Digital radiography in dentistry: a survey of Indiana dentists

Simulation of three intraoral radiographic techniques in pediatric dental patients: subjective comfort assessment using the VAS and Wong-Baker FACES Pain Raiting Scale

BACKGROUND

Perception of pain associated with intraoral radiography in pediatric patients was evaluated through statistical comparisons of data obtained using the Wong-Baker FACES Pain Raiting Scale (WBFPRS) and visual analog scale (VAS) scoring.

METHODS

A total of 75 pediatric patients aged 6-12 years were included in this study. Simulations of each of three radiological methods (analog films, CCD sensor and phosphorus plates) were performed on 25 pediatric patients. Following the simulations, the meaning of each facial expression on the WBFPRS and the numbers on the VAS were explained to each child. For the comparison between groups, the homogeneity of the variances was tested with Levene's test; because the variances were not homogeneous, Welch's test was used. Tamhane's T2 test was used because the homogeneity assumption was not provided to determine the source of the difference between the groups.

RESULTS

When the conventional method was compared to the PSPL (photostimulable phosphor luminescence) method, no significant differences were noted in either the WBFPRS or VAS results (p >0.05). The results obtained from both of the scales were significantly different between the conventional method and the CCD sensor method (p < 0.05). When the PSPL and CCD sensors were compared, a significant difference was observed for the WBFPRS (p < 0.05). It was found the highest level of pain scores when used the CCD sensor method than the analog film and PSPL methods (p < 0.05).

CONCLUSIONS

It is expected that digital radiographic techniques will be improved in the future and that their disadvantages will be eliminated, resulting in imaging devices that are more comfortable for pediatric patients.

Digital dental radiology in Belgium: a nationwide survey

OBJECTIVES

The aim of this study is to analyse the use of digital dental radiology in Belgium, by focussing on the use of extraoral and intraoral radiographic techniques, digitalisation and image communication.

METHODS

A nationwide survey has been performed amongst Belgian general dentists and dental specialists. Questionnaires were distributed digitally via mailings lists and manually on multiple refresher courses and congresses throughout the country. The overall response rate was 30%.

RESULTS

Overall, 94% of the respondents had access to an intraoral radiographic unit, 76% had access to a panoramic unit, 21% has an attached cephalometric arm. One in five Belgian dentists also seem to have direct access to a cone beam CT. 90% of all intraoral radiography unit worked with digital detectors, while this was 91% for panoramic units (with or without cephalometrics). In 70% of the cases, general dental practitioners with a digital intraoral unit used a storage phosphor plate while in 30% of the cases they used sensor technology (charge-coupled device or complementary metal-oxide-semiconductor). The most common method for professional image transfer appeared to be email. Finally, 16% of all respondents used a calibrated monitor for image analysis.

CONCLUSIONS

The survey indicates that 90% of the respondents, Belgian dentists, make use of digital image techniques. For sharing images, general dental practitioners mainly use methods such as printout and e-mail. The usage of calibrated monitors, however, is not well established yet.

Assessment of periodontal bone level revisited: a controlled study on the diagnostic accuracy of clinical evaluation methods and intra-oral radiography

OBJECTIVES

The accuracy of analogue and especially digital intra-oral radiography in assessing interdental bone level needs further documentation. The aim of this study was to compare clinical and radiographic bone level assessment to intra-surgical bone level registration (1) and to identify the clinical variables rendering interdental bone level assessment inaccurate (2).

MATERIALS AND METHODS

The study sample included 49 interdental sites in 17 periodontitis patients. Evaluation methods included vertical relative probing attachment level (RAL-V), analogue and digital intra-oral radiography and bone sounding without and with flap elevation. The latter was considered the true bone level. Five examiners evaluated all radiographs.

RESULTS

Significant underestimation of the true bone level was observed for all evaluation methods pointing to 2.7 mm on average for analogue radiography, 2.5 mm for digital radiography, 1.8 mm for RAL-V and 0.6 mm for bone sounding without flap elevation (p < 0.001). Radiographic underestimation of the true bone level was higher in the (pre)molar region (p ≤ 0.047) and increased with defect depth (p < 0.001). Variation between clinicians was huge (range analogue radiography 2.2-3.2 mm; range digital radiography 2.1-3.0 mm).

