Clinical guidelines for dental cone-beam computed tomography

Optimizing radiation safety in dentistry: Clinical recommendations and regulatory considerations

BACKGROUND

The value of dental radiographs to oral health care decision making must be balanced with radiation safety to minimize patient exposure and occupational risk of oral health care providers. This review summarizes recommendations and regulatory guidance regarding dental radiography and cone-beam computed tomography. An expert panel presents recommendations on radiation safety, appropriate imaging practices, and reducing radiation exposure.

TYPES OF STUDIES REVIEWED

A systematic search run in Ovid MEDLINE, Embase, and Cochrane Database of Systematic Reviews identified relevant topical systematic reviews, organizational guidelines, and regulatory reviews published in the peer-reviewed literature since 2010. A supplemental search of the gray literature (eg, technical reports, standards, and regulations) identified topical nonindexed publications. Inclusion criteria required relevance to primary oral health care (ie, general or pediatric dentistry).

RESULTS

A total of 95 articles, guidance documents, and regulations met the inclusion criteria. Resources were characterized as applicable to all modalities, operator and occupational protection, dose reduction and optimization, and quality assurance and control.

PRACTICAL IMPLICATIONS

Understanding factors affecting imaging safety and applying fundamental principles of radiation protection consistent with federal, state, and local requirements are essential for limiting patient ionizing radiation exposure, in conjunction with implementing optimal imaging procedures to support prudent use of dental radiographs and cone-beam computed tomographic imaging. The regulatory guidance and best practice recommendations summarized in this article should be followed by dentists and other oral health care providers.

Comparative diagnosis of the alveolar antral artery canal in the lateral maxillary sinus wall in corresponding panoramic radiography and cone-beam computed tomography

PURPOSE

Sinus lift operations are a tried and tested means of providing adequate implant prosthetics to patients with compromised jawbones. Knowledge of the arterial supply of the maxillary sinus region is essential for surgical treatment in this area. The aim of the present comparative study was to determine whether alveolar antral artery (AAA) canal can be diagnosed both in corresponding panoramic radiography (PR) and cone-beam computed tomography (CBCT).

METHODS

A total of 335 patients with 635 sites and corresponding maxillary sinus in both PR and CBCT were selected and examined for AAA canal visibility.

RESULTS

The visibility of the AAA canal was significantly higher in CBCT than in PR. A total of 154 (46.0%) AAA canals could be identified in the maxillary sinus on the right. However, only four (1.2%) of these were also visible in PR. The detected values of the AAA canals in the maxillary sinus on the left in the PR and CBCT images were similar to those of the right. While 164 AAA canals (49%) were observed in CBCT images, only 1 (0.3%) was identifiable in PR.

CONCLUSIONS

The results show that CBCT can be recommended for visualising the AAA canal when surgically planning sinus augmentation procedures.

Evaluation of trabecular changes following advancement genioplasty combined with or without bilateral sagittal split osteotomy by fractal analysis: a retrospective cohort study

BACKGROUND

It is aimed to investigate whether there was a difference in radiographic changes in the operational areas between genioplasty alone and genioplasty combined with mandibular advancement and to evaluate the fractal dimension (FD) to assess trabecular changes after genioplasty surgery.

METHODS

Preoperative-(T0) and postoperative-(T1) panoramic radiographs of 26 patients without any complications who underwent genioplasty combined with bilateral sagittal osteotomy and mandibular advancement or genioplasty alone were selected. In the panoramic radiographs of both groups, the genial segment, mandibular angulus, and surgical osteotomy line were examined using FD. The box-counting method was used for FD evaluation.

RESULTS

It was determined that FD values before and after treatment were similar in both groups for all regions where measurements were made. After surgery, the FD values of the middle region of the genial segment were found to be significantly lower than the other regions. At T1, the FD values at the osteotomy area were found to be significantly higher than those in the middle region of the genial segment.

CONCLUSION

Trabecular structure does not differ in patients undergoing genioplasty alone or in combination with mandibular advancement osteotomy. The middle region of the genial segment heals later than other regions.

