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Barakat RM, Almohareb RA, Alharbi AO, Alhazmi A, Alomar R. Comparative Accuracy and Reliability of Three Electronic Apex Locators in Determining the Apical Constriction of Molar Canals: A Micro-CT Evaluation. J Clin Med 2024; 13:5199. [PMID: 39274411 PMCID: PMC11396558 DOI: 10.3390/jcm13175199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/25/2024] [Accepted: 08/31/2024] [Indexed: 09/16/2024] Open
Abstract
Background: Determining the correct apical limit for root canal treatment is essential for its success. This study evaluates the accuracy of three electronic apex locators (EALs) in locating the apical constriction (AC) in molar canals. Methods: Forty extracted human mandibular molars were scanned using micro-CT, and endodontic access cavities were created. Teeth were mounted in alginate, and three EALs-Root ZX-mini, Root ZX-II, and Sirona integrated apex locator-were used to measure the canal working length in dry canals and with EDTA gel. Micro-CT scans were performed with files in place, and the distance from the AC was calculated. Measurements within 0.1-0.5 mm were categorized as 'close'. Those extending beyond towards the major foramen were categorized as 'beyond', otherwise they were classified as 'far'. Data analysis was conducted with a level of significance set at 5%. Results: Most readings for all EALs were in the 'close' category, with significant differences between devices (p < 0.0001). Root ZX-mini and Root ZX-II had 74.4% and 72.5% 'close' readings, respectively, versus 51% for Sirona integrated. Accuracy did not differ significantly between dry and EDTA-treated canals (p = 0.306). All EALs demonstrated excellent operator reliability (ICC 0.996-1.00). Conclusions: All EALs accurately determined AC, unaffected by lubricants. However, Root ZX-mini and Root ZX-II outperformed Sirona integrated. All EALs showed consistent reliability.
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Affiliation(s)
- Reem M Barakat
- Dental Clinics Department, King Abdullah bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Rahaf A Almohareb
- Department of Clinical Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Arwa O Alharbi
- Dental Intern, College of Dentistry, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 1167, Saudi Arabia
| | - Asma Alhazmi
- Dental Intern, College of Dentistry, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 1167, Saudi Arabia
| | - Reem Alomar
- Dental Intern, College of Dentistry, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 1167, Saudi Arabia
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Kaşıkçı S, Özbek SK, Şirinoğlu E, Özdemir O. Clinicians' perspectives, inducements, preferences, and clinical experiences regarding the use of electronic apex locator and apex locator integrated engine-driven instrumentation: a cross-sectional study. BMC Oral Health 2024; 24:939. [PMID: 39143627 PMCID: PMC11323617 DOI: 10.1186/s12903-024-04710-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/06/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND This study aimed to investigate the perspectives, preferences, and clinical experiences regarding using electronic apex locator and apex locator integrated instrumentation of dentists and endodontists. METHODS A web-based questionnaire consisting of 3 parts and 23 closed-ended questions to achieve the objective of the study was carried out in ethical conditions between August and October 2023. The first part of survey included demographic information, while the second part was about evaluating electronic apex locator usage. In the last part, only participants' use of apex locator-integrated instrumentation was evaluated. Data were analyzed at a significance level of p < 0.05. RESULTS A total of 297 clinicians, including 59 endodontists and 34 endodontic residents/Ph.D. students participated in the questionnaire. Endodontists and endodontic residents/Ph.D. students perform statistically significantly more root canal treatments per week on average (p = 0.001). For the working length determination method (multiple option question), 78.5% of participants use an electronic apex locator and 39.7% apex locator-integrated engines. However, the preference rate for electronic apex determination technique was generally 95.6%, with the full rate confirmation of endodontists and endodontic residents/Ph.D. students (100%). A total of 21 endodontists out of 59 prefer apex locator integrated engine-driven instrumentation. Although many of these specialized clinicians use this technique, they stated that they measure electronic working length passively for confirmation of the working length before (90.5%) and after the preparation (66.7%). CONCLUSIONS Dentists, as well as endodontists, are skeptical about apex locator-integrated engine-driven instrumentation. Using this technique as a supporter rather than a primary way for preparation within safe limits may give safer results in terms of treatment outcomes.