CONCLUSION

All evaluation methods significantly underestimated the true bone level. Bone sounding was most accurate, whereas intra-oral radiographs were least accurate. Deep periodontal defects in the (pre)molar region were most underrated by intra-oral radiography.

CLINICAL RELEVANCE

Bone sounding had the highest accuracy in assessing interdental bone level.

Brazilian young dental practitioners' use and acceptance of digital radiographic examinations

Purpose

The aim of this study was to investigate the use and acceptance of digital radiographic examinations by Brazilian dental practitioners in daily practice and to evaluate the advances that have occurred over the past 5 years.

Materials and Methods

Dental practitioners enrolled in extension courses at the Piracicaba Dental School, University of Campinas, Brazil, responded to a self-administered questionnaire in the years 2011 and 2015. They were asked about sociodemographic factors and their knowledge and use of digital radiographic examinations. Descriptive analysis was performed, as well as the chi-square and Fisher exact tests, with a significance level of 5% (α=0.05).

Results

A total of 181 participants responded to the questionnaire in the years 2011 and 2015. Most of the respondents worked in private practice, had graduated within the last 5 years, and were between 20 and 30 years old. In 2011, 55.6% of respondents reported having ever used digital radiographic examinations, while in 2015 this number increased significantly to 85.4% (p<.0001), out of which 71.4% preferred it to conventional images. Moreover, 21.4% of respondents reported having used digital radiographic examinations for more than 3 years. A significant increase in use of intraoral digital radiography (p=0.0316) was observed in 2015. In both years, image quality and high cost were indicated, respectively, as the main advantage and disadvantage of digital radiographic examinations.

Conclusion

This study showed that digital radiology has become more common in Brazil over the past 5 years. Most of the Brazilian dental practitioners evaluated in 2015 used digital radiographic examinations.

Diagnostic accuracy of periapical radiography and cone beam computed tomography in detecting apical periodontitis using histopathological findings as a reference standard

AIM

To compare the diagnostic accuracy of periapical radiography (PR) and cone beam computed tomography (CBCT) in detecting apical periodontitis (AP) using histopathological findings as a reference standard.

METHODOLOGY

Jaw sections containing 67 teeth (86 roots) were collected from unclaimed bodies due for cremation. Imaging was carried out to detect AP by digital PR with a central view (DP group), digital PR combining central with 10˚ mesially and distally angled (parallax) views (DPS group) and CBCT scans. All specimens underwent histopathological examination to confirm the diagnosis of AP. Sensitivity, specificity and predictive values of PR and CBCT were analysed using rater mean (n = 5). Receiver-operating characteristic (ROC) analysis was carried out.

RESULTS

Sensitivity was 0.27, 0.38 and 0.89 for DP, DPS and CBCT scans, respectively. CBCT had specificity and positive predictive value of 1.0 whilst DP and DPS had specificity and positive predictive value of 0.99. The negative predictive value was 0.39, 0.44 and 0.81 for DP, DPS and CBCT scans, respectively. Area under the curve (AUC) for the various imaging methods was 0.629 (DP), 0.688 (DPS), and 0.943 (CBCT).

CONCLUSIONS

All imaging techniques had similar specificity and positive predictive values. Additional parallax views increased the diagnostic accuracy of PR. CBCT had significantly higher diagnostic accuracy in detecting AP compared to PR, using human histopathological findings as a reference standard.

Image quality evaluation of eight complementary metal-oxide semiconductor intraoral digital X-ray sensors

PURPOSE

To evaluate the image quality generated by eight commercially available intraoral sensors.

METHODS

Eighteen clinicians ranked the quality of a bitewing acquired from one subject using eight different intraoral sensors. Analytical methods used to evaluate clinical image quality included the Visual Grading Characteristics method, which helps to quantify subjective opinions to make them suitable for analysis.