Content Analysis of YouTube Videos That Demonstrate Panoramic Radiography

In this digital era, dental students often search for online resources for self-directed learning. YouTube is one of the most commonly sought online platforms for educational or instructional videos. No prior study has examined the validity of panoramic radiography videos available on YouTube. This study provides a content analysis of these YouTube videos. A search for relevant YouTube videos was conducted in April 2022. The search string was: (panoramic OR pan OR OPG) AND (dental OR dentistry OR X-ray). The first 100 videos that resulted from the search and their related videos were screened. Exclusion criteria included irrelevance (e.g., no demonstration of panoramic radiography procedures) and non-English videos. For each included video, the following parameters were recorded: image receptor type, patient age, patient type (real patient, animation, or phantom head), patient preparation procedures, machine preparation, patient positioning, and operator safety. The number of views, comments, likes, and channel subscribers were recorded, as well as the video duration and the age of the video. Forty videos were included and analyzed. Most of the videos demonstrated digital panoramic radiography with an adult patient. Procedures on the patient and machine preparations as well as patient positioning were generally explained well. However, most videos did not well-demonstrate operator safety details concerning the use of adequate personal protective equipment. View count, comment count, and channel subscriber count positively correlated with the like count. Clinicians and students should carefully critique the content of such instructional videos and refer to the contents from other sources such as user manuals and latest recommendations from local authorities.

Three-Dimensional Distance Mapping Method to Evaluate Mandibular Symmetry and Morphology of Adults with Unilateral Premolar Scissors Bite

(1) Objective: This study aimed to evaluate the association between unilateral premolar scissors bite and mandibular symmetry of adults via the 3D distance mapping method. (2) Methods: A total of 53 cone-beam computed tomography (CBCT) images of adults with unilateral premolar scissors bite were set as study samples. A total of 53 age- and sex-matched samples without scissors bite were in the control group. Three-dimensional mandibular models and seven mandibular functional units, including condylar process (Co), coronoid process (Cr), mandibular ramus (Ra), mandibular angle (Ma), alveolar process (Ap), mandibular body (Mb), and chin process (Ch) were constructed and mirrored. After superimposition of the original and the mirrored models, 3D distance maps and deviation analysis were performed to evaluate the mandibular symmetry and morphology. (3) Results: In the study group, the matching percentages of the entire mandible (50.79 ± 10.38%), Ap (67.00 ± 12.68%), Mb (66.62 ± 9.44%), Ra (62.52 ± 11.00%), Ch (80.75 ± 9.86%), and Co (62.78 ± 13.56) were lower than that of the entire mandible (58.60 ± 5.52) (p < 0.01), Ap (73.83 ± 8.88%) (p < 0.01), Mb (72.37 ± 8.69%) (p < 0.01), Ra (68.60 ± 7.56%) (p < 0.01), Ch (85.23 ± 6.80%) (p < 0.01), and Co (67.58 ± 10.32%) (p < 0.05) in the control group. However, Cr and Ma showed no significant difference (p > 0.05). (4) Conclusions: The 3D distance mapping method provided a qualitative and quantitative mandibular symmetry and morphology assessment. Mandibular asymmetry was found in adults with unilateral premolar scissors bites. Mandibular functional units, including the alveolar process, mandibular body, mandibular ramus, chin process, and condylar process, showed significant differences, while no significant difference was observed in the coronoid process and mandibular angle.

Anatomical variations of the ethmoid sinuses and their association with health or pathology of the ethmoid and maxillary sinuses in a Southern Chinese population: An analysis using cone-beam computed tomography

Purpose

The aim of this study was to evaluate the prevalence of clinically relevant anatomical variations of the ethmoid sinuses and their potential association with ethmoid and maxillary sinus pathologies on cone-beam computed tomography (CBCT) scans. Additionally, potential associations with different sides and demographic factors, including age and sex, were evaluated.

Materials and Methods

In total, 273 CBCT scans with complete ethmoid and maxillary sinuses were analyzed to determine the prevalence of Agger nasi cell, supraorbital ethmoid cell, Haller cell, Onodi cell, and ethmomaxillary sinus. In addition, the health or pathology of the ethmoid and maxillary sinuses was also recorded to assess correlations with the aforementioned variations.

Results

The prevalence of Agger nasi cell was found to be the highest (95.6%) in this study, followed by Onodi cell (60.4%), Haller cell (29.3%), and supraorbital ethmoid cell (19.4%). Ethmomaxillary sinus was the least common finding (16.5%). Males and persons above 61 years of age had a significantly higher frequency of supraorbital ethmoid cell and Onodi cell, respectively. However, no significant relationships were noted between anatomical variations of the ethmoid sinus and pathologies of the ethmoid or maxillary sinus.

Conclusion

There was a high prevalence of ethmoid sinus variations in this Southern Chinese population. The prevalence of Agger nasi cell and Onodi cell was higher than that of other anatomical variations of the ethmoid sinuses. Anatomical variations of the ethmoid sinuses were not associated with ethmoid or maxillary sinus pathologies in this patient cohort.

