Awareness and practice of 2D and 3D diagnostic imaging among dentists in Hong Kong

A comparison of virtual reality and three-dimensional multiplanar educational methods for student learning of cone beam computed tomography interpretations

OBJECTIVES

The purpose of this study was to compare student learning of cone beam computed tomography (CBCT) interpretation using immersive virtual reality (VR) and three-dimensional multiplanar (MP) reconstructions.

METHODS

Sixty first-year dental students were randomly allocated to two groups, VR and MP, and underwent a one-on-one educational intervention to identify anatomic structures using CBCT data. All participants completed three multiple-choice questionnaires (MCQs) before (T1), immediately after (T2), and 2 weeks following (T3) the intervention. Additionally, pre-survey, post-survey, NASA Task Load Index (NASA-TLX), and presence questionnaires were completed. Analysis of objective measures of performance on MCQs and subjective data from the questionnaires was completed (α = 0.05).

RESULTS

There was a significant increase in test performance and informational recall between T1-T2 and T1-T3 for VR and MP groups (p < 0.001). However, there were no significant differences in performance on MCQs between T2 and T3. Analysis of the Presence questionnaire indicated that the VR group felt decreased distraction (p = 0.013), increased realism (p = 0.035), and increased involvement (p = 0.047) during the educational intervention when compared with the MP group. Analysis of the NASA-TLX indicated that the VR group experienced more physical demand (p < 0.01) but similar cognitive demand when compared with the MP group. Qualitative responses indicated that the VR group had a more dynamic sense of visualization and manipulation compared to the MP group.

CONCLUSION

Results from this study show that VR is as effective as traditional MP methods of CBCT interpretation learning. Further benefits of VR educational intervention include increased involvement, realism and less distraction.

Awareness and practice of dentomaxillofacial imaging among paediatric dentists: a questionnaire survey of members of the European Academy of Paediatric Dentistry

OBJECTIVES

Assess knowledge, attitudes and practices of paediatric dentists towards dentomaxillofacial imaging and correlate findings with practitioner and practice-specific characteristics.

METHODS

An online questionnaire was sent to all paediatric dentists who attended a scientific seminar organized by the European Academy of Paediatric Dentistry (EAPD) regarding dental radiology. Data regarding available equipment, number, type and reason for performing radiographs, frequency and reasoning for retakes were collected. Data analysis was performed according to practitioner- and practice-specific characteristics and factors directly associated with the type and frequency of radiographs taken, and reason and frequency of repeats were determined. Significant differences were tested using Chi-square and Fisher's exact test. Statistical significance was set at p < 0.05.

RESULTS

More than half of the participants (58%) reported having digital radiographic equipment and almost 1/4 (23%) conventional. A panoramic equipment was available in 39% working places and a CBCT scanner in 41%. Two thirds of the participants reported taking up to 10 intra-oral radiographs per week, mainly for trauma (75%) and caries diagnosis (47%). Extra-oral radiographs were prescribed to monitor development (75%) and for orthodontic evaluation, (63%) with a frequency of less than 5 weekly (45%). Participants reported that they repeat radiographs in a frequency of < 5 per week (70%) mainly due to patient's movement (55%).

CONCLUSIONS

The majority of paediatric dentists within Europe use digital imaging equipment for both intra- and extra-oral radiographs. Nevertheless, great variation in practices exists and, therefore, continuous education in oral imaging is crucial to maintain high quality standards for the radiographic examination of patients.

The Performance of Paralleling Technique and Bisecting Angle Technique for Taking Periapical Radiographs: A Systematic Review

Periapical radiography is a routine radiographic procedure performed by dentists on a daily basis. It can be taken with two techniques, the paralleling technique (P tech) and the bisecting angle technique (B tech). This systematic review aimed to identify the relevant literature, compare the use of P and B techs across various dental specialties, and determine the most appropriate technique to be used for different purposes in taking periapical radiographs. In January 2023, we searched PubMed, Web of Science, Scopus, and Google Scholar to identify the studies that compared the two radiographic techniques. The search string was: (paralleling AND ("bisecting angle" OR "bisected angle")). Manual reference tracing was also performed to identify the studies potentially missed. After screening, 26 studies were included for the qualitative review. The 26 included studies were published between 1976 and 2021. Ten of the studies were about general dentistry (dental radiology in general applications), whereas another ten studies were related to endodontics, such as working length estimation. Most studies advocated the use of the P tech for general, endodontics, implantology, and other indications. B tech was advocated for patients with a low palatal height. More future studies are needed to evaluate their performance in different scenarios with standardized equipment and radiographic positioning.

Is use of CBCT without proper training justified in paediatric dental traumatology? An exploratory study

BACKGROUND

Proper skills in radiographic diagnosis are essential for optimal management of dental trauma.