RESULTS

The Dexis sensor was ranked significantly better than Sirona and Carestream-Kodak sensors; and the image captured using the Carestream-Kodak sensor was ranked significantly worse than those captured using Dexis, Schick and Cyber Medical Imaging sensors. The Image Works sensor image was rated the lowest by all clinicians. Other comparisons resulted in non-significant results.

CONCLUSIONS

None of the sensors was considered to generate images of significantly better quality than the other sensors tested. Further research should be directed towards determining the clinical significance of the differences in image quality reported in this study.

Image optimization in digital dental radiography

Presented is a method for establishing the appropriate balance of image quality and radiation dose for dental imaging. Using the Monte Carlo N-Particle Extended (MCNPX) radiation transport code, the DC Planmeca radiographic unit and a dental bitewing phantom were modeled. The Carestream 6100 RVG sensor signal response, noise response, dose rate dependence, and reproducibility were determined experimentally, including uncertainties and inter/intraunit variabilities. The computationally varied parameters were peak kilovoltage and tube filtration. The entrance air kerma for the current clinical technique was used to establish reference image quality. Four figures of merit (FOM) were chosen to encompass parameter variation. With equal weighting of FOMs and no equipment limitations, the optimal parameters were 90 kVp with 0.1 mm added copper filtration. The optimal technique in the radiographic units' operating range was 70 kVp and 0.1 mm added copper filtration, resulting in a ∼50% (±17%) entrance dose and ∼40% effective dose savings.

Defective plastic infection-control barriers and faulty technique may cause PSP plate contamination used in digital intraoral radiography

SUBJECTS

Fifty-two disinfected photostimulable phosphor (PSP) plates in plastic barrier envelopes were evaluated for contamination following placement in 30 study participants. Forty-four plates were acceptable for use in the study.

KEY RISK/STUDY FACTOR

The risk factor was the abundant oropharyngeal microbial flora and its ability to breach infection-control barrier sheaths.

MAIN OUTCOME MEASURE

The presence of bacterial colonies on an agar plate was used to determine bacterial contamination and the presence of any growth indicated failure of the barrier envelope.

MAIN RESULTS

Before clinical placement of the plates, quality review of the PSP plates revealed defects in the integrity of 4 barrier envelopes most likely caused by forceps-related damage or failure to achieve a uniform seal during manufacturing. These defects allowed substantial contamination. Contamination also occurred as a result of failure to extract the PSP plate from the barrier envelope cleanly. Of the 44 barriers with no obvious signs of a defect, 3 produced bacterial growth following culture.

CONCLUSIONS

The authors concluded that digital sensor sheathed in barrier envelopes remain a potential source of contamination. PSP plates must be disinfected between removal from a contaminated barrier envelope (used in a patient) and placement in a new barrier envelope. In addition, placement into the barrier envelope should ideally be carried out under aseptic conditions. Finally, the integrity of each sealed barrier envelope must be verified visually.

Evaluate the usage of different advanced endodontic instruments and techniques in pediatric dentistry

OBJECTIVE

The purpose of study is to find the prevalence of usage of different advanced endodontic instruments and techniques in pediatric dentistry.

MATERIALS AND METHODS

A self-administered, structured questionnaire written in English validated through a pretested survey was randomly mailed to the postgraduate students in different dental colleges. A total of 182 of the complete filled questionnaires were returned with response rate of 68.2%. The data were analyzed using the SPSS version 15.0. The Student's t-test and ANOVA test were used as test of significance. Karl Pearson's correlation test was used to assess years of education and usage of endodontic instruments.

RESULTS

There was a limited use of new endodontic technologies in the present study. The highest positive response to the usage of advanced endodontic instruments was related to NiTi rotary files with highest number seen among 3rd year students. A linear relationship was found between years of postgraduation and usage of advanced endodontic instruments using Karl Pearson's correlation coefficient.

CLINICAL SIGNIFICANCE

Based on the results of the present study, it seems that the usage of advanced endodontic instruments is not up to the level. Also we found increased use of new technologies with years of postgraduation.

