A systematic review of relative indications and contra-indications for prescribing panoramic radiographs in dental paediatric patients

Radiologic evaluation of associated symptoms and fractal analysis of unilateral dens invaginatus cases

OBJECTIVE

The aim of this study is to determine the age-based prevalence of dens invaginatus cases and to learn the radiologic findings. In addition, fractal analysis of the periapical regions of unilateral dens invaginatus cases and contralateral teeth was performed to determine the effect of possible microleakage on fractal dimension.

METHODS

A total of 136 patients (170 teeth) identified in panoramic radiographs taken for diagnostic purposes between January 2018 and December 2023 at our Department of Oral and Maxillofacial Radiology were included in the study. Data were analysed using IBM SPSS V23. The Chi-square test was used for comparing categorical variables between groups. The relationship between the FD values calculated around the apexes of the teeth with unilateral dens invaginatus and the contralateral teeth was analyzed by paired t test. A significance level of p < 0.050 was adopted.

RESULTS

The mean age of the cases was calculated as 28.1 (8-63) years. 66 (48.5%) of the cases were female, and 70 (51.1%) were male. The lateral incisor was the most affected tooth among these cases. Bilateral cases were observed in 34 patients. Type 2 was detected in 93 patients, Type 1 in 35 patients, and Type 3 dens invagination in 8 patients. Dens invaginatus cases were observed in 134 maxillary and 2 mandibular teeth. Periapical lesions were seen in 22 of these cases.

CONCLUSIONS

Dens invaginatus cases are a congenital anomaly encountered at any age. Early diagnosis is crucial to prevent the loss of pulp vitality due to these invaginations. It should be noted that these invaginations can affect both jaws. However, due to the prevalence of occurrence in the maxillary anterior teeth and asymptomatic nonvitality, particular attention should be paid to evaluating this region.

YOLO-V5 based deep learning approach for tooth detection and segmentation on pediatric panoramic radiographs in mixed dentition

OBJECTIVES

In the interpretation of panoramic radiographs (PRs), the identification and numbering of teeth is an important part of the correct diagnosis. This study evaluates the effectiveness of YOLO-v5 in the automatic detection, segmentation, and numbering of deciduous and permanent teeth in mixed dentition pediatric patients based on PRs.

METHODS

A total of 3854 mixed pediatric patients PRs were labelled for deciduous and permanent teeth using the CranioCatch labeling program. The dataset was divided into three subsets: training (n = 3093, 80% of the total), validation (n = 387, 10% of the total) and test (n = 385, 10% of the total). An artificial intelligence (AI) algorithm using YOLO-v5 models were developed.

RESULTS

The sensitivity, precision, F-1 score, and mean average precision-0.5 (mAP-0.5) values were 0.99, 0.99, 0.99, and 0.98 respectively, to teeth detection. The sensitivity, precision, F-1 score, and mAP-0.5 values were 0.98, 0.98, 0.98, and 0.98, respectively, to teeth segmentation.

CONCLUSIONS

YOLO-v5 based models can have the potential to detect and enable the accurate segmentation of deciduous and permanent teeth using PRs of pediatric patients with mixed dentition.

ORCA-EFCD consensus report on clinical recommendation for caries diagnosis. Paper I: caries lesion detection and depth assessment

OBJECTIVES

The aim of the present consensus paper was to provide recommendations for clinical practice considering the use of visual examination, dental radiography and adjunct methods for primary caries detection.

MATERIALS AND METHODS

The executive councils of the European Organisation for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD) nominated ten experts each to join the expert panel. The steering committee formed three work groups that were asked to provide recommendations on (1) caries detection and diagnostic methods, (2) caries activity assessment and (3) forming individualised caries diagnoses. The experts responsible for "caries detection and diagnostic methods" searched and evaluated the relevant literature, drafted this manuscript and made provisional consensus recommendations. These recommendations were discussed and refined during the structured process in the whole work group. Finally, the agreement for each recommendation was determined using an anonymous Delphi survey.