An anthropomorphic maxillofacial phantom using 3-dimensional printing, polyurethane rubber and epoxy resin for dental imaging and dosimetry

OBJECTIVE

The aim of this study was to construct an anthropomorphic maxillofacial phantom for dental imaging and dosimetry purposes using three-dimensional (3D) printing technology and materials that simulate the radiographic properties of tissues.

METHODS

Stereolithography photoreactive resins, polyurethane rubber and epoxy resin were modified by adding calcium carbonate and strontium carbonate powders or glass bubbles. These additives were used to change the materials' CT numbers to mimic various body tissues. A maxillofacial phantom was designed using CT images of a head.

RESULTS

Commercial 3D printing resins were found to have CT numbers near 120 HU and were used to print intervertebral discs and an external skin for the maxillofacial phantom. By adding various amounts of calcium carbonate and strontium carbonate powders the CT number of the resin was raised to 1000 & 1500 HU and used to print bone mimics. Epoxy resin modified by adding glass bubbles was used in assembly and as a cartilaginous mimic. Glass bubbles were added to polyurethane rubber to reduce the CT number to simulate soft tissue and filled spaces between the printed anatomy and external skin of the phantom.

CONCLUSION

The maxillofacial phantom designed for dental imaging and dosimetry constructed using 3D printing, polyurethane rubbers and epoxy resins represented a patient anatomically and radiographically. The results of the designed phantom, materials and assembly process can be applied to generate different phantoms that better represent diverse patient types and accommodate different ion chambers.

Dental cone beam CT: An updated review

Cone beam computed tomography (CBCT) is a diverse 3D x-ray imaging technique that has gained significant popularity in dental radiology in the last two decades. CBCT overcomes the limitations of traditional two-dimensional dental imaging and enables accurate depiction of multiplanar details of maxillofacial bony structures and surrounding soft tissues. In this review article, we provide an updated status on dental CBCT imaging and summarise the technical features of currently used CBCT scanner models, extending to recent developments in scanner technology, clinical aspects, and regulatory perspectives on dose optimisation, dosimetry, and diagnostic reference levels. We also consider the outlook of potential techniques along with issues that should be resolved in providing clinically more effective CBCT examinations that are optimised for the benefit of the patient.

The comparison of roof visibility of the mandibular canal between cone-beam computed tomography scans and panoramic radiograph images as dependent on the cortical bone thickness of the mandible

Background

Accurate detection of the mandibular canal is a difficult process despite cutting-edge radiographic methods. The present study analyses whether mandibular canal roof visibility is comparable to panoramic radiography (PR) and cone-beam computed tomography (CBCT) and, further, examines whether the visibility in PR and CBCT is dependent on cortical bone thickness in the mandible.

Methods

This study was conducted on a group of 343 selected patients. It incorporated anonymised data on 343 patients in which a CBCT and PR were available. The first stage examines whether the mandibular canal roof visibility is comparable to PR and CBCT. In the second stage, measurements of cortical bone thickness showed buccal and lingual in the P2, M1, M2 and M3 teeth areas, both to the left and right of the mandible in CBCT images.

Statistical analysis was supported by statistical software (IBM SPSS 25; Armonk, NY, USA).

Results

The mean age of the patients was 58.8 years with an almost equal gender distribution. When performing a McNemar test on the P2, M1, M2 and M3 on both the left and right jaws, the difference between the two image modalities, with regard to the visibility of the canal roof, was found to be significant (McNemar test, p < 0.001).

Statistically (U test, p≥0.05), it follows that the thickness of the cortical bone of the mandible exerts no influence on the visibility of the roof of canalis mandibulae in PR and CBCT images.

Conclusion

We conclude that the visibility of the mandibular canal in PR and CBCT rays is not identical, and that the thickness of the cortical bone in the mandible does not represent a factor affecting the visibility of the roof of the mandibular canal.

Two decades of research on CBCT imaging in DMFR - an appraisal of scientific evidence

OBJECTIVE

This article aims to appraise how scientific evidence related to CBCT has changed over the years, based on levels of evidence and diagnostic efficacy.

METHODS

A general search strategy was used in different databases (Pubmed, Embase, and Web of Science) to identify systematic reviews (SRs) on CBCT until November of 2020. The SRs included were divided according to different specialties of dentistry. A critical review of the articles was made, describing the level of evidence and efficacy.