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Affiliation(s)
- Sena Kaşıkçı
- Department of Endodontics, Faculty of Dentistry, Kocaeli University, Kocaeli, 41190, Türkiye.
| | - Sena Kolunsağ Özbek
- Department of Endodontics, Faculty of Dentistry, Kocaeli University, Kocaeli, 41190, Türkiye
| | - Ebru Şirinoğlu
- Department of Endodontics, Faculty of Dentistry, Kocaeli University, Kocaeli, 41190, Türkiye
| | - Olcay Özdemir
- Department of Endodontics, Faculty of Dentistry, Karabük University, Karabük, 78050, Türkiye
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Moreira-Souza L, Gaêta-Araujo H, Lima CADS, Brasil DM, Costa ED, Oliveira ML, Freitas DQ. Influence of different viewing conditions on the detection of fractured endodontic instruments using periapical radiographs at 3 projection angles. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:744-750. [PMID: 34272189 DOI: 10.1016/j.oooo.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/12/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The objective of this study was to assess the influence of ambient lighting levels and horizontal viewing angle (HVA) on the radiographic detection of fractured endodontic instruments in root canals in extracted human mandibular molars. STUDY DESIGN Thirty-two root canals were selected. Endodontic instrument fracture was induced in 24 canals, and all canals were endodontially treated. Periapical radiographs were obtained at orthoradial, mesioradial, and distoradial projection angles. Five oral radiologists examined the radiographs for detection of fractured endodontic instruments under 3 ambient lighting levels (high, 450 lux; medium, 28 lux; and low, 2.5 lux) and 3 HVAs (90°, 67.5°, and 45°). Area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, and specificity were calculated and compared by 2-way analysis of variance using Tukey post hoc tests (α = .05). RESULTS AUROC data indicated that ambient lighting (P = .739) and HVA (P = .238) did not significantly influence the detection of fractured endodontic instruments. Overall mean diagnostic values were 0.745, 0.57, 0.46, and 0.90 for AUROC, accuracy, sensitivity, and specificity, respectively. CONCLUSIONS The viewing conditions assessed in this study did not influence the radiographic detection of fractured endodontic instruments in root canals.
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Affiliation(s)
- Larissa Moreira-Souza
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil.
| | - Hugo Gaêta-Araujo
- Division of Oral Radiology, School of Dentistry, Federal University of Alfenas (UNIFAL-MG), Minas Gerais, Brazil
| | - Carlos Augusto de Souza Lima
- Division of Oral Radiology, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, São Paulo, Brazil; Department of Stomatology, Public Health and Forensic Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Danieli Moura Brasil
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Eliana Dantas Costa
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Matheus L Oliveira
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
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Effect of Orthodontic Brackets on the Accuracy of Apex Locators: A Pilot Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6615560. [PMID: 33987442 PMCID: PMC8093058 DOI: 10.1155/2021/6615560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to evaluate the effect of metal orthodontic brackets on the accuracy of electronic apex locator (EAL). The actual canal lengths (ACL) of 40 mandibular incisor teeth were determined. Then, the teeth were randomly divided into two groups (n = 20). Orthodontic metal brackets were applied in the first group, and no brackets, in the second group. The working length of each tooth was measured with an EAL under 3 test conditions according to the distance between the lip clip and sample tooth. Data were analyzed using one-way repeated measures analysis of variance and Tukey's post hoc tests (p = 0.05). In the bracketed samples, when the lip clip was located at 1 cm and 2 cm from the samples. The mean differences between the EAL measurements and ACLs were statistically higher than those when the samples were located 3 cm from the lip clip (p < 0.05). There were also statistically significant differences between EAL measurements and ACLs in the bracketed samples located 1 and 2 cm from the lip clip (p < 0.05). In the nonbracketed group, the differences between EAL measurements and ACLs were not statistically significant in the samples located 1, 2, and 3 cm from the lip clip (p > 0.05). Use of orthodontic metal brackets can negatively influence the accuracy of the electronic apex locator when the distance between the lip clip and bracket was short. A minimum of 3 cm distance should be kept between the lip clip and tooth in order to make consistent electronic measurements.
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Ex Vivo Evaluation of the Accuracy of 3 Electronic Apex Locators in Different Environments: A Micro-Computed Tomography Study. Eur Endod J 2020; 5:226-230. [PMID: 33353910 PMCID: PMC7881377 DOI: 10.14744/eej.2020.30633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: The aim of this study was to compare the accuracy of three electronic apex locators (EALs) (Propex Pixi, Mini Root ZX, Raypex 5) in determining working length (WL) under different environments (existence of blood-pulp/sodium hypochlorite in root canal space) using micro-computed tomography (micro-CT) measurements. Methods: Twenty-five single-rooted human teeth that were scheduled for extraction were selected for the study. Measurements were performed with the Propex Pixi, Mini Root ZX, Raypex 5 in vivo conditions in the presence of NaOCl irrigant solution or blood-pulp tissue. After that the teeth were extracted and scanned using micro-CT. The measurements of WL obtained with the different EALs in different environments were statistically compared. Significance was set at P<0.05. Results: There were no significant differences among the WL measurements performed with EALs or micro CT groups under different clinical enviroments. All EALs tested gave reliable results in respect to apical constriction. Conclusion: The accuracy of the tested EALs is not affected by pulp tissues and blood or NaOCl.
