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Becker K, Ehrlich H, Hüfner M, Rauch N, Busch C, Schwarz-Herzke B, Drescher D, Becker J. Eligibility of a novel BW + technology and comparison of sensitivity and specificity of different imaging methods for radiological caries detection. Oral Radiol 2024; 40:424-435. [PMID: 38683260 PMCID: PMC11180636 DOI: 10.1007/s11282-024-00748-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/12/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES Bitewing radiography is considered to be of high diagnostic value in caries detection, but owing to projections, lesions may remain undetected. The novel bitewing plus (BW +) technology enables scrolling through radiographs in different directions and angles. The present study aimed at comparing BW + with other 2D and 3D imaging methods in terms of sensitivity, specificity, and user reliability. MATERIALS AND METHODS Five human cadavers were used in this study. In three cadavers, natural teeth were transplanted post-mortem. BW + , two-dimensional (digital sensors, imaging plates, 2D and 3D bitewing radiographs) and 3D methods (high and low dose CBCT) were taken. Carious lesions were evaluated on 96 teeth at three positions (mesial, distal, and occlusal) and scored according to their level of demineralization by ten observers, resulting in 35,799 possible lesions across all observers and settings. For reference, µCT scans of all teeth were performed. RESULTS Overall, radiographic evaluations showed a high rate of false-negative diagnoses, with around 70% of lesions remaining undetected, especially enamel lesions. BW + showed the highest sensitivity for dentinal caries and had comparatively high specificity overall. CONCLUSIONS Within the limits of the study, BW + showed great potential for added diagnostic value, especially for dentinal caries. However, the tradeoff of diagnostic benefit and radiation exposure must be considered according to each patient's age and risk.
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Affiliation(s)
- Kathrin Becker
- Department of Orthodontics and Dentofacial Orthopaedics, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany.
| | - Henrike Ehrlich
- Department of Orthodontics, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Mira Hüfner
- Department of Orthodontics, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Nicole Rauch
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Caroline Busch
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - Dieter Drescher
- Department of Orthodontics and Dentofacial Orthopaedics, Charité-Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Jürgen Becker
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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Vanni JS, Thomazi E, Zorzi JE, Perottoni CA, Gamba TO. Determination of relative dose of ionizing radiation in the thyroid gland using a panoramic device with different protocols. Int J Paediatr Dent 2024. [PMID: 38783546 DOI: 10.1111/ipd.13213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/06/2024] [Accepted: 04/27/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The use of panoramic radiography (PR) is a complementary examination to aid in the diagnosis of cases in paediatric dentistry. The lack of specific protocols for these devices, however, can result in high doses of radiation, affecting critical organs such as the thyroid. AIM To evaluate the discrepancies in ionizing radiation received by the thyroid during PR examinations using anthropomorphic paediatric simulators built from computed tomography images. DESIGN Two anthropomorphic paediatric phantoms were printed and used, representing children aged 6 and 11 years, with an opening in the thyroid region for the insertion of dosimetric radiographic films. The simulators were subjected to different pre-existing protocols in the PR devices. The radiographic films were processed and analysed using a luxmeter. RESULTS The radiation dose to the thyroid was higher in the 6-year-old phantom than in the 11-year-old phantom, for given exposure factors. In addition, there was an increase in dose in children's protocols compared with small adult protocols. CONCLUSION Therefore, companies that develop PR equipment must develop child protocols for separate age groups that will consequently reduce the radiation dose in children, especially in their critical organs.
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Affiliation(s)
- Jéssica Silvestre Vanni
- Graduate Program in Health Sciences (PPGCS), University of Caxias do Sul (UCS), Caxias do Sul, RS, Brazil
| | - Eduardo Thomazi
- Graduate Program in Materials Science and Engineering (PPGMAT), University of Caxias do Sul (UCS), Caxias do Sul, RS, Brazil
- Federal Institute of Education, Science and Technology of Rio Grande do Sul (IFRS), Caxias do Sul, RS, Brazil
| | - Janete Eunice Zorzi
- Graduate Program in Health Sciences (PPGCS), University of Caxias do Sul (UCS), Caxias do Sul, RS, Brazil
- Graduate Program in Materials Science and Engineering (PPGMAT), University of Caxias do Sul (UCS), Caxias do Sul, RS, Brazil
| | - Cláudio Antônio Perottoni
- Graduate Program in Health Sciences (PPGCS), University of Caxias do Sul (UCS), Caxias do Sul, RS, Brazil
- Graduate Program in Materials Science and Engineering (PPGMAT), University of Caxias do Sul (UCS), Caxias do Sul, RS, Brazil
| | - Thiago Oliveira Gamba
- Graduate Program in Health Sciences (PPGCS), University of Caxias do Sul (UCS), Caxias do Sul, RS, Brazil
- Surgery and Orthopedics Department, Dental School, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Stervik C, Lith A, Ekestubbe A. Radiation exposure during orthodontic treatment: risk to children and adolescents. Acta Odontol Scand 2024; 83:296-301. [PMID: 38745537 DOI: 10.2340/aos.v83.40571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/26/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVES To estimate radiation risk to children and adolescents during orthodontic treatment by retrieving number and type of radiographs from the patient records. MATERIAL AND METHODS Radiographs, along with justifications for radiation exposure, were obtained retrospectively from the patient records of 1,790 children and adolescents referred to two Swedish orthodontic clinics. Data were grouped according to treatment stage: treatment planning, treatment, and follow-up. Estimated risk was calculated using the concept of effective dose. RESULTS Each patient had received around seven radiographs for orthodontic purposes. The most common exposures during treatment planning were one panoramic, one lateral, and three intraoral periapical radiographs. A small number of patients received a tomographic examination (8.2%). Few justifications for treatment planning and follow-up, but more in the actual treatment stage, had been recorded. The most common examinations were to assess root resorption and the positions of unerupted teeth, or simply carry out an unspecified control. The estimated risk of developing fatal cancer was considered low. The radiation risk from orthodontic treatment was equivalent to about 5-10 days of natural background radiation. CONCLUSIONS Children and adolescents sometimes undergo multiple radiographic examinations, but despite the low radiation burden, accumulated radiation exposure should be considered and justified in young patients.
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Affiliation(s)
- Christina Stervik
- Department of Oral and Maxillofacial Radiology, Institute of Odontology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
| | - Agneta Lith
- Department of Oral and Maxillofacial Radiology, Institute of Odontology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Annika Ekestubbe
- Department of Oral and Maxillofacial Radiology, Institute of Odontology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Benavides E, Krecioch JR, Connolly RT, Allareddy T, Buchanan A, Spelic D, O'Brien KK, Keels MA, Mascarenhas AK, Duong ML, Aerne-Bowe MJ, Ziegler KM, Lipman RD. Optimizing radiation safety in dentistry: Clinical recommendations and regulatory considerations. J Am Dent Assoc 2024; 155:280-293.e4. [PMID: 38300176 DOI: 10.1016/j.adaj.2023.12.002] [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: 07/26/2023] [Revised: 11/20/2023] [Accepted: 12/12/2023] [Indexed: 02/02/2024]
Abstract
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.
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Michelinakis G, Apostolakis D, Nikolidakis D, Blum IR. A comprehensive review and update on the current state of computer-assisted rehabilitation in implant dentistry. Prim Dent J 2024; 13:64-73. [PMID: 38424692 DOI: 10.1177/20501684241231672] [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] [Indexed: 03/02/2024]
Abstract
AIM This paper provides a comprehensive review of the established concepts and newer developments related to computer-assisted implant rehabilitation. METHODS Two independent researchers searched the English literature published to 31st December 2023 in the PubMed/Medline database for primary and secondary research and related publications on computer-assisted implant planning, computer-assisted implant placement and computer-assisted implant restoration. RESULTS A total of 58,923 papers were identified, 198 relevant papers were read in full text and 110 studies were finally included. Computer-assisted implant rehabilitation was found to result in more precise implant positioning than freehand placement. Advantages include reduced trauma and surgery time; disadvantages include reduced primary implant stability and higher cost. CONCLUSION Computer-assisted surgery is particularly indicated in cases of critical anatomy, but may encounter limitations in terms of cost, restricted mouth opening, visibility and adjustment of the surgical guides and the need for prior familiarisation with the procedure. Nonetheless, this surgical technique reduces the post-implant placement complication rate.