RESULTS

In total, 75 articles were selected. There was an increase in the number of SRs on CBCT from 2014 onwards, as 83% of the SRs on this topic were published after 2013, and 72% between 2016 and to date. Twenty SRs (27%) performed meta-analysis. Only 28% of the SRs provided a detailed description of CBCT protocols. According to SR evidence, almost all specialties of dentistry have advanced concomitantly with the introduction of CBCT. The majority of SRs were related to clinical applications (level 2 of efficacy), followed by technical parameters (level 1 of efficacy). Only some CBCT models were mentioned in the SRs selected.

CONCLUSION

Over the course of 20 years, SRs related to CBCT applications for a broad range of dental specialties have been published, with the vast majority of studies at levels 1 and 2 of diagnostic efficacy. Not all CBCT models available on the market have been scientifically validated. At all times, one should remain cautious as such not to simply extrapolate in vitro results to the clinical setting. Also, considering the wide variety of CBCT devices and protocols, reported results should not be overstated or generalized, as outcomes often refer to specific CBCT devices and protocols.

Root canal sealers affect artifacts on cone-beam computed tomography images

The purpose of this study was to evaluate the appearance of artifacts by four types of root canal filling sealers on cone-beam computed tomography (CBCT) images. Thirty standardized tooth models were given the radiopacity equivalent to human teeth, and root canal preparation was performed using WaveOne Gold. Root canal filling by a single-point method was performed using WaveOne Gold gutta-percha points and four types of root canal sealers: AH Plus (AH), CANALS (CA), BioRoot RCS (BR), and MTA Fillapex (MTA). Samples were taken by periapical radiography at 60 kV and scanned by CBCT at three tube voltages (70, 85, and 100 kV). The gray-scale values (GVs) of the periapical radiographs were measured and the aluminum equivalents were calculated. On the CBCT axial images, the artifact and dentin area GVs were measured and the rate of change in the GV (RCGV) was calculated as follows: RCGV (%) = (dentin area GV - artifact GV)/dentin area GV × 100. High-density areas with artifacts on the CBCT images were also measured. On the periapical radiographs, the aluminum equivalent was largest for AH and smallest for MTA. On the CBCT images, AH showed the largest values for both RCGV and the high-density areas, while BR and MTA showed comparable values. Correlations were found between the radiopacity on the periapical radiographs and the degree of artifacts on the CBCT images. These findings suggest that the greater the contrast in the 2D image, the higher the artifacts in the 3D image.

A User-Friendly Protocol for Mandibular Segmentation of CBCT Images for Superimposition and Internal Structure Analysis

BACKGROUND

Since cone-beam computed tomography (CBCT) technology has been widely adopted in orthodontics, multiple attempts have been made to devise techniques for mandibular segmentation and 3D superimposition. Unfortunately, as the software utilized in these methods are not specifically designed for orthodontics, complex procedures are often necessary to analyze each case. Thus, this study aimed to establish an orthodontist-friendly protocol for segmenting the mandible from CBCT images that maintains access to the internal anatomic structures.

METHODS

The "sculpting tool" in the Dolphin 3D Imaging software was used for segmentation. The segmented mandible images were saved as STL files for volume matching in the 3D Slicer to validate the repeatability of the current protocol and were exported as DICOM files for internal structure analysis and voxel-based superimposition.

RESULTS

The mandibles of all tested CBCT datasets were successfully segmented. The volume matching analysis showed high consistency between two independent segmentations for each mandible. The intraclass correlation coefficient (ICC) analysis on 20 additional CBCT mandibular segmentations further demonstrated the high consistency of the current protocol. Moreover, all of the anatomical structures for superimposition identified by the American Board of Orthodontics were found in the voxel-based superimposition, demonstrating the ability to conduct precise internal structure analyses with the segmented images.

CONCLUSION

An efficient and precise protocol to segment the mandible while retaining access to the internal structures was developed on the basis of CBCT images.

Cone-beam computed tomography classification of the mandibular second molar root morphology and its relationship to panoramic radiographic appearance

OBJECTIVES

This study aimed to clarify the relationship between the panoramic radiographic appearance and the longitudinal cone-beam computed tomography (CBCT) classification of root configurations of the mandibular second molar.