AIM

To assess diagnostic accuracy obtained by paediatric dentists using Cone Beam Computed Tomography (CBCT) without specific training and to compare this with their performance using intraoral radiographs.

METHODS

Intraoral and CBCT images of 89 teeth, spread over twenty dental trauma cases were presented in random order to nine paediatric dentists. Diagnostic findings were compared with those of a benchmark reference. Sensitivity and specificity were calculated and compared using paired t-tests.

RESULTS

Overall, observers' diagnostic performance was rather poor with significantly higher sensitivity when using 2D images (P = 0.017). Performance differed considerably according to the type of pathology. Using either imaging modality, sensitivity for diagnosing apical pathology and root fractures was high while the opposite was seen for inflammatory root resorption, root cracks and subluxations. Statistically significant differences between imaging modalities were seen for root fractures (P = 0.013) and apical pathology (P = 0.001), in favor of 3D, and for crown fractures (P = 0.009) in favor of 2D.

CONCLUSION

Overall poor performance of paediatric dentists indicates that additional training in radiographic diagnosis is required. In order to justify the use of CBCT to increase diagnostic performance, proper training of the paediatric dentist is mandatory.

Application of Cone Beam Computed Tomography in Risk Assessment of Lower Third Molar Surgery

Risks of lower third molar surgery like the inferior alveolar nerve injury may result in permanent consequences. Risk assessment is important prior to the surgery and forms part of the informed consent process. Traditionally, plain radiographs like orthopantomogram have been used routinely for this purpose. Cone beam computed tomography (CBCT) has offered more information from the 3D images in the lower third molar surgery assessment. The proximity of the tooth root to the inferior alveolar canal, which harbours the inferior alveolar nerve, can be clearly identified on CBCT. It also allows the assessment of potential root resorption of the adjacent second molar as well as the bone loss at its distal aspect as a consequence of the third molar. This review summarized the application of CBCT in the risk assessment of lower third molar surgery and discussed how it could aid in the decision-making of high-risk cases to improve safety and treatment outcomes.

Impact of case complexity on paediatric dentists' ability to radiographically diagnose traumatic dental injuries

BACKGROUND/AIMS

Being able to correctly interpret radiographs after a traumatic dental injury is an essential skill for providing appropriate and timely treatment. The aim of this study was to assess the impact of case complexity on paediatric dentists' performance when radiographically diagnosing traumatic dental injuries (TDI) and to investigate a possible added value of cone-beam computed tomography (CBCT) when compared with digital intra-oral radiography (2D vs 3D).

MATERIALS AND METHODS

A test panel of paediatric dentists was instructed to detect, identify and interpret radiographic findings using either 2D or 3D images. Intra-oral radiographs and CBCT images of 20 trauma cases were presented in random order, and the findings were recorded using structured scoring sheets. Case complexity was determined by two experienced benchmark scorers. Results were analysed using generalized linear mixed modelling.

RESULTS

In general, performance for detection, identification and interpretation of findings was low, both with 2D and 3D images, with significantly lower values for difficult cases (p < 0.05). For easy as well as for difficult cases, 3D imaging resulted in a significantly better performance for detection and identification of findings (P < 0.001). This was not the case for correct interpretation, where significantly poorer performance was seen when using 3D images for difficult cases (p < 0.05).

CONCLUSION

This study provides evidence that case complexity of traumatic dental injuries influences diagnostic performance. The use of CBCT enhanced detection and identification of findings but when case complexity increased, 3D imaging adversely affected correct interpretation.

Content Analysis of YouTube Videos on Radiographic Anatomy on Dental Panoramic Images

The radiographic anatomy on dental panoramic images is essential knowledge for proper diagnosis and treatment planning purposes. No prior study has examined the content of YouTube videos with regard to radiographic anatomy on panoramic radiography. The objective of this study was to provide a content analysis on these videos. The initial search string was: (panoramic anatomy). An additional search was performed with the search string: (OPG landmarks). By screening the resultant videos and their related videos (recommended by YouTube as a list on the right of the screen), a total of 62 videos were screened. Videos were excluded if they were irrelevant (e.g., focusing on radiographic errors without covering the anatomy), elaborating mainly with drawings without showing the landmarks on panoramic images, duplicate videos, and non-English speaking. Finally, 38 videos were included and analyzed. Most of them showed clear panoramic images and had clear tracing or delineation of the anatomical landmarks. On average, each video described 26 landmarks, including 12.3 from the midfacial region, 8.2 from the mandible, and 5.2 from soft tissue/air space/others. The videos were of good quality in general, with some frequent shortcomings being lack of visual aid with skull and schematic diagrams, and lack of discussion on clinical relevance. The maxillary sinus was the structure mostly involved in wrong information, particularly the wrong delineation of its posterior wall.