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Pour DG, Sedaghati A, Shamshiri AR. Effect of Resolution and Bit Depth on Inferior Alveolar Canal Visualization on Exported Mandibular Cone-Beam Computed Tomography Images. J Oral Maxillofac Surg 2020; 78:731-737. [PMID: 32006490 DOI: 10.1016/j.joms.2019.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 12/06/2019] [Accepted: 12/18/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Cone-beam computed tomography (CBCT) is commonly requested before dental implant treatment for the anatomic assessment of the inferior alveolar canal (IAC) to prevent its neurovascular content from being traumatized. CBCT images can be saved in different types of resolutions and bit depths; these parameters may significantly affect the diagnostic accuracy of images. This study aimed to assess the effect of resolution and bit depth on IAC visualization on exported mandibular CBCT images. MATERIALS AND METHODS Forty-one mandibular CBCT images of differing image resolutions and voxel sizes (0.16, 0.32, and 0.48 mm) and differing bit depths (12 and 15) were exported from a software program as a single file. Two observers evaluated the cross-sectional images in terms of IAC visibility using a 3-point scale (good, moderate, and poor). Disagreements were resolved by including a third observer, and the highest agreement was recorded. RESULTS Study interobserver agreement was acceptable (84.2%) for IAC observation. The percentage of IAC observation was from 84.1 to 100% with the 12- and 15-bit depths, with a constant image resolution of 0.16 and 0.32 mm, respectively. A significant difference (from 19.5 to 48.8%) was noted between the 2 bit depths in the percentage of good IAC visualization with a constant resolution of 0.48 mm. Reduction in the image resolution to 0.48 mm showed a significant difference (19.5 to 100%) between the 12- and 15-bit depths in good IAC visualization. CONCLUSIONS Exporting the mandibular CBCT images with 0.32 mm of resolution and a 12-bit depth will produce good and moderate radiographic IAC observation with the benefit of a smaller file size.
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Affiliation(s)
- Daryoush Goodarzi Pour
- Associate Professor, Department of Oral and Maxillofacial Radiology, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Sedaghati
- Postgraduate Student, Department of Oral and Maxillofacial Radiology, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ahmad Reza Shamshiri
- Assistant Professor, Community Oral Health Department, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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Lima CAS, Nascimento EHL, Gaêta-Araujo H, Oliveira-Santos C, Freitas DQ, Haiter-Neto F, Oliveira ML. Is the digital radiographic detection of approximal caries lesions influenced by viewing conditions? Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 129:165-170. [PMID: 31474575 DOI: 10.1016/j.oooo.2019.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/04/2019] [Accepted: 08/03/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of this study was to assess the influence of different viewing conditions (combinations of computer display, horizontal viewing angle, and ambient lighting) on the detection of approximal caries lesions on digital radiographic images. STUDY DESIGN Forty posterior teeth were mounted in a plaster block and radiographed by using a CMOS sensor-based system. Three oral radiologists assessed the radiographic images under different conditions of computer display (iMac 5K 27", Barco MDRC-2124, and Dell P2314H), horizontal viewing angles (90 degrees, 67.5 degrees, and 45 degrees), and ambient lighting (low, medium, and high) and were asked to detect the presence of approximal caries lesions, which were confirmed by means of micro-computed tomography (micro-CT), using a 5-point scale. The area under the receiver operating characteristic curve, sensitivity, and specificity were calculated and compared by analysis of variance testing (α = 0.05). Intra- and interobserver agreements were assessed with the Kappa test. RESULTS Computer display, horizontal viewing angle, and ambient lighting did not significantly influence the diagnosis of approximal caries lesions. In general, moderate values of accuracy, low sensitivity, and high specificity were found for all viewing conditions. CONCLUSIONS The viewing conditions assessed in this study did not influence the detection of approximal caries lesions on digital radiographic images. Dental practitioners are encouraged to find their most comfortable viewing condition for this diagnostic task.