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Affiliation(s)
- George Michelinakis
- George Michelinakis DDS, MSc, MPhil Prosthodontist, Crete Implants Private Dental Practice, Heraklion, Crete, Greece
- Dimitrios Apostolakis DDS, MSc, MSc Radiologist, Dental Radiology in Crete, Heraklion, Crete, Greece
- Dimitrios Nikolidakis DDS, MSc, PhD Periodontist, Clinic Perio, Private Dental Practice, Heraklion, Crete, Greece
- Igor R. Blum DDS, PhD, Dr Med Dent, MSc, MA (Educ), MFDS RCS (Eng), MFDS RCS (Edin), FDS (Rest Dent) RCS (Eng), FFDRCSI, FCGDent, PGCHE, FHEA, FICD, LLM (Medico-Legal Law) Professor/Consultant & Specialist in Restorative Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Dimitrios Apostolakis
- George Michelinakis DDS, MSc, MPhil Prosthodontist, Crete Implants Private Dental Practice, Heraklion, Crete, Greece
- Dimitrios Apostolakis DDS, MSc, MSc Radiologist, Dental Radiology in Crete, Heraklion, Crete, Greece
- Dimitrios Nikolidakis DDS, MSc, PhD Periodontist, Clinic Perio, Private Dental Practice, Heraklion, Crete, Greece
- Igor R. Blum DDS, PhD, Dr Med Dent, MSc, MA (Educ), MFDS RCS (Eng), MFDS RCS (Edin), FDS (Rest Dent) RCS (Eng), FFDRCSI, FCGDent, PGCHE, FHEA, FICD, LLM (Medico-Legal Law) Professor/Consultant & Specialist in Restorative Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Dimitrios Nikolidakis
- George Michelinakis DDS, MSc, MPhil Prosthodontist, Crete Implants Private Dental Practice, Heraklion, Crete, Greece
- Dimitrios Apostolakis DDS, MSc, MSc Radiologist, Dental Radiology in Crete, Heraklion, Crete, Greece
- Dimitrios Nikolidakis DDS, MSc, PhD Periodontist, Clinic Perio, Private Dental Practice, Heraklion, Crete, Greece
- Igor R. Blum DDS, PhD, Dr Med Dent, MSc, MA (Educ), MFDS RCS (Eng), MFDS RCS (Edin), FDS (Rest Dent) RCS (Eng), FFDRCSI, FCGDent, PGCHE, FHEA, FICD, LLM (Medico-Legal Law) Professor/Consultant & Specialist in Restorative Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Igor R Blum
- George Michelinakis DDS, MSc, MPhil Prosthodontist, Crete Implants Private Dental Practice, Heraklion, Crete, Greece
- Dimitrios Apostolakis DDS, MSc, MSc Radiologist, Dental Radiology in Crete, Heraklion, Crete, Greece
- Dimitrios Nikolidakis DDS, MSc, PhD Periodontist, Clinic Perio, Private Dental Practice, Heraklion, Crete, Greece
- Igor R. Blum DDS, PhD, Dr Med Dent, MSc, MA (Educ), MFDS RCS (Eng), MFDS RCS (Edin), FDS (Rest Dent) RCS (Eng), FFDRCSI, FCGDent, PGCHE, FHEA, FICD, LLM (Medico-Legal Law) Professor/Consultant & Specialist in Restorative Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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Simonek M, Türp JC, Bornstein MM, Dagassan-Berndt D. Prevalence and correlation with sex, age, and dental status of bone apposition at the mandibular angle and radiographic alterations of the temporomandibular joints: a retrospective observational study in an adult Swiss population. BMC Oral Health 2024; 24:193. [PMID: 38321445 PMCID: PMC10845652 DOI: 10.1186/s12903-024-03855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/03/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The purpose of this study was to determine the prevalence of radiographic changes in the mandibular angle (bone apposition) and osseous alterations in the temporomandibular joints (TMJs) in the adult population of Switzerland. In addition, the study intended to investigate possible correlations between the two sites of contour bone changes (mandibular angle and TMJ) and to analyze various patient-related factors, including sex, age, dental status, and medical history. METHODS Panoramic radiographs of 600 patients distributed into six age groups (283 females, 317 males, aged 20 to 79 years) were included to evaluate radiographic changes. The bone in the mandibular angle region and the shape of the condylar heads were examined for contour changes (bone apposition at the jaw angles and osseous changes of the TMJs). General estimating equations, binormal tests, and chi-squared tests were used for statistical analysis. RESULTS Approximately half of the mandibular angles (47.8%) showed bone apposition, mostly bilateral. TMJ alterations were less common (27%), often unilateral, with flattening being the most frequent finding. No significant correlation was found between the two sites. Bone apposition at the mandibular angle showed a significant male predominance, whereas TMJ changes did not differ by sex. Alterations in both sites increased with age, and were not related to dental status or analgesic use. CONCLUSIONS Bone apposition at the mandibular angle should be interpreted as part of the natural functional adaptation of the bone associated with aging. Assuming that parafunctional habits may influence the development and progression of alterations in the mandibular angle or TMJs, the presence of radiographic changes in these areas should prompt dental clinicians to investigate further in this direction. TRIAL REGISTRATION The study was approved by the Swiss Association of Research Ethics Committees (swissethics), BASEC reference number: 2020-00963 (25.05.2020).
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Affiliation(s)
- Michelle Simonek
- Department of Oral Surgery, University Center for Dental Medicine Basel (UZB), University of Basel, Basel, Switzerland.
| | - Jens Christoph Türp
- Division of Temporomandibular Disorders and Orofacial Pain, Department of Oral Health & Medicine, University Center for Dental Medicine Basel (UZB), University of Basel, Basel, Switzerland
| | - Michael M Bornstein
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel (UZB), University of Basel, Basel, Switzerland
| | - Dorothea Dagassan-Berndt
- Center for Dental Imaging, University Center for Dental Medicine Basel (UZB), University of Basel, Basel, Switzerland
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Cheung MC, Peters OA, Parashos P. Global cone-beam computed tomography adoption, usage and scan interpretation preferences of dentists and endodontists. Int Endod J 2024; 57:133-145. [PMID: 37970748 DOI: 10.1111/iej.14000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/18/2023] [Accepted: 10/31/2023] [Indexed: 11/17/2023]
Abstract
AIM This study investigated the adoption of cone-beam computed tomography (CBCT) by dentists and endodontists around the world, including their preferences in endodontic CBCT usage. METHODOLOGY An online questionnaire surveyed dental association members in Australia and New Zealand, and endodontic association members in Australia, Britain, Canada, Italy, New Zealand and the USA, about their CBCT training history, considerations in acquisition/interpretation, access to and usage of CBCT, preferred scan interpreter, and preferred endodontic scan settings. Data were analysed with Chi-squared, independent sample t-tests, Cochran's Q and McNemar's tests. RESULTS Responses from 578 endodontic specialists or postgraduates (Group E) and 185 non-endodontic dentists (Group NE) were included. Continuing professional education (CPE) was the most common source of CBCT training (69.2%). Factors considered in CBCT acquisition/interpretation included beam hardening (75.4%), radiation exposure (61.1%) and patient movement (58.3%). Group E reported higher CBCT usage (90.8%) than Group NE (45.4%, p < .001) and greater workplace access to CBCT (81.1% vs. 25.9%, p < .001). Scans were interpreted by the respondent in most workplace scans (83.3%) and externally taken scans (60.5%); Group E were significantly more likely to interpret themselves than Group NE. Small field of view (83.6%) and high resolution (86.6%) were most preferred as settings for endodontic CBCTs; Group NE were less likely to choose these settings. There were some geographic variations within Group E. CONCLUSIONS CBCT training was most commonly acquired via CPE. Endodontic respondents reported very high CBCT usage and access in the workplace. There are educational implications regarding CBCT limitations, appropriate applications and interpretation.
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Affiliation(s)
| | - Ove Andreas Peters
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - Peter Parashos
- Melbourne Dental School, The University of Melbourne, Carlton, Victoria, Australia
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Nitanda A, Iwawaki A, Otaka Y, Tamatsu Y, Ishii T, Ochiai A, Otomo Y, Kito S, Saka H. Fundamental research for dose control during supine dental panoramic radiography. J Oral Biosci 2023; 65:365-370. [PMID: 37717634 DOI: 10.1016/j.job.2023.09.003] [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: 04/13/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE This study aimed to control radiation doses when using a portable supine dental panoramic radiography system by measured the scattered doses. METHOD The study used LPX7007 (Asahi Roentgen) for the panoramic radiography system. The subjects comprised a cylinder phantom (QualitA) and a RANDO Phantom (Alderson). The semiconductor dosimeter was an X2 survey sensor (RaySafe). The phantom was set at a height of 1 m from the floor, and the sensor was set at 1 m from the floor at the genital level and 1.5 m at the lens level. Measurements were taken at 30°intervals clockwise from 0°at distances of 0.5 m and 1 m in radius around the phantom. The occupational exposure range was defined as 0 ± 30° and the public exposure range was defined as the occupational exposure range and 30° to 150° and 210° to 330° as the public exposure range. RESULT The highest doses were observed in the 120° and 240° directions, and the lowest in 0° ± 30° range. The lowest limit number of images taken in the occupational exposure range was 130 images at a distance of 0.5 m, 452 images at 1 m at the lens level for the cylinder phantom, and 320 images at 0.5 m and 1098 images at 1 m for the RANDO Phantom. In the public exposure range at the genital level, there was one image at 0.5 m and six images at 1 m for the cylinder phantom, and two images at 0.5 m and eight images at 1 m for the RANDO Phantom. CONCLUSION We found that radiation exposure can be reduced by keeping a distance from the subject, avoiding working at 120° and 240° and staying within 0° ± 30° behind the panoramic radiography system.