RESULTS

Recommendations (N = 8) were approved and agreed upon by the whole expert panel: visual examination (N = 3), dental radiography (N = 3) and additional diagnostic methods (N = 2). While the quality of evidence was found to be heterogeneous, all recommendations were agreed upon by the expert panel.

CONCLUSION

Visual examination is recommended as the first-choice method for the detection and assessment of caries lesions on accessible surfaces. Intraoral radiography, preferably bitewing, is recommended as an additional method. Adjunct, non-ionising radiation methods might also be useful in certain clinical situations.

CLINICAL RELEVANCE

The expert panel merged evidence from the scientific literature with practical considerations and provided recommendations for their use in daily dental practice.

Prescription of panoramic radiographs in children using age-based prevalence of dental anomalies and pathologies

BACKGROUND

Panoramic radiographs (PRs) are used in the detection and diagnosis of developmental dental anomalies and pathologies (DDAPs) in children.

AIM

The primary objective of this observational cohort study was to evaluate the age-based prevalence of DDAP on PRs, whereas the secondary objective was to determine a threshold age for the detection of DDAP to provide supportive evidence for the prescription of PR in paediatric dental practice.

DESIGN

The study examined diagnostic PRs from 581 subjects aged 6 to 19 years. All PRs were reviewed by experienced, calibrated, masked examiners for the identification or presence of anomalies in size, shape, position, structure, and other developmental anomalies and pathologies (ODAP) of the face-neck region in a standardized condition. The data were statistically analyzed for interpretation.

RESULTS

Overall, 74% (n = 411) of the cohort had at least one anomaly (shape anomaly: 12%, number anomaly: 17%, positional anomaly: 28%, structural anomaly: 0%, and ODAP: 63%). The optimal Youden index cutoff for any anomaly was 9 years. Twelve and 15 years also showed predictive ability.

CONCLUSION

The results suggest that PRs should be prescribed at ages 9, 12, and 15 years for the diagnosis of DDAP.

Super-Resolution of Dental Panoramic Radiographs Using Deep Learning: A Pilot Study

Using super-resolution (SR) algorithms, an image with a low resolution can be converted into a high-quality image. Our objective was to compare deep learning-based SR models to a conventional approach for improving the resolution of dental panoramic radiographs. A total of 888 dental panoramic radiographs were obtained. Our study involved five state-of-the-art deep learning-based SR approaches, including SR convolutional neural networks (SRCNN), SR generative adversarial network (SRGAN), U-Net, Swin for image restoration (SwinIr), and local texture estimator (LTE). Their results were compared with one another and with conventional bicubic interpolation. The performance of each model was evaluated using the metrics of mean squared error (MSE), peak signal-to-noise ratio (PNSR), structural similarity index (SSIM), and mean opinion score by four experts (MOS). Among all the models evaluated, the LTE model presented the highest performance, with MSE, SSIM, PSNR, and MOS results of 7.42 ± 0.44, 39.74 ± 0.17, 0.919 ± 0.003, and 3.59 ± 0.54, respectively. Additionally, compared with low-resolution images, the output of all the used approaches showed significant improvements in MOS evaluation. A significant enhancement in the quality of panoramic radiographs can be achieved by SR. The LTE model outperformed the other models.

Improper patient positioning incidence for panoramic radiographic imaging of pediatric patients: Retrospective study