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Affiliation(s)
- Carlos Augusto Souza Lima
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Eduarda Helena Leandro Nascimento
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Hugo Gaêta-Araujo
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Christiano Oliveira-Santos
- Department of Stomatology, Division of Oral Radiology, School of Dentistry of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Francisco Haiter-Neto
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Matheus Lima Oliveira
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil.
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Oliveira-Santos N, Michels M, Freitas DQ, Haiter-Neto F, Oliveira ML. Influence of phosphor plate-based radiographic image specifications on fractal analysis of alveolar bone. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:418-423. [PMID: 31324583 DOI: 10.1016/j.oooo.2019.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/20/2019] [Accepted: 06/23/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the influence of spatial resolution, bit depth, and enhancement filters on the fractal dimension (FD) of photostimulable phosphor (PSP) plate-based intraoral radiographic images of alveolar bone. STUDY DESIGN Periapical radiographs were obtained using PSP plates, which were scanned at 2 spatial resolutions: 1270 dpi and 2000 dpi. All images were subjected to 3 enhancement filters-Perio, Endo, and Fine-and exported in 8 and 16 bits. A region-of-interest was selected on alveolar bone and the FD value was calculated. The multiway analysis of variance test followed by the post hoc Tukey test compared the FD values between the different groups (α = 0.05). RESULTS No significant difference was observed in FD values between the 8- and 16-bit images. Except for the Perio filter, FD values were significantly higher for images at 1270 dpi. FD values were significantly higher for the Perio filter, followed by the Endo filter, and the Fine filter. The FD values of the Fine filter did not differ significantly from the original image. CONCLUSIONS Fractal analysis of alveolar bone obtained from PSP plate-based intraoral radiographic images is influenced by spatial resolution and some digital enhancement filters; therefore, for FD comparison purposes, images should have the same specifications.
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Affiliation(s)
- Nicolly Oliveira-Santos
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Sao Paulo, Brazil.
| | - Mariane Michels
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Sao Paulo, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Sao Paulo, Brazil
| | - Francisco Haiter-Neto
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Sao Paulo, Brazil
| | - Matheus Lima Oliveira
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Sao Paulo, Brazil
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Lima CAS, Freitas DQ, Ambrosano GMB, Haiter-Neto F, Oliveira ML. Influence of interpretation conditions on the subjective differentiation of radiographic contrast of images obtained with a digital intraoral system. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 127:444-450. [PMID: 30738753 DOI: 10.1016/j.oooo.2019.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/24/2018] [Accepted: 01/01/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate interpretation conditions in the subjective in vitro assessment of dental tissue-equivalent radiographic contrast. STUDY DESIGN Radiographic images with the density of dental structures were randomized and arranged in 20 sequences with images juxtaposed and separated. Twelve observers interpreted the sequence among the most radiolucent and radiopaque images with 3 displays, 3 horizontal viewing angles, and 3 ambient light conditions. The evaluation time was recorded. The hit percentage was calculated for each evaluation. Three-way analysis of variance with Tukey's test was used to compare the conditions of interpretation. The intraclass correlation coefficient was used to assess agreement (α = 0.05). RESULTS No differences in hit percentages were found among the 3 displays or among the juxtaposed and separated images. Increased hit percentages were recorded for images assessed at 90° compared with 45° for all displays and in high ambient light vs intermediate and low light at 90°. Increased evaluation time was recorded for the consumer-grade display under high ambient light and for the separated images. CONCLUSIONS The subjective in vitro assessment of dental tissue-equivalent radiographic contrast is not influenced by computer display, which should be viewed at a horizontal viewing angle of 90° and under high ambient light. Longer evaluation times may be expected with consumer-grade displays.
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Affiliation(s)
- Carlos Augusto Souza Lima
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Deborah Queiroz Freitas
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | | | - Francisco Haiter-Neto
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Matheus Lima Oliveira
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.