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Affiliation(s)
- Atsuharu Nitanda
- Division of Forensic Odontology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, Saitama, Japan.
| | - Atsushi Iwawaki
- Division of Forensic Odontology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, Saitama, Japan
| | - Yusei Otaka
- Division of Dental Radiology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, Saitama, Japan; Forensic Odontology Center, Meikai University School of Dentistry, Saitama, Japan
| | - Yuichi Tamatsu
- Department of Gross Anatomy and Forensic Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Takeru Ishii
- Division of Forensic Odontology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, Saitama, Japan
| | - Akihiro Ochiai
- Division of Forensic Odontology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, Saitama, Japan
| | - Yuko Otomo
- Division of Forensic Odontology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, Saitama, Japan
| | - Shinji Kito
- Division of Dental Radiology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, Saitama, Japan
| | - Hideki Saka
- Division of Forensic Odontology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, Saitama, Japan; Forensic Odontology Center, Meikai University School of Dentistry, Saitama, Japan
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Ver Berne J, Politis C, Shaheen E, Jacobs R. Cumulative exposure and lifetime cancer risk from diagnostic radiation in patients undergoing orthognathic surgery: a cross-sectional analysis. Int J Oral Maxillofac Surg 2023; 52:1064-1070. [PMID: 36804279 DOI: 10.1016/j.ijom.2023.02.001] [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: 10/05/2022] [Revised: 01/15/2023] [Accepted: 02/02/2023] [Indexed: 02/17/2023]
Abstract
Radiation doses in dentomaxillofacial imaging are typically very low. However, diagnostic and follow-up protocols in orthognathic surgery result in a patient-specific risk in effective dose. Estimating the cancer risks from these exposures remains abstract for many maxillofacial surgeons. In this study, 40 orthognathic patients were randomly sampled and their cumulative effective dose (ED) calculated. The lifetime attributable risk of cancer (LAR) was calculated based on the standard radiological protocol for orthognathic surgery follow-up using methods described in the BEIR VII report and RadRAT. The mean cumulative ED of the 40 sampled patients at the end of their 2-year follow-up period was 1.91 ± 0.58 mSv. The LAR at the end of follow-up was 17.65 (90% confidence interval 6.46-32.90) per 100,000 person-years for male orthognathic patients and 13.93 (90% confidence interval 6.27-25.24) per 100,000 person-years for female orthognathic patients. This represents 0.70% and 0.68%, respectively, of the baseline cancer risk for oral, thyroid, and brain cancer combined. Although theoretical, these results provide a framework for interpreting radiation doses and cancer risks in patients undergoing orthognathic surgery. Considering the increased radiation sensitivity in children and adolescents, indication-oriented and patient-specific imaging protocols should be advised.
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Affiliation(s)
- J Ver Berne
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium.
| | - C Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium
| | - E Shaheen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium
| | - R Jacobs
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium; Department of Dentistry, Karolinska Institutet, Stockholm, Sweden
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Benavides E, Bhula A, Gohel A, Lurie AG, Mallya SM, Ramesh A, Tyndall DA. Patient shielding during dentomaxillofacial radiography: Recommendations from the American Academy of Oral and Maxillofacial Radiology. J Am Dent Assoc 2023; 154:826-835.e2. [PMID: 37530694 DOI: 10.1016/j.adaj.2023.06.015] [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: 05/12/2023] [Accepted: 06/13/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND The American Academy of Oral and Maxillofacial Radiology established an ad hoc committee to draft evidence-based recommendations and clinical guidance for the application of patient contact shielding during dentomaxillofacial imaging. TYPES OF STUDIES REVIEWED The committee reviewed monographs and reports from radiation protection organizations and studies that reported radiation dose to gonads, breasts, and thyroid gland from dentomaxillofacial imaging. RESULTS Considering the absence of radiation-induced heritable effects in humans and the negligible dose to the gonads and fetus from dentomaxillofacial imaging, the committee recommends discontinuing shielding of the gonads, pelvic structures, and fetuses during all dentomaxillofacial radiographic imaging procedures. On the basis of radiation doses from contemporaneous maxillofacial imaging, the committee considered that the risks from thyroid cancer are negligible and recommends that thyroid shielding not be used during intraoral, panoramic, cephalometric, and cone-beam computed tomographic imaging. PRACTICAL IMPLICATIONS This position statement informs and educates the reader on evolving radiation protection practices and provides simple, unequivocal guidance to dental personnel to implement these guidelines. State and local authorities should be contacted to update regulations to reflect these recommendations.
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Schüler IM, Hennig CL, Buschek R, Scherbaum R, Jacobs C, Scheithauer M, Mentzel HJ. Radiation Exposure and Frequency of Dental, Bitewing and Occlusal Radiographs in Children and Adolescents. J Pers Med 2023; 13:jpm13040692. [PMID: 37109079 PMCID: PMC10141634 DOI: 10.3390/jpm13040692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Dental radiographs are valuable diagnostic aids for oral healthcare, but exposure to ionizing radiation carries health risks, especially in children due to their high radio-sensitivity. Valid reference values for intraoral radiographs in children and adolescents are still missing. This study aimed to investigate the radiation dose values and underlying justifications of dental, bitewing and occlusal X-rays in children and adolescents. Data from routinely executed intraoral radiographs between 2002 and 2020 with conventional and digital tube-heads were extracted from the Radiology Information System. The effective exposure was calculated from technical parameters and statistical tests performed. A total number of 4455 intraoral (3128 dental, 903 bitewing and 424 occlusal) radiographs were investigated. For dental and bitewing radiographs, the dose area product (DAP) was 2.57 cGy × cm2 and the effective dose (ED) 0.77 µSv. For occlusal radiographs, the DAP was 7.43 cGy × cm2 and the ED 2.22 µSv. Overall, 70.2% of all intraoral radiographs were dental, 20.3% bitewing and 9.5% occlusal radiographs. The most frequent indication for intraoral radiographs was trauma (28.7%), followed by caries (22.7%) and apical diagnostics (22.7%). Moreover, 59.7% of all intraoral radiographs were taken in boys, especially for trauma (66.5%) and endodontics (67.2%) (p ≤ 0.00). Girls were significantly more frequently X-rayed for caries diagnostics than boys (28.1% vs. 19.1%, p ≤ 0.00). The average ED of 0.77 µSv for intraoral dental and bitewing radiographs in this study was within the range of other reported values. The technical parameters of the X-ray devices were found at the lowest recommended levels to best limit the radiation exposure and to assure acceptable diagnostic efficacy. Intraoral radiographs were performed predominantly for trauma, caries and apical diagnostics-reflecting general recommendations for the use of X-rays in children. For improved quality assurance and radiation protection, further studies are necessary to determine the meaningful dose reference level (DRL) for children.
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Affiliation(s)
- Ina Manuela Schüler
- Section Preventive Dentistry and Pediatric Dentistry, Department of Orthodontics, Jena University Hospital, 07743 Jena, Germany
| | | | - Rika Buschek
- Section of Pediatric Radiology, Department of Radiology, Jena University Hospital, 07747 Jena, Germany
| | - Rebecca Scherbaum
- Section of Pediatric Radiology, Department of Radiology, Jena University Hospital, 07747 Jena, Germany
| | - Collin Jacobs
- Department of Orthodontics, Jena University Hospital, 07743 Jena, Germany
| | - Marcel Scheithauer
- Radiation Protection, Centre for Health and Safety Management, Jena University Hospital, 07747 Jena, Germany
| | - Hans-Joachim Mentzel
- Section of Pediatric Radiology, Department of Radiology, Jena University Hospital, 07747 Jena, Germany
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12
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Ahmed NA. Typical effective dose values from diagnostic and interventional radiology. Appl Radiat Isot 2023; 192:110611. [PMID: 36516635 DOI: 10.1016/j.apradiso.2022.110611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 12/12/2022]
Abstract
Effective dose (E) in medical procedures is of practical value for comparing doses from different types of procedures which is not possible with the different measurable dose quantities. In this survey we estimated and compared the values of E in 12 medical imaging procedures. The mean E for conventional X-ray in mSv were ranged between 0.01 for skull lateral to 0.5 for abdominal while the mean E for cardiac interventional radiology in mSv was up to 16 for percutaneous transluminal coronary angioplasty (PTCA). For dental radiology the mean E in μSv was 1.2 for intraoral and 10 for panoramic. In mammography the mean E was 0.5 mSv. Compared with the literature, chest postero-anterior (PA), lumbar spine AP, PTCA and mammography procedures had shown larger E values. The obtained results can help in justification of techniques.
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Affiliation(s)
- Nada A Ahmed
- Sudan Atomic Energy Commission, Radiation Safety Institute, P.O. Box 3001, Khartoum, Sudan; Physics Department, Faculty of Science, Taibah University, AL- Madina al Munawarah, Saudi Arabia.
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13
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Pinto Nicodemo O, Fiori-Chíncaro GA, Agudelo-Botero AM, Llaguno-Rubio JM, García Díaz R. [Radiation dose permitted in dentistry patients. A review]. REVISTA CIENTÍFICA ODONTOLÓGICA 2023; 11:e144. [PMID: 38303741 PMCID: PMC10832395 DOI: 10.21142/2523-2754-1101-2023-144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/01/2023] [Indexed: 02/03/2024] Open
Abstract
In dental practice, the use of imaging has increased over the years, generating an increase in the radiation dose for the dental patient. One factor under discussion is the amount of dose used in patients, men, women and children, at different stages of their life, due to the scientific evidence of the harmful effects of ionizing radiation. This review of the literature analyzed the characteristics of radiation and its effects in relation to the doses administered, and its equivalences in dental practice in panoramic periapical radiographs and cone beam tomographies. A search of the literature was carried out in the main information sources such as Medline (via PubMed), SEVIER, SCIELO, and LILACS, using the search terms with a date limitation of the last 10 years. The selected articles had to include information regarding the keywords used, including "Dental Offices, Radiation Dose, X-Rays, Ambulatory Care."
