medical diagnostic monitor were utilized. For Observer 2, Az values were statistically significantly higher when software was used on medical monitor [p = 0.036, p = 0.015 and p = 0.002, for normal-resolution mode (0.200 mm(3) voxel size), high-resolution mode (0.150 mm(3) voxel size) and low-resolution mode (0.400 mm(3) voxel size), respectively]. No statistically significant differences were found among other display types for all modes (p > 0.05). In general, no difference was found among 3 different voxel sizes (p > 0.05). In general, higher Az values were obtained for composite restorations than for amalgam restorations for all observers. For Observer 1, Az values for composite restorations were statistically significantly higher than those of amalgam restorations for MacBook and iPhone (Apple Inc., Cupertino, CA) assessments (p = 0.002 and p = 0.048, respectively).

CONCLUSIONS

Higher Az values were observed with medical monitors when used with dedicated software compared to other display types which performed similarly in the diagnosis of recurrent caries under restorations. In addition, observers performed better in detection of recurrent caries when assessing composite restorations than amalgams.

Influence of Image Filters and Variation in Horizontal Angle of Incidence of X-ray Beam in Digital Interproximal Radiographs for Diagnosis of Secondary Caries in Esthetic Restorations

BACKGROUND

Secondary or recurrent caries are located around restoration margins or under these lesions, and can lead to tooth loss. The interproximal or bite wing radiograph is the technique of choice to assist diagnosis of secondary caries.

OBJECTIVE

To evaluate diagnostic accuracy of secondary caries in pulpal walls artificially created in extracted human premolars, observed in digital bitewing radiographs using variations in horizontal X-ray beam angle of incidence and application of enhancement filters.

MATERIALS AND METHODS

The sample consisted of 20 healthy premolars, in which secondary caries lesions were simulated by means of subjecting the pulpal wall of the cavity to wear with spherical carbide drill half, fitted to a high speed handpiece, under constant cooling, focused perpendicular to the tooth surface. The orifices were filled with wax and all teeth were restored with composite resin Filtek Z350 XT(®). Later teeth were radiographed with a digital sensor complementary metal-oxide-semiconductor (CMOS) varying the horizontal angle at intervals of 2°, covering a range of -10 to +10°.

RESULTS

The results showed that in the diagnosis of secondary caries, there was no statistically significant difference between the 2 pseudocolor filters, and negative and direct digital radiography. The pseudocolor filter no. 1 showed statistically significant differences, except at a horizontal angle of 0°, thus indicating lower efficiency in the diagnosis of secondary caries.

CONCLUSION

Secondary caries with esthetic pulp wall restoration can be diagnosed irrespective of variation in the horizontal angle of incidence of the X-ray beam. The use of different radiographic enhancement filters did not result in improved diagnosis of secondary caries.

Effect of display type, DICOM calibration and room illuminance in bitewing radiographs

OBJECTIVES

To compare observer performance in the detection of both anatomical structures and caries in bitewing radiographs using consumer grade displays with and without digital imaging and communications in medicine (DICOM) calibration, tablets (third generation iPad; Apple, Cupertino, CA) and 6-megapixel (MP) displays under different lighting.

METHODS

30 bitewing radiographs were blindly evaluated on four displays under bright (510 lx) and dim (16 lx) ambient lighting by two observers. The dentinoenamel junction, enamel and dentinal caries, and the cortical border of the alveolar crests were evaluated. Consensus was considered as reference. Intraobserver agreement was determined. The proportion of equivalent ratings and weighted kappa were used to assess reliability.

RESULTS

The proportion of equivalent ratings with consensus differed significantly between uncalibrated and DICOM-calibrated consumer grade display in enamel caries in upper and lower molars in bright (p = 0.013 and p = 0.003) lighting, and in dentinal caries in lower molars in both bright (p = 0.022) and dim (p = 0.004) lighting. The proportion also differed significantly between DICOM-calibrated consumer grade and 6-MP display in dentinal caries in lower molars in bright lighting (p = 0.039), tablet and consumer grade display in enamel caries in upper molars (p = 0.017) in bright lighting, tablet and 6-MP display in dentinal caries in lower molars (p = 0.003) in bright lighting and in enamel caries in lower molars (p = 0.012) in dim lighting.

CONCLUSIONS

DICOM calibration improves the detection of enamel and dentinal caries in bitewing radiographs, particularly in bright lighting. Therefore, a calibrated consumer grade display can be recommended as a diagnostic tool for viewing bitewing radiographs.

Effect of Different Tube Potential Settings on Caries Detection using PSP Plate and Conventional Film

PURPOSE

To compare intraoral Phosphor Stimulable Plate digital system and intraoral film using different tube settings on incipient proximal caries detection.

MATERIALS AND METHODS

Five blocks, with five teeth each, were radiographically examined using phosphor plates and F-speed films. The images were acquired in 07 different tube potentials from 50-80 kV. The films were digitized. Three oral radiologists scored the images for the presence of caries using a 5-point rating scale. The areas under ROC curve were calculated. The influence of tube kilovoltage was verified by ANOVA and pair wise comparisons performed using Tukey test.

RESULTS

Mean ROC curve areas varied from 0.446-0.628 for digital images and 0.494-0.559 for conventional images. The tube setting of 70 kV presented the best result both for digital and conventional images. Considering the image type separately, 70 kV scored highest followed by 75 and 65 kV for digital images (p=0.084). For conventional image modality, even though 70 kV presented the best result, it did not differ significantly from 80 kV, not differing from 60 and 55 kV, which did not differ from 75, 65 and 50 kV (p=0.53).

CONCLUSION

Phosphor plate digital images seem to be more susceptible to tube setting potential variations then digitized film images.