Background/Aim: Improper positioning of the patient reduces the diagnostic quality of panoramic radiographs. It is important to perfect the panoramic patient positioning technique to avoid unnecessary repeat exposures especially in pediatric patients. In this study, pediatric patient sample of records collected from an oral and dental health center were analyzed to determine the relative incidence of positioning errors of panoramic radiographs. Material and Methods: 3788 (1928 girls, 1860 boys) digital panoramic radiographs obtained from the stored data in the system were selected randomly. The radiographs were evaluated by two radiology specialists, by recording separately. The positioning errors of the images were categorized into ten groups: the chin tipped high, chin tipped low, a slumped position, the patient positioned forward, the patient positioned backward, failure to position the tongue against the palate, patient movement during exposure, the head tilted, and the head turned to one side. The results were statistically analyzed for positioning errors according to age and gender. Results: In 3788 radiographs, 2138 (56.4%) were error-free and 1650 (43.6%) were present with positioning errors. In the improper images, a single positional error was present in 1379 (83.6%); two positional errors were present in 248 (15%) and three or more positional errors in 23 (1.4%). The most common error observed was the tongue not being in contact with the hard palate (32.1%). On the other hand, the least common experienced error was patient movement during exposure (2.0%). Conclusions: The positioning errors of panoramic radiographs were common in the sample group of this study. Careful patient positioning can play a significant role in improving the radiographic quality and reducing the number of retakes.

Potential impact of pediatric obstructive sleep apnea on mandibular cortical width dimensions

STUDY OBJECTIVES

To analyze differences in mandibular cortical width (MCW) among children diagnosed with obstructive sleep apnea (OSA) or at high- or low-risk for OSA.

METHODS

A total of 161 children were assessed: 60 children with polysomnographically diagnosed OSA, 56 children presenting symptoms suggestive of high-risk for OSA, and 45 children at low risk for OSA. Children at high- and low-risk for OSA were evaluated through the Pediatric Sleep Questionnaire. MCW was calculated using ImageJ software from panoramic radiograph images available from all participants. Differences between MCW measurements in the 3 groups were evaluated using analysis of covariance and Bonferroni post-hoc tests, with age as a covariate. The association between MCW and specific cephalometric variables was assessed through regression analysis.

RESULTS

The participants' mean age was 9.6 ± 3.1 years (59% male and 41% female). The mean body mass index z-score was 0.62 ± 1.3. The polysomnographically diagnosed OSA group presented smaller MCW than the group at low-risk for OSA (mean difference = -0.385 mm, P = .001), but no difference with the group at high-risk for OSA (polysomnographically diagnosed OSA vs high-risk OSA: P = .085). In addition, the MCW in the group at high-risk for the OSA was significantly smaller than the group at low-risk for the OSA (mean difference = -0.301 mm, P = .014). The cephalometric variables (Sella-Nasion-A point angle (SNA) and Frankfort - Mandibular Plane angle (FMA)) explained only 8% of the variance in MCW.

CONCLUSIONS

Reductions in MCW appear to be present among children with OSA or those at high-risk for OSA, suggesting potential interactions between mandibular bone development and/or homeostasis and pediatric OSA.

CITATION

Fernandes Fagundes NC, d'Apuzzo F, Perillo L, et al. Potential impact of pediatric obstructive sleep apnea on mandibular cortical width dimensions. J Clin Sleep Med. 2021;17(8):1627-1634.

Artificial intelligence system for automatic deciduous tooth detection and numbering in panoramic radiographs

OBJECTIVE

This study evaluated the use of a deep-learning approach for automated detection and numbering of deciduous teeth in children as depicted on panoramic radiographs.

METHODS AND MATERIALS

An artificial intelligence (AI) algorithm (CranioCatch, Eskisehir-Turkey) using Faster R-CNN Inception v2 (COCO) models were developed to automatically detect and number deciduous teeth as seen on pediatric panoramic radiographs. The algorithm was trained and tested on a total of 421 panoramic images. System performance was assessed using a confusion matrix.

RESULTS

The AI system was successful in detecting and numbering the deciduous teeth of children as depicted on panoramic radiographs. The sensitivity and precision rates were high. The estimated sensitivity, precision, and F1 score were 0.9804, 0.9571, and 0.9686, respectively.

CONCLUSION

Deep-learning-based AI models are a promising tool for the automated charting of panoramic dental radiographs from children. In addition to serving as a time-saving measure and an aid to clinicians, AI plays a valuable role in forensic identification.

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).