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Numerical Evaluation of Image Contrast for Thicker and Thinner Objects among Current Intraoral Digital Imaging Systems. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5215413. [PMID: 28497053 PMCID: PMC5401743 DOI: 10.1155/2017/5215413] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/23/2017] [Indexed: 11/17/2022]
Abstract
The purpose is to evaluate the performance of current intraoral digital detectors in detail using a precise phantom and new method. Two aluminum step wedges in 0.5 mm steps were exposed by two photostimulable phosphor plate (PSP) systems—one with automatic exposure compensation (AEC) and the other without AEC—and a CCD sensor. Images were obtained with 3 doses at 60 kV. The effect of metallic material also was evaluated. The contrast-to-noise ratio (CNR) for thinner steps and the low contrast value (LCV) for thicker steps were obtained. The CCD system was the best under all conditions (P < 0.001), although the Gray value was sensitive to the dose, and the Gray value-dose relation varied greatly. The PSP system with AEC was superior to that without AEC for the LCV (P < 0.001) but was inferior to it regarding the CNR (P < 0.001). CNR and LCV in the PSP system without AEC were not affected by the metallic plate. Intraoral digital imaging systems should be chosen according to their diagnostic purpose. PSP system with AEC may be the best for detecting molar proximal caries, whereas the PSP system without AEC may be better for evaluating small bone regeneration in periodontal disease. The CCD system provided the best performance.
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Aydin U, Karataslioglu E, Aksoy F, Yildirim C. In vitro evaluation of Root ZX and Raypex 6 in teeth with different apical diameters. J Conserv Dent 2015; 18:66-9. [PMID: 25657531 PMCID: PMC4313483 DOI: 10.4103/0972-0707.148899] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/14/2014] [Accepted: 12/18/2014] [Indexed: 11/16/2022] Open
Abstract
Background: There is a growing interest about electronic apex locators for working length determination. There are several studies dealing with their performance in different conditions. Aims: The aim of this study is to evaluate the accuracy of Root ZX and Raypex 6 in teeth with different apical diameters. Materials and Methods: Actual working length (AWL) of 80 single rooted teeth were determined as 0.5 mm short of apical foramen. The teeth were divided into 4 groups (n = 20). First group (G 0) included teeth with mature apices. Root canals of the other groups (G 32, G 57 and G 72) were enlarged until apical sizes of 0.32, 0.57 and 0.72 mm were obtained. Samples were embedded in alginate and electronic measurements (EM) were performed. Statistical analysis: was achieved with Fisher exact test. Results: Both devices revealed a high rate of success in G 0 and G 32. Their accuracy decreased significantly in G 57 and G 72 groups (P < 0.05). Intra-group results of Root ZX and Raypex 6 were similar (P > 0.05). Conclusions: Root ZX and Raypex 6 are reliable in teeth with mature apices. At foramen diameters exceeding 0.57 mm, their accuracy is susceptible.
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Affiliation(s)
- Ugur Aydin
- Department of Endodontics, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey
| | - Emrah Karataslioglu
- Department of Endodontics, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey
| | - Fatih Aksoy
- Department of Endodontics, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey
| | - Cihan Yildirim
- Department of Endodontics, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey
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Abstract
OBJECTIVES Doses induced by individual dental examinations are low. However, dental radiography accounts for nearly one third of the total number of radiological examinations in the European Union. Therefore, special attention is needed with regard to radiation protection. In order to lower patient doses, the staff performing dental examinations must have competence in imaging as well as in radiation protection issues. This paper presents a systematic review about the core competencies needed by the healthcare staff in performing digital dental radiological imaging quality assurance. MATERIALS AND METHODS The following databases were searched: Pubmed, Cinahl, Pro Quest and IEEXplore digital library. Also volumes of some dental imaging journals and doctoral theses of the Finnish universities educating dentists were searched. The search was performed using both MeSH terms and keywords using the option 'search all text'. The original keywords were: dental imaging, digital, x-ray, panoramic, quality, assurance, competence, competency, skills, knowledge, radiographer, radiologist technician, dentist, oral hygienist, radiation protection and their Finnish synonyms. RESULTS Core competencies needed by the healthcare staff performing digital dental radiological imaging quality assurance described in the selected studies were: management of dental imaging equipment, competence in image quality and factors associated with it, dose optimization and quality assurance. CONCLUSIONS In the future there will be higher doses in dental imaging due to increasing use of CBCT and digital imaging. The staff performing dental imaging must have competence in dental imaging quality assurance issues found in this review. They also have to practice ethical radiation safety culture in clinical practice.