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Affiliation(s)
- Omar Pinto Nicodemo
- Carrera de Estomatologia, Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca. Sucre, Bolivia. Universidad Mayor de San Francisco Xavier Carrera de Estomatologia Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca Sucre Bolivia
| | - Gustavo Adolfo Fiori-Chíncaro
- Division de Radiologia Bucal y Maxilofacial, Instituto Latinoamericano de Altos Estudios en Estomatologia. Lima, Peru. , Division de Radiologia Bucal y Maxilofacial Instituto Latinoamericano de Altos Estudios en Estomatologia Lima Peru
| | - Ana María Agudelo-Botero
- Facultad de Estomatologia, Universidad Autonoma de Manizales. Manizales, Colombia. Universidad Autonoma de Manizales Facultad de Estomatologia Universidad Autonoma de Manizales Manizales Colombia
| | - Jhoana M Llaguno-Rubio
- Division de Radiologia Bucal y Maxilofacial, Instituto Latinoamericano de Altos Estudios en Estomatologia. Lima, Peru. , Division de Radiologia Bucal y Maxilofacial Instituto Latinoamericano de Altos Estudios en Estomatologia Lima Peru
| | - Rosaura García Díaz
- Facultad de Estomatologia, Universidad de Guadalajara. Guadalajara, Mexico. Universidad de Guadalajara Facultad de Estomatologia Universidad de Guadalajara Guadalajara Mexico
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Impact of thyroid gland shielding on radiation doses in dental cone beam computed tomography with small and medium fields of view. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:245-253. [PMID: 35534405 DOI: 10.1016/j.oooo.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/11/2022] [Accepted: 03/04/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the impact of thyroid gland shielding on radiation doses in dental cone beam computed tomography (CBCT) with small and medium fields of view (FOVs). STUDY DESIGN Six CBCT protocols were investigated by exposing an adult anthropomorphic male phantom head without and with thyroid shielding, using 4 small (4 × 5 cm) and 2 medium (10 × 6 cm) FOVs. Twenty metal oxide semiconductor field-effect transistor dosimeters were placed in the phantom head to measure absorbed doses and calculate equivalent doses at 11 sites. Effective doses were calculated based on the tissue weighting factors in International Commission on Radiological Protection Publication 103. The data were analyzed using the independent samples t test. RESULTS Thyroid gland shielding led to significant equivalent dose reductions in many tissues for all protocols. Equivalent dose reductions to the thyroid were significant in all 6 protocols (P ≤ .037). Significant reduction depended on the FOV and ranged between 24.5% and 42.6% for the thyroid gland and 4.9% and 34.5% for other tissues and organs. Effective doses were significantly lower in all protocols (P ≤ .016). CONCLUSIONS Thyroid gland shielding protects the thyroid gland and other organs and should be utilized with all CBCT examinations where feasible.
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15
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Evaluating the X-ray-Shielding Performance of Graphene-Oxide-Coated Nanocomposite Fabric. MATERIALS 2022; 15:ma15041441. [PMID: 35207983 PMCID: PMC8875570 DOI: 10.3390/ma15041441] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 02/01/2023]
Abstract
Exposure to ionizing radiation (IR) during diagnostic medical procedures brings certain risks, especially when experiencing recurrent exposures. The fabrication of nano-based composites, doped with different nanoparticles, have been suggested as effective shielding materials to replace conventional lead-based ones in material sciences and nanotechnology. In this study, commercially available fabrics, used to produce scrubs and gowns for clinical staff, are modified utilizing graphene oxide (GO) nanoparticles using a layer-by-layer (LBL) technique. GO was obtained from graphite through environmentally friendly technology by using a modified-improved Hummers' method without NaNO3. Lightweight, flexible, air- and water-permeable shielding materials are produced that are wearable in all-day clinical practice. The nanoparticles are kept to a minimum at 1 wt%; however, utilizing the LBL technique they are distributed evenly along the fibers of the fabrics to achieve as much shielding effect as possible. The evaluation of samples is accomplished by simulating real-time routine clinical procedures and the radiographic programs and devices used daily. The GO-coated nanocomposite fabrics demonstrated promising results for X-ray shielding.
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Jose A, Kumar AS, Govindarajan KN, Sharma SD. Assessment of Regional Diagnostic Reference Levels in Dental Radiography in Tamil Nadu. J Med Phys 2022; 47:86-92. [PMID: 35548027 PMCID: PMC9084574 DOI: 10.4103/jmp.jmp_119_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 11/07/2022] Open
Abstract
Aim The aim of this article is to assess Tamil Nadu adult diagnostic reference levels (DRLs) by collecting radiation dose data from the four different dental modalities. Materials and Methods The study was carried out using routine adult exposure settings in 131 intraoral, 75 panoramic, 35 cephalometric, and 10 dental cone beam computed tomography (CBCT) X-ray devices. DRLs were assessed for intraoral and extraoral (panoramic, cephalometric, and CBCT) examinations in terms of incident air kerma (Ka, i) and kerma area product (PKA), respectively. Air kerma measurements, for all dental units, were made using calibrated RTI black Piranha 557 dosimeter (RTI Electronics AB, Sweden). The dosimeter was kept at the exit cone of the X-ray tube and on the detector side of the X-ray unit for intraoral and extraoral air kerma measurements, respectively. The obtained air kerma in extraoral modalities is multiplied with the beam area to evaluate PKA. Results The third quartile values calculated from the median for adult intraoral (mandibular molar), panoramic, cephalometric, and CBCT were 1.5 mGy, 116 mGycm2, 40 mGycm2, and 532 mGycm2, respectively. The proposed DRL in the present study was comparable to those reported in Germany, Greece, the UK, Japan, and Korea. Conclusion This study revealed the need for dose management and radiation dose optimization, in various dental facilities in the state. It was also found that dental facilities employed with the digital type of detector are not always related to lower exposure.
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Affiliation(s)
- Amal Jose
- Department of Medical Physics, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - A. Saravana Kumar
- Department of Medical Physics, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India,Address for correspondence: Dr. A. Saravana Kumar, Department of Medical Physics, PSG Institute of Medical Sciences and Research, Coimbatore - 641 004, Tamil Nadu, India. E-mail:
| | - K. N. Govindarajan
- Department of Medical Physics, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Sunil Dutt Sharma
- Radiological Physics and Advisory Division, Bhabha Atomic Research Centre, Anushaktinagar, Mumbai, Maharashtra, India
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17
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Janani K, Malarkodi T, Sankarapandian S. Estimation of Surface Radiation Dosage to Thyroid Gland and Lower Abdomen While Using Intraoral Periapical Radiography: A Phantom Study. Cureus 2021; 13:e19727. [PMID: 34934590 PMCID: PMC8684574 DOI: 10.7759/cureus.19727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background and objective Every dose of radiation has the potential to cause biological harm. Quantitative assessment of radiation doses to radiosensitive organs can aid dental professionals in taking the appropriate protective measures against radiation. This data may also be used among the general public to alleviate fears of radiation exposure in dental radiography. This study aimed to estimate the surface radiation dose at the level of the thyroid and lower abdomen during intraoral periapical radiography (IOPAR). Materials and methods A total of 80 calcium sulfate (CaSO4) discs were utilized in this cross-sectional in vitro study to estimate the surface radiation dose at the level of thyroid and lower abdomen on a phantom model while using an IOPAR. After exposure, the discs were submitted to the Radiation Laboratory's "Personnel Monitoring Service" to measure the surface radiation dose. Mean and standard deviations were calculated using descriptive statistics for continuous variables. The Mann-Whitney U test was used to compare bi-variate samples of independent groups. All statistical analyses were performed using SPSS Statistics version 21.0 (IBM, Armonk, NY). Results The results showed a statistically significant difference in radiation exposure between the maxillary anterior and mandibular anterior regions when the thermoluminescent dosimeter (TLD) was placed in the lower abdomen (p=0.000). When the maxillary and mandibular posterior regions were compared, there was a statistically significant difference in radiation exposure when the TLD was placed in the lower abdomen (p=0.000). Conclusion When the cone was positioned in the maxillary region, there was an increase in surface radiation dosage to the lower abdomen and thyroid.
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Affiliation(s)
- Krishnamachari Janani
- Department of Conservative Dentistry and Endodontics, SRM Dental College, SRM Institute of Science and Technology, Ramapuram, Chennai, IND
| | - T Malarkodi
- Oral Medicine and Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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18
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Lee H, Badal A. A Review of Doses for Dental Imaging in 2010-2020 and Development of a Web Dose Calculator. Radiol Res Pract 2021; 2021:6924314. [PMID: 35070450 PMCID: PMC8767401 DOI: 10.1155/2021/6924314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/24/2022] Open
Abstract
Dental imaging is one of the most common types of diagnostic radiological procedures in modern medicine. We introduce a comprehensive table of organ doses received by patients in dental imaging procedures extracted from literature and a new web application to visualize the summarized dose information. We analyzed articles, published after 2010, from PubMed on organ and effective doses delivered by dental imaging procedures, including intraoral radiography, panoramic radiography, and cone-beam computed tomography (CBCT), and summarized doses by dosimetry method, machine model, patient age, and technical parameters. Mean effective doses delivered by intraoral, 1.32 (0.60-2.56) μSv, and panoramic, 17.93 (3.47-75.00) μSv, procedures were found to be about1% and 15% of that delivered by CBCT, 121.09 (17.10-392.20) μSv, respectively. In CBCT imaging, child phantoms received about 29% more effective dose than the adult phantoms received. The effective dose of a large field of view (FOV) (>150 cm2) was about 1.6 times greater than that of a small FOV (<50 cm2). The maximum CBCT effective dose with a large FOV for children, 392.2 μSv, was about 13% of theeffective dose that a person receives on average every year from natural radiation, 3110 μSv. Monte Carlo simulations of representative cases of the three dental imaging procedures were then conducted to estimate and visualize the dose distribution within the head. The user-friendly interactive web application (available at http://dentaldose.org) receives user input, such as the number of intraoral radiographs taken, and displays total organ and effective doses, dose distribution maps, and a comparison with other medical and natural sources of radiation. The web dose calculator provides a practical resource for patients interested in understanding the radiation doses delivered by dental imaging procedures.