Does clinical experience with dental traumatology impact 2D and 3D radiodiagnostic performance in paediatric dentists? An exploratory study

Background

The aim of this study is to evaluate the impact of experience with traumatic dental injuries (TDI) on paediatric dentists’ performance and self-assessed confidence when radiodiagnosing traumatic dental injuries (TDI) and to explore whether this is influenced by the imaging technique used (2D versus 3D).

Materials and methods

Both 2D and 3D radiological images of young anterior permanent teeth having experienced dental trauma were assessed randomly by a panel of paediatric dentists using structured scoring sheets. The impact of level of experience with dental traumatology on radiological detection, identification and interpretation of lesions and on observer’s self-assessed confidence was evaluated. Findings were compared to benchmark data deriving from expert consensus of an experienced paediatric endodontologist and dentomaxillofacial radiologist. Results were analysed using generalized linear mixed modelling.

Results

Overall, observers performed moderately to poor, irrespective of their level of TDI experience and imaging modality used. No proof could be yielded that paediatric dentists with high TDI experience performed better than those with low experience, for any of the outcomes and irrespective of the imaging modality used. When comparing the use of 3D images with 2D images, significantly higher sensitivities for the detection and correct identification of anomalies were observed in the low experienced group (P < 0.05). This was not the case regarding interpretation of the findings. Self-assessed confidence was significantly higher in more experienced dentists, both when using 2D and 3D images (P < 0.05).

Conclusion

There was no proof that paediatric dentist’s higher experience with TDI is associated with better radiodiagnostic performance. Neither could it be proven that the use of Cone Beam Computed Tomography (CBCT) contributes to an improved interpretation of findings, for any experience level. More experienced dentists feel more confident, irrespective of the imaging modality used, but this does not correlate with improved performance. The overall poor performance in image interpretation highlights the importance of teaching and training in both dental radiology and dental traumatology.

Knowledge, attitude, and behavior of Turkish dentists about radiation protection and radiation safety

OBJECTIVES

Dentists use dental imaging methods frequently in the diagnosis and treatment of dental diseases. This study aimed to determine dentists' knowledge, attitudes, and behaviors about radiation protection during dental imaging procedures.

METHODS

Dentists from two major dental health centres in İzmir province were asked to participate in this study. The participants replied to a questionnaire that consisted of questions on the use of radiographic devices, knowledge on the radiation protection of patients and staff, and attitudes and behaviors regarding radiation protection. The questionnaire also included questions about the socio-demographic characteristics of the participants. Descriptive statistics of data were performed using the SPSS software program.

RESULTS

Sixty-six dentists participated in the survey. The mean knowledge score of dentists on dental imaging, radiation, and radiation protection was 8.3 ± 2.6 out of 17, while the mean attitude and behavior score was 8.3 ± 2.1 out of 27.97% of the participants stated that medical imaging technicians should carry out imaging procedures. The use of rectangular collimators was 9.1%, and using E/F film was 56.3% among dentists. 23.3% of participants stated that they applied the bisecting angle technique during dental imaging, 23.8% stated that they wear a lead apron during imaging, and 37.8% stated that they always used thyroid shields on the patients. In addition, 37.2% of the dentists stated that the patient holds the film during preapical radiography, and 81.5% used the same imaging parameters for adult and pediatric patients. 62% of dentists stated that they question the pregnancy of female patients before imaging.

CONCLUSION

Findings of the study suggest that the knowledge of dentists about dental imaging procedures and radiation protection needs to be improved. The implementation and the follow-up of quality training programs in accordance with the standards set by the national authority will be of great importance.

Questionnaire surveys - sources of error and implications for design, reporting and appraisal

Questionnaire surveys of dentists are a commonly used research method which can yield important results. Nevertheless, in order to give reliable information, surveys must be carefully designed to avoid bias. The challenge of planning, designing and implementing a questionnaire study is often underestimated. While headline response rate is commonly used as an indication of survey quality, there are four potential areas of survey error. These are coverage, sampling, measurement and response. These four areas of error are discussed, with examples from the current literature, to assist readers in critically appraising questionnaire studies. We make 12 key recommendations to researchers to help avoid bias in their research; approaches to response enhancement are also considered. Reporting guidelines for questionnaire studies are suggested which improve transparency and assist in understanding of research methodologies and results. We have termed these guidelines: Reporting Items for Surveys and Questionnaires (RISQ). In conclusion, there is no single solution that can guarantee a successful study. Conversely, failure to pay careful attention to any one of many crucial aspects of survey design can be the downfall of an otherwise robust study.