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Affiliation(s)
- Eija Metsälä
- Degree Programme of Radiography and Radiotherapy, Helsinki Metropolia University of Applied Sciences , Helsinki , Finland
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Martins JNR, Marques D, Mata A, Caramês J. Clinical efficacy of electronic apex locators: systematic review. J Endod 2014; 40:759-77. [PMID: 24862702 DOI: 10.1016/j.joen.2014.03.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 03/13/2014] [Accepted: 03/15/2014] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Apical constriction has been proposed as the most appropriate apical limit for the endodontic working length. Despite being the most used, some limitations are attributed to the radiographic method of working length determination. It lacks precision because it is based on the average position of the apical constriction. The electronic apex locators have been presented as an alternative to the odontometry performed by radiography. These devices detect the transition of the pulp to the periodontal tissue, which is anatomically very close to the apical constriction and may perform with improved accuracy. METHODS A systematic review was performed to compare the radiographic and electronic methods. Clinical studies that compared both methods were searched for on 7 electronic databases, a manual search was performed on the bibliography of articles collected on the electronic databases, and the authors were contacted to ask for references of more research not detected on the electronic and manual search. RESULTS Twenty-one articles were selected. The majority were comparative or evaluation studies, and very few clinical studies comparing both methods are available. Several methodological limitations are present on the collected articles and debated in this review. CONCLUSIONS Although the available scientific evidence base is short and at considerable risk of bias, it is still possible to conclude that the apical locator reduces the patient radiation exposure and also that the electronic method may perform better on the working length determination. At least one radiographic control should be performed to detect possible errors of the electronic devices.
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Affiliation(s)
- Jorge N R Martins
- School of Dental Medicine, Lisbon University, Lisbon, Portugal; Inter PG Endodontics, New York University College of Dentistry, New York, New York; Department of Endodontics, Implantology Institute, Lisbon, Portugal.
| | - Duarte Marques
- School of Dental Medicine, Lisbon University, Lisbon, Portugal; Oral Biology and Biochemistry Group, Biomedical and Oral Sciences Research Unit (FCT Unit 4062), Evidence Based Dentistry Center, Lisbon University, Lisbon, Portugal; Implantology Institute, Lisbon, Portugal
| | - António Mata
- School of Dental Medicine, Lisbon University, Lisbon, Portugal; Oral Biology and Biochemistry Group, Biomedical and Oral Sciences Research Unit (FCT Unit 4062), Evidence Based Dentistry Center, Lisbon University, Lisbon, Portugal; Basic Science and Cranio-Facial Biology, New York University College of Dentistry, New York, New York
| | - João Caramês
- School of Dental Medicine, Lisbon University, Lisbon, Portugal; Implantology Institute, Lisbon, Portugal
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Brito-Júnior M, Camilo CC, Moreira-Júnior G, Pecora JD, Sousa-Neto MD. Effect of pre-flaring and file size on the accuracy of two electronic apex locators. J Appl Oral Sci 2013; 20:538-43. [PMID: 23138740 PMCID: PMC3881801 DOI: 10.1590/s1678-77572012000500008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 08/23/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This ex vivo study evaluated the effect of pre-flaring and file size on the accuracy of the Root ZX and Novapex electronic apex locators (EALs). MATERIAL AND METHODS The actual working length (WL) was set 1 mm short of the apical foramen in the palatal root canals of 24 extracted maxillary molars. The teeth were embedded in an alginate mold, and two examiners performed the electronic measurements using #10, #15, and #20 K-files. The files were inserted into the root canals until the "0.0" or "APEX" signals were observed on the LED or display screens for the Novapex and Root ZX, respectively, retracting to the 1.0 mark. The measurements were repeated after the preflaring using the S1 and SX Pro-Taper instruments. Two measurements were performed for each condition and the means were used. Intra-class correlation coefficients (ICCs) were calculated to verify the intra- and inter-examiner agreement. The mean differences between the WL and electronic length values were analyzed by the three-way ANOVA test (p<0.05). RESULTS ICCs were high (>0.8) and the results demonstrated a similar accuracy for both EALs (p>0.05). Statistically significant accurate measurements were verified in the pre-flared canals, except for the Novapex using a #20 K-file. CONCLUSIONS The tested EALs showed acceptable accuracy, whereas the pre-flaring procedure revealed a more significant effect than the used file size.
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Affiliation(s)
- Manoel Brito-Júnior
- Inter-Institutional PhD Program, State University of Montes Claros, Montes Claros, MG, Brazil.