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Affiliation(s)
- Hawon Lee
- Montgomery Blair High School, Silver Spring, MD, USA
- Division of Imaging, Diagnostics and Software Reliability, OSEL, CDRH, Food and Drug Administration, Silver Spring, MD, USA
| | - Andreu Badal
- Division of Imaging, Diagnostics and Software Reliability, OSEL, CDRH, Food and Drug Administration, Silver Spring, MD, USA
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19
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Sebring D, Kvist T, Buhlin K, Jonasson P, Lund H. Calibration improves observer reliability in detecting periapical pathology on panoramic radiographs. Acta Odontol Scand 2021; 79:554-561. [PMID: 34077685 DOI: 10.1080/00016357.2021.1910728] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine whether calibration improves observer reliability when assessing DMFT-score, root-filled teeth and periapical lesions on panoramic radiographs. MATERIAL AND METHODS A sample of 100 panoramic radiographs was selected from a cohort of myocardial infarction patients (n = 797) and matched controls (n = 796). The following variables were assessed: DMFT-score, remaining teeth, root-filled teeth and periapical lesions. Two specialists, an endodontist and a radiologist, served as reference examiners and undertook two separate assessments. Disagreement cases were jointly assessed and the final results were used as the reference standard. Three observers undertook three separate assessments, the first without prior training, the second after calibration against the reference standard and the third with the sample concealed in the complete material. Statistical analysis was made with Wilcoxon Signed rank test and Sign test. Agreement was calculated as Intraclass Correlation Coefficient (ICC) (95% CI) and Weighted Kappa (κ) (95% CI). RESULTS Periapical lesions disclosed high inter-observer variability for the reference examiners and diverged significantly between the observers and the reference standard. For the reference examiners, inter-observer agreement was κ = 0.53. The observers, in their first assessments had κ values ranging from 0.22 to 0.60 in relation to the reference standard. Following calibration, the κ values increased, ranging from 0.59 to 0.80. For the third assessment, the κ values ranged from 0.54 to 0.75. DMFT-score, remaining teeth and root-filled teeth disclosed high reliability throughout all assessments (ICC = 0.88-0.98 and κ = 0.98-0.99). CONCLUSIONS DMFT-score, remaining teeth and root-filled teeth can be reliably assessed on panoramic radiographs. Calibration against a reference standard improves observer reliability in the detection of periapical lesions.
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Affiliation(s)
- Dan Sebring
- Department of Endodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Kvist
- Department of Endodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kåre Buhlin
- Department of Dental Medicine, Division of Periodontology, Karolinska Institutet, Huddinge, Sweden
| | - Peter Jonasson
- Department of Endodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Lund
- Department of Oral Maxillofacial Radiology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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20
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Abstract
Background: In 2013, the American Thyroid Association (ATA) issued a "Policy Statement on Thyroid Shielding During Diagnostic Medical and Dental Radiology." The recently updated National Council on Radiation Protection and Measurement Radiation Protection in Dentistry and Oral and Maxillofacial Imaging (NCRP Report No. 177) prompts this review of progress related to patient thyroid shielding since the ATA statement was published. Summary: Relevant publications appearing since the ATA statement were identified by querying PubMed for "thyroid and dental and (collar or shielding)" and substituting specific dental radiographic procedures in the search. The search was expanded by reviewing the cited papers in the PubMed-retrieved papers and by use of the Web of Science to retrieve papers citing the PubMed retrieved publications. Although many quantitative studies have appeared reflective of current dental radiographic instrumentation and practice, much more can be done to foster minimizing radiation to the thyroid. Conclusions: We list seven areas that should be pursued. Among them are harmonizing guidelines for the use of thyroid collars based on the recent studies and a comprehensive survey of current dental radiological practice patterns.
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Affiliation(s)
- Arthur B Schneider
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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21
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Li Y, Huang B, Cao J, Fang T, Liu G, Li X, Wu J. ESTIMATING RADIATION DOSE TO MAJOR ORGANS IN DENTAL X-RAY EXAMINATIONS: A PHANTOM STUDY. RADIATION PROTECTION DOSIMETRY 2020; 192:328-334. [PMID: 33320946 DOI: 10.1093/rpd/ncaa196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/30/2020] [Accepted: 11/05/2020] [Indexed: 06/12/2023]
Abstract
The radiation doses absorbed by major organs of males and females were studied from three types of dental X-ray devices. The absorbed doses from cone-beam computed tomography (CBCT), panoramic and intraoral X-ray machines were in the range of 0.23-1314.85 μGy, and were observed to be high in organs and tissues located in or adjacent to the irradiated area, there were discrepancies in organ doses between male and female. Thyroid, salivary gland, eye lens and brain were the organs that received higher absorbed doses. The organ absorbed doses were considerably lower than the diagnostic reference level for dental radiography in China. The calculated effective radiation doses for males and females were 56.63, 8.15, 2.56 μSv and 55.18, 8.99, 2.39 μSv, respectively, when using CBCT, the panoramic X-ray machine and intraoral X-ray machine. The effective radiation dose caused by CBCT was much higher than those of panoramic and intraoral X-ray machines.
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Affiliation(s)
- Yong Li
- Department of Nuclear Science and Technology, School of Physics and Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, China
| | - Bingsheng Huang
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518071, China
| | - Jun Cao
- Department of Stomatology, Shenzhen University General Hospital, Shenzhen 518055, China
| | - Tianqi Fang
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518071, China
- Shenzhen University General Hospital Clinical Research Center for Neurological Diseases, Shenzhen 518071, China
| | - Guoqing Liu
- Department of Nuclear Science and Technology, School of Physics and Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, China
| | - Xuguang Li
- Department of Stomatology, Shenzhen University General Hospital, Shenzhen 518055, China
| | - Jiabao Wu
- Department of Nuclear Science and Technology, School of Physics and Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, China
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Tayman MA, Kamburoğlu K, Öztürk E, Küçük Ö. The accuracy of periapical radiography and cone beam computed tomography in measuring periodontal ligament space: Ex vivo comparative micro‐CT study. AUST ENDOD J 2020; 46:365-373. [DOI: 10.1111/aej.12416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 11/27/2022]
Affiliation(s)
- M. Ayşe Tayman
- Department of Periodontology Faculty of Dentistry Ankara Yıldırım Beyazıt University Ankara Turkey
| | - Kıvanç Kamburoğlu
- Department of Dentomaxillofacial Radiology Faculty of Dentistry Ankara University Ankara Turkey
| | - Ebru Öztürk
- Department of Biostatistics School of Medicine Hacettepe University Ankara Turkey
| | - Özlem Küçük
- Department of Nuclear Medicine Faculty of Medicine Ankara University Ankara Turkey
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23
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Geist JR. This far but no farther: elimination of protective radiation shielding for dental patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:347-349. [DOI: 10.1016/j.oooo.2020.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 01/30/2023]
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Low-dose X-ray imaging may increase the risk of neurodegenerative diseases. Med Hypotheses 2020; 142:109726. [PMID: 32361669 DOI: 10.1016/j.mehy.2020.109726] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/22/2020] [Accepted: 04/08/2020] [Indexed: 12/12/2022]
Abstract
The hypothesis presented here explores the possibility that X-ray imaging commonly used in dental practices may be a shared risk factor for sporadic dementias and motor-neuron diseases. As the evidence will suggest, the brain is ill-equipped to manage the intrusion of low-dose ionizing radiation (IR) beyond that which is naturally occurring. When the brain's antioxidant defenses are overwhelmed by IR, it produces an abundance of reactive oxygen species (ROS) that can lead to oxidative stress, mitochondrial dysfunction, loss of synaptic plasticity, altered neuronal structure and microvascular impairment that have been identified as early signs of neurodegeneration in Alzheimer's disease, Parkinson's, amyotrophic lateral sclerosis, vascular dementia and other diseases that progressively damage the brain and central nervous system. Although genes play a role in all outcomes, the focus here will be on the non-genetic processes at work. Common assumptions regarding the risks of low-dose IR will be addressed, such as: 1) comparing rapid, repeated bursts of man-made IR sent exclusively into the head to equivalent amounts of head-to-toe background IR over longer periods of time; 2) whether epidemiological studies that dismiss concerns regarding low-dose IR due to lack of evidence it causes cancer, heritable mutations or shortened life spans also apply to neurodegeneration; and 3) why even radiation-resistant neurons can be severely impacted by IR exposure, due to IR-induced injury to the processes they need to function. Also considered will be the difficulty of distinguishing the effects of dental X-ray exposure from similarly low amounts of background IR and where to find the evidence that they may, in fact, be responsible for neurodegeneration. Finally, the long-standing belief that whatever risks are inherent in dental radiography must be undertaken for the sake of oral health is challenged on two counts: 1) while dentists continue to drape their patients in lead-lined aprons, the most effective IR safety precautions are often ignored; and 2) there is an alternative dental imaging technology that does not use IR. While the thrust of this article will be on dental radiation and will touch on how age, gender, X-ray equipment and protocols may increase risk, chiropractic radiographs also will be considered because they focus exclusively on the central nervous system. If X-ray imaging is found to be associated with neurodegeneration, the risk-versus-benefit must be reevaluated, every means of reducing exposure implemented and imaging protocols revised.