METHODS

Panoramic radiographs of 1058 mandibular second molars were classified into five types according to the number and configuration of the roots. These molars were also examined with CBCT at four levels between the pulp chamber and the root apex, and axial images perpendicular to the root axis were categorized into three patterns: single (fused root with small grooves on both buccal and lingual sides or a round root with one canal); double (two separate roots with a trabecular appearance between them); and C-shaped (root with a deep groove opening only on the lingual or buccal side relative to the opposite side). Based on these patterns and their scan levels, the CBCT root morphology appearance in each tooth unit was classified into seven groups. Relationships were investigated between these seven CBCT groups and the five panoramic root types.

RESULTS

In panoramic types 1 and 2 (with separate roots), 85% had roots with a double pattern (groups II and III) on the CBCT images. In panoramic types 3 and 4 (with fused roots), 85% had C-shaped CBCT patterns at the lower scan levels.

CONCLUSIONS

When panoramic images show fused root types, CBCT examinations should be planned to clarify the root canal configuration.

Cone beam computed tomography in dentomaxillofacial radiology: a two-decade overview

OBJECTIVES

The aim of this study was to evaluate and summarise features of currently and formerly available cone beam CT (CBCT) devices from 1996 to 2019. Additionally, a recommendation for standardised reporting of CBCT characteristics was provided.

METHODS AND MATERIALS

Information about the features of all available CBCT devices was obtained from the manufacturers' available data. Moreover, site visits to newly developed CBCT machines' manufacturers were performed in order to obtain relevant information.

RESULTS

A total of 279 CBCT models from 47 manufacturers located in 12 countries (Brazil, China, Denmark, Finland, France, Germany, Italy, Japan, Republic of Korea, Slovakia, Thailand, and USA) could be listed. Overall, wide variations in CBCT features and technical specifications were identified.

CONCLUSIONS

CBCT in dentomaxillofacial radiology is a generic term applicable to a broad range of CBCT machines and features. Experimental outcomes and literature statements regarding radiation doses, imaging performance and diagnostic applicability of dental CBCT cannot be simply transferred from one CBCT model to another considering a wide variation in technical characteristics and clinical diagnostic performance. The information tabulated in the present study will be later provided on the International Association of DentoMaxilloFacial Radiology website (www.iadmfr.one).

Image retake rates of cone beam computed tomography in a dental institution

OBJECTIVES

To investigate the frequency and reasons for retaking cone beam computed tomography (CBCT) scans in an oral and maxillofacial radiology imaging clinic in a dental institution.

MATERIALS AND METHODS

A retrospective cohort chart audit of the patient image database was performed for 1737 patients attending the Diagnostic Imaging clinic at the Prince Philip Dental Hospital from February 2016 to May 2019, and the rate of, and reasons for, CBCT image re-exposure was tallied. Patient demographics (age and gender) and CBCT acquisition parameters (CBCT unit, field-of-view (FOV), scanned region of interest, and exposure time) were recorded and correlated to retake analysis.

RESULTS

The retake rate was 4.6% (80/1737). The most common reasons for re-exposure were incomplete FOV coverage (57.5%) and motion artifacts (27.5%). Patients under 12 years of age had a significantly higher risk for motion artifacts. CBCT for the temporomandibular joint (TMJ) had a significantly higher risk for incomplete FOV coverage.

CONCLUSIONS

Children (less than 12 years of age) demonstrate a higher frequency of retakes, principally due to motion artifacts. TMJ CBCT examinations have a higher frequency of retakes due to an incomplete FOV coverage.

CLINICAL RELEVANCE

Information regarding the frequency and reasons for CBCT retakes is beneficial to identify procedures, practices, or patients susceptible to additional radiation exposure and implement appropriate and specific quality control protocols.

Best clinical practice guidance for prescribing dental radiographs in children and adolescents: an EAPD policy document

BACKGROUND

The European Academy of Paediatric Dentistry (EAPD) proposes this best clinical practice guidance to help practitioners decide when and how to prescribe dental radiographs in children and adolescents.

METHODS

Four expert working groups conducted each a systematic review of the literature. The main subjects were radiation protection, intraoral dental radiography (bitewing and periapical radiographs), panoramic radiography (PR) and cone-beam computed tomography (CBCT). In addition, three workshops were held during the corresponding EAPD Interim Seminar in Chania (Crete, Greece) in 2019. On the basis of the identified evidence, all invited experts presented their findings and during the workshops aspects of clinical relevance were discussed.

RESULTS

Several clinical-based recommendations and statements were agreed upon.

CONCLUSION

There is no or low-grade evidence about the efficacy of dental radiographic examinations in young populations. The given recommendations and rationales should be understood as best clinical practice guidance. It is essential to respect the radiological principles of an individualized and patient-specific justification. When a dental radiograph is required, its application needs to be optimized, aiming at limiting the patient's exposure to ionising radiation according to the ALADAIP principle (As Low As Diagnostically Achievable being Indication-oriented and Patient-specific).