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Alothmani OS, Friedlander LT, Monteith BD, Chandler NP. Influence of clinical experience on the radiographic determination of endodontic working length. Int Endod J 2012; 46:211-6. [DOI: 10.1111/j.1365-2591.2012.02109.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 07/04/2012] [Indexed: 12/01/2022]
Affiliation(s)
- O. S. Alothmani
- Division of Endodontics, Department of Conservative Dentistry, Faculty of Dentistry; King Abdulaziz University; Jeddah; Saudi Arabia
| | - L. T. Friedlander
- Department of Oral Rehabilitation, School of Dentistry; University of Otago; Dunedin; New Zealand
| | - B. D. Monteith
- Department of Oral Rehabilitation, School of Dentistry; University of Otago; Dunedin; New Zealand
| | - N. P. Chandler
- Department of Oral Rehabilitation, School of Dentistry; University of Otago; Dunedin; New Zealand
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Comparison between embossed digital imaging and unprocessed film-based radiography in detecting periodontal bone defects: an in vitro study. Oral Radiol 2012. [DOI: 10.1007/s11282-012-0088-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Saghiri MA, Asgar K, Boukani KK, Lotfi M, Aghili H, Delvarani A, Karamifar K, Saghiri AM, Mehrvarzfar P, Garcia-Godoy F. A new approach for locating the minor apical foramen using an artificial neural network. Int Endod J 2011; 45:257-65. [PMID: 22007705 DOI: 10.1111/j.1365-2591.2011.01970.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To develop a new approach for locating the minor apical foramen (AF) using feature-extracting procedures from radiographs and then processing data using an artificial neural network (ANN) as a decision-making system. METHODOLOGY Fifty straight single-rooted teeth were selected and placed in a socket within the alveolar bone of a dried skull. Access cavities were prepared and a file was place in the canals to determine the working length. A radiograph was taken to evaluate the location of the file in relation to the minor foramen and further checked after retrieving the tooth from the alveolar socket. The location of the file tip was categorized into: beyond the AF (long), within the root canal (short) and just at the minor AF (exact). Each radiograph was used to extract relevant features using K-means, Otsu method and Wavelet protocol. Thirty-six extracted features were used for training and the rest were used for evaluating the multi-layer Perceptron ANN model. RESULTS Analysis of the images from radiographs (test samples) by ANN showed that in 93% of the samples, the location of the AF had been determined correctly by false rejection and acceptation error methods. CONCLUSION Artificial neural networks can act as a second opinion to locate the AF on radiographs to enhance the accuracy of working length determination by radiography. In addition, ANN can function as a decision-making system in various similar clinical situations.
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Affiliation(s)
- M A Saghiri
- Department of Dental Material, Dental Branch, Islamic Azad University, Tehran, Iran.
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Vieyra JP, Acosta J. Comparison of working length determination with radiographs and four electronic apex locators. Int Endod J 2011; 44:510-518. [DOI: 10.1111/j.1365-2591.2011.01855.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Kim TY, Choi JW, Lee SS, Huh KH, Yi WJ, Heo MS, Choi SC. Effect of LCD monitor type and observer experience on diagnostic performance in soft-copy interpretations of the maxillary sinus on panoramic radiographs. Imaging Sci Dent 2011; 41:11-6. [PMID: 21977468 PMCID: PMC3174453 DOI: 10.5624/isd.2011.41.1.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 11/29/2010] [Accepted: 12/31/2010] [Indexed: 11/19/2022] Open
Abstract
Purpose The aim of this study was to evaluate the effect of liquid crystal display (LCD) monitor type and observer experience on the diagnostic performance in soft-copy interpretations of maxillary sinus inflammatory lesions on panoramic radiographs. Materials and Methods Ninety maxillary sinuses on panoramic images were grouped into negative and positive groups according to the presence of inflammatory lesions, using CT for confirmation. Monochrome and color LCDs were used. Six observers participated and ROC analysis was performed to evaluate the diagnostic performance. The reading time, fatigue score, and inter-/intra-observer agreements were assessed. Results The interpretation of maxillary sinus inflammatory lesions was affected by the LCD monitor type used and by the experience of the observer. The reading time was not significantly different, however the fatigue score was significantly different between two LCD monitors. Inter-observer agreement was relatively good in experienced observers, while the intra-observer agreement for all observers was good with monochrome LCD but not with color LCD. Conclusion The less experienced observers showed lowered diagnostic ability with a general color LCD.
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Affiliation(s)
- Tae-Young Kim
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
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Vandenberghe B, Bosmans H, Yang J, Jacobs R. A comprehensive in vitro study of image accuracy and quality for periodontal diagnosis. Part 2: The influence of intra-oral image receptor on periodontal measurements. Clin Oral Investig 2010; 15:551-62. [DOI: 10.1007/s00784-010-0417-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 04/14/2010] [Indexed: 11/30/2022]
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Abstract
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.