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25
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Does dose optimisation in digital panoramic radiography affect diagnostic performance? Clin Oral Investig 2020; 25:637-643. [PMID: 32845471 DOI: 10.1007/s00784-020-03535-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare the overall diagnostic performance of digital panoramic radiographs obtained with low-dose protocols and to estimate the absorbed dose in the head and neck. MATERIALS AND METHODS Forty-eight panoramic radiographs were obtained from eight imaging phantoms using six exposure protocols of progressively lower tube voltages (kVp) and currents (mA), as follows: (1) 70 kVp and 12.5 mA, (2) 66 kVp and 10 mA, (3) 66 kVp and 8 mA, (4) 66 kVp and 5 mA, (5) 66 kVp and 4 mA and (6) 66 kVp and 3.2 mA. Five oral radiologists independently evaluated the images and reported all detectable radiographic findings. Intra-examiner reproducibility was assessed by re-evaluation of 25% of the images. The data were analysed using the McNemar and weighted Kappa tests. Absorbed doses of the six protocols were obtained from thermoluminescent dosimeters placed inside a Rando phantom and compared using one-way ANOVA with post hoc Tukey (α = 0.05). RESULTS The overall diagnostic performance of panoramic radiographs obtained with low-dose protocols did not differ from that of panoramic radiographs obtained with the highest dose (p > 0.05). Moreover, substantial agreement was observed between all protocols. Protocol 1 resulted in the highest absorbed dose and protocols 4, 5 and 6 in the lowest absorbed doses, with the difference being significant (p ≤ 0.05). CONCLUSION Although digital panoramic radiography is considered a relatively low-dose examination, the radiation dose can be further reduced without negatively affecting its overall diagnostic performance. CLINICAL RELEVANCE Considering the risks associated with X-rays, digital panoramic radiographs can be obtained at even lower exposure levels.
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Schulze RKW, Drage NA. Cone-beam computed tomography and its applications in dental and maxillofacial radiology. Clin Radiol 2020; 75:647-657. [PMID: 32451060 DOI: 10.1016/j.crad.2020.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/16/2020] [Indexed: 12/14/2022]
Abstract
Cone-beam computed tomography (CBCT) was first used in dental and maxillofacial radiology (DMFR) at the end of the 1990s. Since then, it has been successfully established as the standard three-dimensional radiographic imaging technique in DMFR, with a wide variety of applications in this field. This manuscript briefly reviews the background information on the technology and summarises available data on effective dose and dose optimisation. In addition, typical clinical applications and indications of the technique in DMFR are presented.
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Affiliation(s)
- R K W Schulze
- Department of Oral and Maxillofacial Surgery, Section of Oral Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany.
| | - N A Drage
- Department of Dental and Maxillofacial Radiology, University Dental Hospital, Cardiff, UK
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Multi-modular bone healing assessment in a randomized controlled clinical trial of root-end surgery with the use of leukocyte- and platelet-rich fibrin and an occlusive membrane. Clin Oral Investig 2020; 24:4439-4453. [DOI: 10.1007/s00784-020-03309-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/23/2020] [Indexed: 01/24/2023]
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Kamburoğlu K, Ereş G, Akgün C. Qualitative and Quantitative Assessment of Alveolar Bone Destruction in Adult Rats Using CBCT. J Vet Dent 2020; 36:245-250. [PMID: 32207386 DOI: 10.1177/0898756420911108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cone-beam computed tomography (CBCT) has strong potential to be utilized in various aspects of veterinary dentistry. Using ex vivo rat maxillary bone and teeth, the purpose of this study was to compare gray value, surface area, and volumetric measurements of teeth with and without experimental periodontitis by CBCT. Periodontitis was induced in 36 molar teeth, while 36 teeth with a healthy periodontium served as control. Images of each specimen along with teeth were obtained using CBCT. The following measurements for each tooth with periodontitis (n = 36) were recorded: gray value measurement, width, height, depth, surface area, and volume of the alveolar bone loss. For the control group (n = 36), gray value measurement, surface area, and volume of the alveolar bone were recorded. All measurements were repeated after 3 weeks. As the gold standard, the rat maxillas were decalcified and paraffin-embedded for further immunocytochemical study. One-way analysis of variance (ANOVA) was used. Significance level was set at P < .05. Correlation values for gray value, width, height, depth, surface area, and volume measurements were 0.983, 0.966, 0.962, 0.880, 0.998, and 0.999, respectively, for the first and second measurements. One way ANOVA showed statistically significant differences between teeth with and without alveolar bone destruction conducted for gray value, surface area, and volume measurements (P = .000). Mean gray value, surface area, and volume measurements decreased 56.46%, 81.89%, and 78.56%, respectively, for teeth with alveolar bone destruction in comparison to healthy teeth. Cone-beam computed tomography provided useful qualitative and quantitative information regarding induced periodontitis in the rat maxilla.
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Affiliation(s)
- Kıvanç Kamburoğlu
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Gülden Ereş
- Department of Periodontology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - Ceren Akgün
- Department of Periodontology, Faculty of Dentistry, Ankara University, Ankara, Turkey
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Measuring the dose-width product and proposing the local diagnostic reference level in panoramic dental radiography: a multi-center study from Iran. Oral Radiol 2020; 37:80-85. [PMID: 32065334 DOI: 10.1007/s11282-020-00428-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 02/04/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Although radiation exposure associated with dental radiography is relatively low, patient exposure must be kept practically low. Therefore, it is necessary for each country to establish its own diagnostic reference levels (DRLs) suitable for its equipment and practice. In the present study, dose-width product (DWP) values for panoramic dental radiography were measured and a local DRL was established. METHODS Five panoramic devices from five radiology clinics of Kashan, Iran were selected to measure the DWP values of panoramic dental radiography. To investigate the DWP values, the parameters of each patient's exposure (e.g., tube voltage, tube current, and exposure time) at these five radiology clinics were extracted. Then, the dose value received by each patient was measured based on a CT pencil chamber. Finally, the overall median DWP values for the patients with small, medium, and large sizes were obtained, and these values were considered as the local DRLs for panoramic dental radiography. RESULTS A total of 99 adult patients were included in the present study. The findings demonstrated that the median and third-quartile DWP values for these five radiology clinics ranged from 42.3 to 94.3 and 49.7 to 142.8 mGy mm, respectively. The local DRL values, which were established as the overall median DWP values, were 43.4, 52.0, and 80.3 mGy mm for the adults with small, medium, and large sizes, respectively. CONCLUSION The local DRL proposed in this study for the adult with standard/medium size was lower than those proposed by other reports and seemed acceptable for panoramic radiography in Kashan, Iran.
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Schwindling FS, Hilgenfeld T, Weber D, Kosinski MA, Rammelsberg P, Tasaka A. In vitro diagnostic accuracy of low‐dose CBCT for evaluation of peri‐implant bone lesions. Clin Oral Implants Res 2019; 30:1200-1208. [DOI: 10.1111/clr.13533] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 08/25/2019] [Accepted: 09/04/2019] [Indexed: 12/18/2022]
Affiliation(s)
| | - Tim Hilgenfeld
- Department of Neuroradiology Heidelberg University Hospital Heidelberg Germany
| | - Dorothea Weber
- Institute of Medical Biometry and Informatics Heidelberg University Heidelberg Germany
| | | | - Peter Rammelsberg
- Department of Prosthetic Dentistry Heidelberg University Hospital Heidelberg Germany
| | - Akinori Tasaka
- Department of Removable Partial Prosthodontics Tokyo Dental College Tokyo Japan
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Qiang W, Qiang F, Lin L. ESTIMATION OF EFFECTIVE DOSE OF DENTAL X-RAY DEVICES. RADIATION PROTECTION DOSIMETRY 2019; 183:417-421. [PMID: 30169836 DOI: 10.1093/rpd/ncy159] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/07/2018] [Accepted: 08/21/2018] [Indexed: 06/08/2023]
Abstract
This study aims to estimate the effective doses of dental X-ray devices under common scanning protocols. After putting TLDs in the Alderson Radiation Therapy Phantom, we exposed the phantom under common scanning protocols of three dental X-ray devices, namely CBCT, dental panoramic machine and intraoral round cone device. Then effective doses were calculated using the measured absorbed doses of organs and tissues. Tissue weighting factors recommended by the ICRP were adopted in the calculation. Effective doses under common scanning protocols of three Dental X-ray devices were obtained. The effective dose of dental CT was 0.20 mSv, and that of dental panoramic machine and intraoral radiography were 0.013 and 0.0050 mSv, respectively. The tissue absorbed doses of dental CT scan were 0.63 mGy of brain, 7.7 mGy of salivary glands, 8.7 mGy of thyroid and 4.0 mGy of the lens of the eye. The tissue absorbed doses from dental panoramic machine are 0.62 mGy of salivary glands and 0.25 mGy of thyroid. And finally the tissue absorbed dose of intraoral radiography was 0.80 mGy of salivary gland. Among the three dental X-ray devices studied, dental CBCT scan can cause much higher effective dose than the other two. Brain, salivary glands, thyroid and the lens of the eye are tissues receiving relatively higher absorbed doses.