The validity of different display monitors in the assessment of dental implant site dimensions in cone beam computed tomography images

OBJECTIVE

To determine if the differing contrast resolution of various LCD monitors affects the reliability or accuracy of measurements of proposed implant sites.

MATERIALS AND METHODS

Edentulous areas of human dry skulls were marked with radiopaque markers in order to standardize the plane of the transverse cross-sections of the ridges and path of measurements. The skulls were imaged by a CBCT device and the images stored in proprietary format on the workstation. The data sets were then transferred, with the proprietary reformatting software, to two different laptops using CDs. Transverse cross-sectional images of the ridges were reformatted on all three computers and ridge dimensions were recorded using the linear measurement tool of the proprietary software. Ridge dimensions were recorded directly from the three different monitors by two observers and compared to measurements recorded directly from the bone. The measurement errors and intra- and inter-examiner reliability were calculated for each monitor and compared with each other.

RESULTS

Intra- and inter-examiner reliability scores for the measurements recorded from all three devices were very high and ranged between 0.993-0.999. The mean of the absolute errors was 0.55 mm for the workstation, 0.61 mm for laptop 1 and 0.68 mm for laptop 2. The absolute errors were statistically significant for all three monitors (p-value < 0.001), but there was no statistically significant difference between the absolute errors obtained from the three monitors.

CONCLUSIONS

No differences in the reliability or accuracy of measurements of implant site dimensions were obtained using color LCD monitors with different contrast resolution capabilities.

Digital radiography with computerized conventional monitors compared to medical monitors in vertical root fracture diagnosis

INTRODUCTION

Vertical root fracture (VRF) is a complication which is chiefly diagnosed radiographically. Recently, film-based radiography has been substituted with digital radiography. At the moment, there is a wide range of monitors available in the market for viewing digital images. The present study aims to compare the diagnostic accuracy, sensitivity and specificity of medical and conventional monitors in detection of vertical root fractures.

MATERIAL AND METHODS

In this in vitro study 228 extracted single-rooted human teeth were endodontically treated. Vertical root fractures were induced in 114 samples. The teeth were imaged by a digital charge-coupled device radiography using parallel technique. The images were evaluated by a radiologist and an endodontist on two medical and conventional liquid-crystal display (LCD) monitors twice. Z-test was used to analyze the sensitivity, accuracy and specificity of each monitor. Significance level was set at 0.05. Inter and intra observer agreements were calculated by Cohen's kappa.

RESULTS

Accuracy, specificity and sensitivity for conventional monitor were calculated as 67.5%, 72%, 62.5% respectively; and data for medical grade monitor were 67.5%, 66.5% and 68% respectively. Statistical analysis showed no significant differences in detecting VRF between the two techniques. Inter-observer agreement for conventional and medical monitor was 0.47 and 0.55 respectively (moderate). Intra-observer agreement was 0.78 for medical monitor and 0.87 for conventional one (substantial).

CONCLUSION

The type of monitor does not influence diagnosis of vertical root fractures.

Effect of tube potential and image receptor on the detection of natural proximal caries in primary teeth

The aim of this study was to assess the detection of proximal caries in primary teeth at three different tube potentials using Ektaspeed films, storage phosphor plates (SPPs), and a charge-coupled device (CCD). Fifty-three extracted human primary molars with natural proximal caries were radiographed with three different imaging modalities--Digora Optime SPP system, RVGui CCD system, and Ektaspeed films--at 50-, 65-, and 70-kV tube potentials. Three observers scored the resultant images for the presence or absence of caries. The definitive diagnosis was determined by stereomicroscopic assessment. The diagnostic accuracy for each imaging modality was expressed as the area under the receiver operating characteristic curves (A(z)). Differences among the A(z) values were assessed using two-way ANOVA and t tests. Kappa was used to measure inter- and intra-observer agreement. Higher accuracy was found for SPPs compared to film and CCD images at all tube potentials. Accuracy was significantly different only at 50-kV tube setting in favor of SPPs (p < 0.05). Inter- and intra-observer agreement was high for all systems. A SPP system can be recommended for dental peadodontic clinics particularly with 50-kV tube potential for the diagnosis of proximal caries since further advantages include the elimination of chemical processing, image enhancement, and a better low-contrast detectability performance.

Work flow with digital intraoral radiography: a systematic review

OBJECTIVE

This systematic review evaluates the six most frequently emphasized advantages of working with digital radiography: less working time, lower radiation dose to the patient, fewer retakes and errors, wider dynamic range, easier access to patient information and easier image storage and communication. Moreover, some clinical aspects and possible disadvantages of digital imaging that were not foreseen at the beginning of the digital era, such as patient discomfort, damage to the receptor, degradation of the image, cross-contamination and viewing conditions, were assessed.

MATERIAL AND METHODS

The literature search used the PubMed database with no limits and was performed during June to August 2009. Search strategies are described in the text for each of the mentioned tasks. A hand search of task-specific journals supplemented the search strategies.

RESULTS

Time seems to be saved when switching from film to digital imaging in dental practice, a dose reduction may not be obtained, retakes and errors may be increased, the dynamic range may be wider with photostimulable storage phosphor (PSP) plates but not with sensors, the effect on patient information has not been well studied and storage and communication create new challenges with regard to handling large files and image compression. In addition, patient discomfort seems to be pronounced with sensors compared with PSP plates and film, the PSP plate may be scratched in clinical use and a two-layer barrier seems to be needed to prevent contamination of the receptor. The type of monitor may not be of major concern if the image is viewed in a room with subdued light.

CONCLUSIONS

Not all of the predicted advantages with digital compared to film-based radiography hold true in daily clinical work. Of particular interest is the relationship between number of images, retakes and the dose given to the patient.