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Affiliation(s)
- Ann Wenzel
- Department of Oral Radiology, School of Dentistry, Aarhus University, Vennelyst Boulevard, Aarhus, Denmark.
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Park JC, Ha SR, Kim SM, Kim MJ, Lee JB, Lee JH. A randomized clinical 1-year trial comparing two types of non-submerged dental implants. Clin Oral Implants Res 2010; 21:228-36. [DOI: 10.1111/j.1600-0501.2009.01828.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vandenberghe B, Jacobs R. The influence of tube potential on periodontal bone level measurements and subjective image quality using a digital photostimulable storage phosphor sensor. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2010; 1:e5. [PMID: 24421961 PMCID: PMC3886041 DOI: 10.5037/jomr.2010.1105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 12/18/2009] [Indexed: 01/05/2023]
Abstract
Objectives The purpose of the present study was to determine
the measurement accuracy and subjective image quality for periodontal disease diagnosis
when using two X-ray tube voltages with a digital photostimulable storage phosphor
sensor. Material and Methods A digital photostimulable storage phosphor
(PSP) sensor (Vistascan) and a multipulse X-ray generator (Prostyle Intra) with
two tube voltages were used in this study. The front, premolar and molar region
of two adult human cadaver skulls jaws were imaged using the X-ray tube at 63 kV
and 70 kV, both at 8 mA and decreasing exposure times (160 ms, 120 ms and 80 ms).
A standardized exposure protocol containing waxed occlusal keys and an aiming device
ensured proper and reproducible beam alignment. Three observers assessed the digital
radiographs for 31 selected periodontal bone loss sites. Radiographic measurements
were compared to physical measurements (Standard). Subjective ratings of lamina
dura, crater defect and furcation involvement visibility, contrast perception
and bone quality were also performed. Results Multiple regression equation of the variables kV and
exposure time demonstrated no significant difference for the periodontal bone level
measurements (P > 0.05). In 90.3% and 96.7% of the measurements for 70 kV and 63
kV respectively, deviation was within 1 mm. The subjective ratings produced similar
findings in terms of image quality for both tube voltages and the three exposure
times. Conclusions The results of the present study revealed that tube
voltages of 63 kV and 70 kV provided similar accuracy and image quality for periodontal
disease diagnosis.
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Affiliation(s)
- Bart Vandenberghe
- Oral Imaging Center, Department of Dentistry, Oral Pathology and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven Belgium
| | - Reinhilde Jacobs
- Oral Imaging Center, Department of Dentistry, Oral Pathology and Maxillofacial Surgery, Faculty of Medicine, Catholic University of Leuven, Leuven Belgium
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Pascon EA, Marrelli M, Congi O, Ciancio R, Miceli F, Versiani MA. Anin vivocomparison of working length determination of two frequency-based electronic apex locators. Int Endod J 2009; 42:1026-31. [DOI: 10.1111/j.1365-2591.2009.01615.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Heo MS, Choi DH, Benavides E, Huh KH, Yi WJ, Lee SS, Choi SC. Effect of bit depth and kVp of digital radiography for detection of subtle differences. ACTA ACUST UNITED AC 2009; 108:278-83. [PMID: 19272812 DOI: 10.1016/j.tripleo.2008.12.053] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 11/05/2008] [Accepted: 12/22/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The purpose of this study is to investigate the effects of different bit depths and kilovoltage peak (kVp) values used in intraoral digital radiography on observer performance in detecting subtle radiographic density differences. STUDY DESIGN Using an intraoral CCD sensor set at 8- or 12-bit depth, kVp set at 60 or 70, and 14 different exposure times, digital radiographs were acquired of a specially designed aluminum step-wedge phantom with small holes of different depths in each step. Ten observers examined all images. RESULTS The observers counted more holes with the 12-bit images compared with the 8-bit images, particularly at 60 kVp. Significantly more holes were also counted with images taken at 70 kVp compared with those taken at 60 kVp. CONCLUSION Regarding the detection of subtle radiographic density differences, 12-bit images and 70 kVp were superior to 8-bit images and 60 kVp.
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Affiliation(s)
- Min-Suk Heo
- Department of Oral and Maxillofacial Radiology, BK21 and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
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Brito-Júnior M, Santos LAN, Baleeiro ÉN, Pêgo MMF, Eleutério NB, Camilo CC. Linear measurements to determine working length of curved canals with fine files: conventional versus digital radiography. J Oral Sci 2009; 51:559-64. [DOI: 10.2334/josnusd.51.559] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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