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Affiliation(s)
- Wang Qiang
- Changzhou CDC, No. 203, Taishan Road, Changzhou, Jiangsu, China
| | - Fu Qiang
- Changzhou CDC, No. 203, Taishan Road, Changzhou, Jiangsu, China
| | - Lin Lin
- Changzhou CDC, No. 203, Taishan Road, Changzhou, Jiangsu, China
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Rahmel S, Schulze RKW. Accuracy in Detecting Artificial Root Resorption in Panoramic Radiography versus Tomosynthetic Panoramic Radiographs. J Endod 2019; 45:634-639.e2. [PMID: 30905574 DOI: 10.1016/j.joen.2019.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/08/2019] [Accepted: 01/13/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The aim of this study was to compare the detection accuracy of panoramic radiography (PAN) and tomosynthetically reconstructed panoramic radiography (TPAN) for the detection of artificial external root resorption in a multiobserver approach. METHODS Thirty-six teeth in 5 dry human mandibles were prepared with artificial root resorption by means of diamond bur defects (0.8, 1.0, and 1.2 mm). The samples were exposed in a digital panoramic radiographic unit in a predetermined appropriate position using a wax layer (6.25 mm thickness) as soft tissue scatter equivalent and a water-filled plastic bottle to mimic the absorption of the cervical spine. This resulted in 5 panoramic radiographs and 5 tomosynthetically reconstructed panoramic radiographs, which were evaluated by 13 observers regarding the visibility of artificial root resorption by means of a 5-point confidence scale. Seven of these observers repeated the process after a minimum interval of 30 days. A receiver operating characteristic analysis was conducted with the area beneath the receiver operating characteristic curves (Az) as the main accuracy parameter. Inter- and intrarater reproducibility were calculated by means of the intraclass coefficient using a 2-way random effects model. RESULTS The mean Az for TPAN (0.76; median = 0.77; range, 0.70-0.85) was slightly yet significantly higher (P < .05, Wilcoxon test) than for PAN (0.75; median = 0.75; range, 0.69-0.82). The Az values for both methods were highest in the premolar and lowest in the molar region. The mean sensitivity for TPAN was 0.54 (specificity = 0.96) and 0.50 (specificity = 0.96) for PAN. Intraclass coefficient values indicated that intra- (PAN: mean = 0.53 ± 0.088; TPAN: mean = 0.55 ± 0.102; P < .05,Wilcoxon test) and interrater (PAN: mean = 0.47 [0.43-0.51], TPAN: mean = 0.47 [0.42-0.51]) reproducibility were both moderate. CONCLUSIONS From our ex vivo study, we observed slightly higher accuracy in the detection of artificial root resorption from tomosynthetically reconstructed panoramic radiographs compared with conventional digital panoramic radiographs.
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Affiliation(s)
- Selina Rahmel
- Section of Oral Radiology, Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ralf K W Schulze
- Section of Oral Radiology, Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
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Zenóbio EG, Zenóbio MAF, Azevedo CDB, Nogueira MDS, Almeida CD, Manzi FR. Assessment of image quality and exposure parameters of an intraoral portable X-rays device. Dentomaxillofac Radiol 2019; 48:20180329. [PMID: 30426762 PMCID: PMC6476356 DOI: 10.1259/dmfr.20180329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/30/2018] [Accepted: 11/02/2018] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: To evaluate the exposure parameters, radiation protection, absorbed dose and radiographic image quality of the DIOX® intraoral portable radiography device. METHODS: The exposure parameters were measured using the Xi UNFORS detector. Operator exposure to secondary radiation was measured using the 1800cc ionization chamber coupled to the electrometer. The absorbed dose (D) in the patient was calculated using TLD-100H positioned in the Alderson RANDO anthropomorphic simulator. The quality of the radiographic digital image was assessed by comparing radiographic images obtained from two conventional devices (CS 2200®, Carestream Health; Heliodent plus®, Sirona Dental Systems GMbH) with the radiological simulator of the upper molar region RMI (Radiation Measurements Instruments), using three acquisition sensors: Kodak RVG 5000® and Kodak PSP®, Eastman Kodak Company, Rochester, NY; EVO Micro Image®, Brazil. RESULTS: The DIOX intraoral portable radiographic device demonstrated reliability in relation to the performance of the standard evaluated parameters, except for the diameter of the radiation field (5.8 mm) less or greater. No evidence of device head radiation was detected. The Pb lead protection of the apparatus attenuates the secondary radiation, thus protecting the operator. However, it was observed that the region of the operator's gonads was the most exposed during the measurements. In the Alderson RANDO anthropomorphic simulator, the highest value of D was in the region corresponding to the submandibular and lingual glands of the left side (0.568 mGy). The image quality of the DIOX portable radiographic apparatus presented quality standards equivalent to those produced by the two conventional radiographic devices. CONCLUSION: The DIOX intraoral portable radiography device demonstrated reliability in relation to the quality control and radioprotection criteria, according to international standards. Results obtained demonstrated the safe use of the DIOX intraoral portable radiography device and indicated the need for debate and change in international sanitary oversight standards regarding the use of portable XR devices in dentistry.
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Affiliation(s)
- Elton G Zenóbio
- PhD, Implantology – Associate Professor Master’s Program, PUC Minas (Pontifical Catholic University), Belo Horizonte, MG, Brazil
| | - Madelon AF Zenóbio
- PhD, UFMG - CDTN – Associate Professor, Center for Nuclear Development of Nuclear Technologies, Belo Horizonte, Brazil
| | - Carolina DB Azevedo
- Ms, Clinical Dentistry – Master’s Program, PUC Minas, (Pontifical Catholic University), Belo Horizonte, MG, Brazil
| | - Maria do Socorro Nogueira
- PhD, UFMG - CDTN – Associate Professor, Center for Nuclear Development of Nuclear Technologies, Belo Horizonte, Brazil
| | | | - Flávio R Manzi
- PhD, Radiology – Associate Professor Master’s Program, PUC Minas, (Pontifical Catholic University), Belo Horizonte, MG, Brazil
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Chauhan V, Wilkins RC. A comprehensive review of the literature on the biological effects from dental X-ray exposures. Int J Radiat Biol 2019; 95:107-119. [PMID: 30496029 DOI: 10.1080/09553002.2019.1547436] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Routine dental X-rays are among the most common sources of ionizing radiation exposure for healthy individuals globally, with 300 examinations/1000 individuals/year as documented by the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) global survey of medical radiation usage and exposure. Furthermore, in the United States of America, an increased use of dental radiography is evident. However, with the shift from using film to digital image receptors, the dose of radiation per routine examination has decreased. Despite this, there remains public concern of dental X-rays. This continuing concern highlights the need to review the literature on biological and health effects related to exposure, from dental X-rays. MATERIAL AND METHODS This report presents studies investigating biological and health effects related to exposures using dental X-rays in patients and provides a critical evaluation. Relevant studies specific to dental X-rays are reviewed from 1970 and onward with the bulk data in this field resulting from epidemiological and biomonitoring studies. RESULTS While, most epidemiological studies suggest a possible correlation between head/neck related tumors and exposure to dental X-rays, evidence for causation is lacking. Biomonitoring studies suggest that exposure to low-level radiation such as that of dental radiography may not be a factor in inducing long-term chromosomal damage, but may result in localized cytotoxicity in the irradiated region of the mouth, with no long-term harm. CONCLUSIONS In general, the total number of studies is low and the majority of the data has been generated from poorly designed experiments. This review will highlight shortcomings that could influence outcomes and provide a more balanced interpretation that could impact the public perception and the level of public concern on the health effects resulting from dental X-rays.
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Affiliation(s)
- Vinita Chauhan
- a Consumer and Clinical Radiation Protection Bureau, Healthy Environments and Consumer Safety Branch , Health Canada , Ottawa , Canada
| | - Ruth C Wilkins
- a Consumer and Clinical Radiation Protection Bureau, Healthy Environments and Consumer Safety Branch , Health Canada , Ottawa , Canada
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Comparison of linear and volumetric measurements obtained from periodontal defects by using cone beam-CT and micro-CT: an in vitro study. Clin Oral Investig 2018; 23:2235-2244. [DOI: 10.1007/s00784-018-2665-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/25/2018] [Indexed: 01/25/2023]
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Benchimol D, Koivisto J, Kadesjö N, Shi XQ. Effective dose reduction using collimation function in digital panoramic radiography and possible clinical implications in dentistry. Dentomaxillofac Radiol 2018; 47:20180007. [PMID: 29722543 PMCID: PMC6196069 DOI: 10.1259/dmfr.20180007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/27/2018] [Accepted: 04/30/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES: The primary aim was to evaluate the effective dose for a full size panoramic image and nine different panoramic protocols using collimation. The secondary aim was to estimate possible reduction of effective dose in clinical situations. METHODS Effective dose, according to International Commission on Radiological Protection 2007 was determined for a full size panoramic image and nine different panoramic protocols applying collimation on an anthropomorphic Rando phantom, using metal-oxide semiconductor field-effect transistor dosemeters. The collimation protocols were chosen based on common diagnostic questions. 10 exposures were made for each protocol using a Planmeca ProMax® 2D (Helsinki, Finland). The mean effective doses were calculated according to clinical default exposure settings and compared for all protocols. A retrospective analysis of 252 referrals to a specialist clinic in dentomaxillofacial radiology assessed usability and dose reduction applying nine different collimation protocols, based on possible collimation of panoramic images. Dose reduction was calculated applying collimation feature in comparison to constant use of full size panoramic imaging. Referrals were categorized according to indication for radiographic examination. RESULTS: Effective dose of a full size panoramic radiograph was 17.6 µSv at 8 mA and 66 kV. The dose reduction for the collimated images compared to a full size panoramic radiograph ranged from 4.5 to 86.9%. Potential total dose reduction in the studied sample was 35% if collimation feature had been applied. In four out of five of the referrals, collimation was possible and in 61% of the referrals the indication for radiographic examination was restricted to the dental alveolar region, reducing the dose by 40.3% compared with a full size panoramic image. CONCLUSIONS: Since the effective dose may be reduced without losing diagnostic information in the area of interest, collimation feature of panoramic imaging should be routinely applied when the diagnostic task allows.