Generative Noise Reduction in Dental Cone-Beam CT by a Selective Anatomy Analytic Iteration Reconstruction Algorithm

Dental cone-beam computed tomography (CBCT) is a powerful tool in clinical treatment planning, especially in a digital dentistry platform. Currently, the “as low as diagnostically acceptable” (ALADA) principle and diagnostic ability are a trade-off in most of the 3D integrated applications, especially in the low radio-opaque densified tissue structure. The CBCT benefits in comprehensive diagnosis and its treatment prognosis for post-operation predictability are clinically known in modern dentistry. In this paper, we propose a new algorithm called the selective anatomy analytic iteration reconstruction (SA2IR) algorithm for the sparse-projection set. The algorithm was simulated on a phantom structure analogous to a patient’s head for geometric similarity. The proposed algorithm is projection-based. Interpolated set enrichment and trio-subset enhancement were used to reduce the generative noise and maintain the scan’s clinical diagnostic ability. The results show that proposed method was highly applicable in medico-dental imaging diagnostics fusion for the computer-aided treatment planning, because it had significant generative noise reduction and lowered computational cost when compared to the other common contemporary algorithms for sparse projection, which generate a low-dosed CBCT reconstruction.

Assessing the Translation of Research and Innovation into Dental Practice

INTRODUCTION

Over the past 100 y, there have been an unprecedented number of innovations that have improved oral health and functioning. Variations in lag times between discovery and clinical adoption are related to dentist education, the clinical availability of technology, and the perceived value of an innovation.

OBJECTIVES

The purposes of this cross-sectional study were 1) catalogue research discoveries and innovations over the past 30 y and 2) from that list identify those which practicing dentists believe have maximally affected patient care.

METHODS

Thirty International Association for Dental Research leaders identified innovations over the past 30 y that have significantly affected dental care. The 30 most cited innovations were included in a questionnaire that was sent to a random sample of US dentists who graduated dental school during or before 1995 (before the recency of identified discoveries) and devoted ≥50% of their time to patient care. Eighty-two percent of respondents identified as general dentists and 18% as specialists. Respondents were asked to identify 5 to 7 items whose loss would have the most adverse effects on patient care.

RESULTS

The most cited advances were adhesive dental materials (74.5%), dental implants (71.9%), direct bonding systems (71.2%), dental loupes (54.7%), universal precautions for infection control (48.6%), and digital imaging (46.0%). There were differences in the ranking of responses between generalists and specialists. For the oral surgeons and periodontists (OMSPER, n = 51), top choices were dental implants (82%), cone beam computed tomography (CBCT) imaging (74%), regenerative dentistry and tissue engineering (68%), universal precautions (58%), digital imaging (56%), and dental loupes (48%).

CONCLUSIONS

There was agreement among generalists and specialists about the importance of dental implants, digital imaging, use of dental loupes, and universal precautions in improving patient care. However, generalists also cited the importance of adhesive dental materials and bonding, and OMSPER cited CBCT and biological-based tissue restoration as major advances.

KNOWLEDGE TRANSFER STATEMENT

Many advances in dental patient care capitalize on innovations and technologies that have emerged after dentists graduate from dental school. Adoption of new technologies is influenced by information acquired from professional journals, continuing education, industry marketing activities, and interactions with colleagues. The results of this study suggest that innovations that are directly related to clinical procedures were rated most impactful. Future research should consider cost-effectiveness and patient perceptions on the impact of innovations and technologies.

The missing link in image quality assessment in digital dental radiography

Digital radiography is gaining popularity among general dental practitioners. It includes digital intraoral radiography, digital panoramic radiography, digital cephalography, and cone-beam computed tomography. In this study, we focused on the methods to assess image quality of these techniques, except for digital cephalography, in the light of historical issues. We stressed on the importance of the development of a standardized phantom and quantitative analysis of diagnostic image quality using it, especially in the aspect of psychophysical properties of these digital systems. There is no missing link in the image quality assessment in digital intraoral radiography and cone-beam computed tomography in dental use. However, there are missing links between physical and diagnostic image qualities in panoramic radiography. The development of a semi-standardized phantom and the corresponding quantitative analysis method for image quality may be required in digital panoramic radiography. Quantitative image quality assessment using a standardized phantom will also be promising in the future artificial intelligence era.