Questionnaire surveys of dentists on radiology

OBJECTIVES

Survey by questionnaire is a widely used research method in dental radiology. A major concern in reviews of questionnaires is non-response. The objectives of this study were to review questionnaire studies in dental radiology with regard to potential survey errors and to develop recommendations to assist future researchers.

METHODS

A literature search with the software search package PubMed was used to obtain internet-based access to Medline through the website www.ncbi.nlm.nih.gov/pubmed. A search of the English language peer-reviewed literature was conducted of all published studies, with no restriction on date. The search strategy found articles with dates from 1983 to 2010. The medical subject heading terms used were "questionnaire", "dental radiology" and "dental radiography". The reference sections of articles retrieved by this method were hand-searched in order to identify further relevant papers. Reviews, commentaries and relevant studies from the wider literature were also included.

RESULTS

53 questionnaire studies were identified in the dental literature that concerned dental radiography and included a report of response rate. These were all published between 1983 and 2010. In total, 87 articles are referred to in this review, including the 53 dental radiology studies. Other cited articles include reviews, commentaries and examples of studies outside dental radiology where they are germane to the arguments presented.

CONCLUSIONS

Non-response is only one of four broad areas of error to which questionnaire surveys are subject. This review considers coverage, sampling and measurement, as well as non-response. Recommendations are made to assist future research that uses questionnaire surveys.

The usage of digital radiography and cone beam computed tomography among Turkish dentists

OBJECTIVES

The aim of this study was to determine the prevalence of the use of digital radiography and report how it was used by Turkish dentists.

METHODS

The survey was based on 383 dentists who were present at the sixteenth International Congress organized by the Turkish Dental Association. A questionnaire which consisted of 19 questions was given to the dentists who participated in the study. Data were assessed according to frequency distribution and the χ(2) test was used to determine the significance of differences between two independent groups.

RESULTS

376 questionnaires were analysed. The mean age of the dentists who participated in the study was 37.14 ± 9.6 years (range: 20-63 years). The distribution of the dentists according to the 7 regions of Turkey were: Marmara 58%, Aegean 13% and Mediterranean 10%, Central Anatolia 8%, Black Sea 7%, Southeastern Anatolia 3%, Eastern Anatolia 1%. 124 dentists (33%) said they did not work with digital radiography. 95 dentists indicated that they did not use digital radiography owing to cost (60%). 252 dentists (67%) said they used digital radiography. 40% of the participants noted that the repetition of periapical radiographs was due to digital radiography. 166 dentists (55.9%) and 79.1% academicians had knowledge about cone beam CT (CBCT).

CONCLUSION

Digital radiography users are increasing in Turkey and levels of knowledge of CBCT and awareness of radiation safety has also increased.

Better imaging: the advantages of digital radiography

BACKGROUND

Digital radiography has been available in dentistry for more than 25 years, but it has not replaced conventional film-based radiography completely. This could be because of the costs involved in replacing conventional radiographic equipment with a digital imaging system, or because implementing new technology in the dental practice requires a bit of courage. When the practitioner is fully aware of the new possibilities offered by digital radiography, he or she can make a more informed decision about adopting it. This article offers information about digital radiography, not just as a replacement of conventional radiography, but also as a concept offering benefits beyond those of conventional radiography.

OVERVIEW

Digital radiographs are composed of a set of numbers arranged as a grid of rows and columns. The dentist can perform mathematical operations on these numbers to create a new image in which certain characteristics are enhanced, thus making interpretation of the image easier. The dentist also can correct, to some extent, overexposed or underexposed images and can optimize contrast and brightness for specific diagnostic procedures, such as caries detection and bone level assessment. More advanced procedures are available as well, such as digital subtraction radiography and computer-aided recognition of image features.

CONCLUSIONS AND CLINICAL IMPLICATIONS

The author presents a selection of the advantages of digital radiography that are not achievable with conventional film-based radiography. Implementing digital radiography in the dental office requires additional training. However, once members of the dental team have gone through this initial phase, they have the benefits of several new diagnostic possibilities. With a digital system, information from radiographic images is collected more easily and in a more objective way, which will improve the performance of the diagnostic process.