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Affiliation(s)
- Daniel Benchimol
- Section of Oral Diagnostics and Surgery, Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Juha Koivisto
- Department of Oral and Maxillofacial Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Sönmez G, Koç C, Kamburoğlu K. Accuracy of linear and volumetric measurements of artificial ERR cavities by using CBCT images obtained at 4 different voxel sizes and measured by using 4 different software: an ex vivo research. Dentomaxillofac Radiol 2018; 47:20170325. [PMID: 29851352 DOI: 10.1259/dmfr.20170325] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To compare the accuracy of linear and volumetric measurements of artificial external root resorption (ERR) cavities by cone beam CT (CBCT) images obtained at four voxel sizes and by using four different software ex vivo. METHODS ERR cavities were created on 40 extracted single rooted anterior teeth. Images were obtained by using Planmeca CBCT unit at endo mode (0.075 mm); high-resolution mode (0.1 mm); high-definition mode (0.15 mm) and normal resolution mode (0.2 mm) voxel sizes. Images were analyzed by two observers using four different software (Romexis, 3D Doctor, ITK-SNAP, and OsiriX). (1) Diameter; (2) height; (3) depth; and (4) volume of the ERR were measured. CBCT measurements were then compared with direct physical measurements. ANOVA was used with general linear model analysis. The significance level was set at p < 0.05. RESULTS One-way ANOVA general linear model analysis showed no significant difference between or within observers for diameter, height, depth and volume measurements (p > 0.05). We found significant differences for diameter and volume measurements among softwares in terms of mean differences as compared to mean standard direct measurements (p < 0.05). We found statistically significant differences among voxel sizes and software for height measurements (p < 0.05). In addition, we found significant differences for diameter and volume measurements (p < 0.05) suggesting more accurate measurements for the cervical region when compared to apical region. CONCLUSIONS Observers using CBCT images obtained at four voxel sizes performed similarly in the quantification of artificial ERR with clinically insignificant distinction between CBCT softwares used.
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Affiliation(s)
- Gül Sönmez
- 1 Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University , Ankara , Turkey
| | - Cemre Koç
- 2 Department of Endodontics, Faculty of Dentistry, Başkent University , Ankara , Turkey
| | - Kıvanç Kamburoğlu
- 1 Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University , Ankara , Turkey
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Hafezi L, Arianezhad SM, Hosseini Pooya SM. Evaluation of the radiation dose in the thyroid gland using different protective collars in panoramic imaging. Dentomaxillofac Radiol 2018; 47:20170428. [PMID: 29658781 DOI: 10.1259/dmfr.20170428] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The value for the use of thyroid shield is one of the issues in radiation protection of patients in dental panoramic imaging. OBJECTIVES The objective of this research is to investigate the attenuation characteristics of some models of thyroid shielding in dental panoramic examinations. METHODS The effects of five different types of lead and lead-free (Pb-equivalent) shields on dose reduction of thyroid gland were investigated using implanted Thermoluminescence Dosemeters (TLDs) in head-neck parts of a Rando phantom. RESULTS The results show that frontal lead and Pb-equivalent shields can reduce the thyroid dose around 50% and 19%, respectively. CONCLUSIONS It can be concluded that the effective shielding area is an important parameter in thyroid gland dose reduction. Lead frontal collars with large effective shielding areas (>~300 cm2 but not necessarily very large) are appropriate for an optimized thyroid gland dose reduction particularly for the critical patients in dental panoramic imaging. Regardless of the shape and thickness, using the Pb-equivalent shields is not justifiable in dental panoramic imaging.
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Affiliation(s)
- Ladan Hafezi
- 1 Department of Maxillofacial Radiology, Dental Branch, Islamic Azad University , Tehran , Iran
| | - S Marjan Arianezhad
- 1 Department of Maxillofacial Radiology, Dental Branch, Islamic Azad University , Tehran , Iran
| | - Seyed Mahdi Hosseini Pooya
- 2 Radiation Application Research School, Nuclear Science and Technology Research Institute , Tehran , Iran
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Chan B, Leung Y. SPECT bone scintigraphy for the assessment of condylar growth activity in mandibular asymmetry: is it accurate? Int J Oral Maxillofac Surg 2018; 47:470-479. [DOI: 10.1016/j.ijom.2017.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 07/27/2017] [Accepted: 09/19/2017] [Indexed: 11/24/2022]
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Abstract
Radiation doses were measured for the first time in intraoral and panoramic dental radiology at Sudanese hospitals. Doses were determined using various exposure settings for adults and children in 8 intraoral and 6 panoramic X-ray devices. The study sample was equally divided between devices using a digital image receptor (DR) and those using conventional screen film (SF). Radiation doses are reported in terms of incident air kerma (IAK) (intraoral radiology) and kerma area product (PKA) (panoramic radiology). IAK values in intraoral radiology were: 1.45 mGy (DR), 4.45 mGy (SF), and 3.01 mGy (combined). For panoramic radiology, PKA values ranged: from 35.8 to 103.2 mGy cm2 (average: 70.4 mGy cm2) for children and from 65.7 to 151.4 mGy cm2 (average: 103.4 mGy cm2) for adults. The results showed that the downward trend in patient doses can be achieved using digital imaging. The study revealed important concerns surrounding radiation protection, such as the lack of regular quality assurance programs and the use of circular collimators.
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Affiliation(s)
- I I Suliman
- Sudan Atomic Energy Commission, Radiation Safety Institute, P.O. Box 3001, Khartoum, Sudan; Al Imam Mohammad Ibn Saud Islamic University (IMSIU), College of Science, Physics Department, Committee on Radiation and Environmental Pollution Protection, P.O. Box 11642, Riyadh, Saudi Arabia.
| | - Aziza H Abdelgadir
- Sudan Atomic Energy Commission, Radiation Safety Institute, P.O. Box 3001, Khartoum, Sudan
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Koç C, Sönmez G, Yılmaz F, Karahan S, Kamburoğlu K. Comparison of the accuracy of periapical radiography with CBCT taken at 3 different voxel sizes in detecting simulated endodontic complications: an ex vivo study. Dentomaxillofac Radiol 2018; 47:20170399. [PMID: 29376737 DOI: 10.1259/dmfr.20170399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To compare the accuracy of a photostimulable phosphor plateP sensor with cone beam CT (CBCT) images in the detection of simulated endodontic complications. METHODS Following simulated endodontic complications were created in 40 extracted human mandibular molar teeth: Group 1, Instrument separation (N = 10); Group 2, Strip perforation (N = 10); Group 3, Underfilling of root canals (N = 10); Group 4, Overfilling of root canals (N = 10). Intraoral and CBCT images (voxel size: 0.075 , 0.1 and 0.2 mm) were taken. Images were scored by 4 observers according to a 5-point scale. Weighted kappa and intraclass correlation coefficients were calculated. Receiveroperating characteristic analysis was performed and DeLong test was used to compare areaunder curve values. Significance level was set at p < 0.05. RESULTS Intraobserver kappa ranged from moderate (0.417) to excellent (0.918). Intraclass correlation coefficients ranged from moderate (0.482) to excellent (0.855). For Group 1 (instrument separation) the highest Az values were obtained for intraoral images and the lowest for CBCT (0.2 mm voxel size) (p < 0.05). The highest Az values were obtained for Group 2 (strip perforation) among all groups. With all CBCT image settings, observers performed similarly and better than intraoral images (p < 0.05) in detection of strip perforation. For Group 3 (underfilling), higher Az values for CBCT images were obtained compared to intraoral images without statistically significant difference (p > 0.05). For Group 4 (overfilling), higher Az values for CBCT images were obtained when compared to digital intraoral for observer 1 and 2 (p < 0.05). CONCLUSIONS CBCT images may be useful as an adjunct to periapical imaging in the detection of endodontic complications, such as strip perforation and overfilled root canals.
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Affiliation(s)
- Cemre Koç
- 1 Endodontics, Başkent University, Faculty of Dentistry , Ankara , Turkey
| | - Gül Sönmez
- 2 Dentomaxillofacial Radiology, Ankara University, Faculty of Dentistry , Ankara , Turkey
| | - Funda Yılmaz
- 3 Endodontics, Ankara University, Faculty of Dentistry , Ankara , Turkey
| | - Sevilay Karahan
- 4 Biostatistics, Hacettepe University, Faculty of Medicine , Ankara , Turkey
| | - Kıvanç Kamburoğlu
- 5 Dentomaxillofacial Radiology, Ankara University, Faculty of Dentistry , Ankara , Turkey
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