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Franco A, Moreira DD, Cidade R, Machado M, Bueno J, Malschitzky C, Boedi RM. The Brazilian (FRANCO) method for dental age estimation: Willems' model revisited. Clin Oral Investig 2024; 28:495. [PMID: 39167103 DOI: 10.1007/s00784-024-05869-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/31/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVES This study aimed (I) to test the Willems' dental age estimation method in different geographic samples of the Brazilian population, and (II) to propose a new model combining the geographic samples in a single reference table of Brazilian maturity scores. MATERIALS AND METHODS The sample consisted of 5017 panoramic radiographs of Brazilian males (n = 2443) and females (n = 2574) between 6 and 15.99 years (mean age = 10.99 ± 2.76 years). The radiographs were collected from the Southeastern (SE) (n = 2920), Central-Western (CW) (n = 1176), and Southern (SO) (n = 921) geographic regions. Demirjian's technique was applied followed by Willems' method and the proposed Brazilian model. RESULTS Willems' method led to mean absolute errors (MAE) of 0.79 and 0.81 years for males and females, respectively. Root mean squared errors (RMSE) were 1.01 and 1.03 years, respectively. The Brazilian model led to MAE of 0.72 and 0.74 years for males and females, respectively, and RMSE of 0.93 years for both sexes. The MAE was reduced in 70% of the age categories. Differences between regions were statistically (p < 0.05) but not clinically significant. CONCLUSION The new model based on a combined population had an enhanced performance compared to Willems' model and led to reference outcomes for Brazilians. CLINICAL RELEVANCE Assessing patients' biological development by means of dental analysis is relevant to plan orthopedic treatments and follow up. Having a combined-region statistic model for dental age estimation of Brazilian children contributes to optimal age estimation practices.
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Affiliation(s)
- Ademir Franco
- Division of Forensic Dentistry, Faculdade São Leopoldo Mandic, Rua Dr José Rocha Junqueira 13, Swift Campinas, Block E Office 3, São Paulo, 045-755, Brazil.
- Department of Therapeutic Stomatology, Institute of Dentistry, Moscow, Russia.
| | | | - Rafael Cidade
- Division of Oral Radiology, Faculdade São Leopoldo Mandic, Campinas, Brazil
| | - Marcos Machado
- Division of Oral Radiology, Faculdade São Leopoldo Mandic, Campinas, Brazil
| | - Juliano Bueno
- Division of Oral Radiology, Faculdade São Leopoldo Mandic, Campinas, Brazil
| | - Carolina Malschitzky
- Division of Forensic Dentistry, Faculdade São Leopoldo Mandic, Rua Dr José Rocha Junqueira 13, Swift Campinas, Block E Office 3, São Paulo, 045-755, Brazil
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Abdinian M, Keshani F, Sadeghi F, Soltani P, Spagnuolo G, Rengo C. Evaluation of the effects of postprocessing settings in digital bitewing radiographs on proximal caries detection. Clin Exp Dent Res 2024; 10:e889. [PMID: 38712390 DOI: 10.1002/cre2.889] [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: 12/27/2023] [Revised: 03/25/2024] [Accepted: 04/22/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVE Radiographs are an integral part of detecting proximal caries. The aim of this study was to evaluate the effect of contrast, brightness, noise, sharpness, and γ adjustment of digital intraoral radiographs on the diagnosis of proximal caries. MATERIALS AND METHODS In this in vitro study, 40 extracted teeth including 20 premolars and 20 molars with enamel lesions (white spot or dentin discoloration seen through the enamel) were mounted together in groups of eight inside the skull. Bitewing radiographic images of each dental group were obtained by a photostimulable phosphor plate sensor with exposure conditions of 8 mA, 70 kV, and 0.2 s. The images were reconstructed by the built-in software and examined by two oral and maxillofacial radiologists in various settings of contrast, brightness, sharpness, noise, and γ. The teeth were then cut mesiodistally and the presence or absence of caries was confirmed by an oral and maxillofacial pathologist using a stereomicroscope. The data were then analyzed using the κ agreement coefficient, sensitivity, specificity, and accuracy (α = .05). RESULTS Adjustment of brightness and contrast led to higher diagnostic performance with an accuracy of 82.5% and 83.8 (for observers 1 and 2, respectively) and 82.5% (for both observers), respectively. Noise adjustment was the least helpful approach for diagnosis of proximal dental caries among other adjustments, with an accuracy of 78.8% and 77.5% for observers 1 and 2, respectively. CONCLUSION Brightness and contrast setting was more efficient in improving the diagnostic potential of bitewing radiographs compared to other adjustments.
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Affiliation(s)
- Mehrdad Abdinian
- Department of Oral and Maxillofacial Radiology, Dental Implants Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Forooz Keshani
- Department of Oral and Maxillofacial Pathology, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fateme Sadeghi
- Students Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parisa Soltani
- Department of Oral and Maxillofacial Radiology, Dental Implants Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Gianrico Spagnuolo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
- Therapeutic Dentistry Department, Institute for Dentistry, Sechenov University, Moscow, Russia
| | - Carlo Rengo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
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Menezes LDS, Silva TP, Lima Dos Santos MA, Hughes MM, Mariano Souza SDR, Leite Ribeiro PM, Freitas PHLD, Takeshita WM. Assessment of landmark detection in cephalometric radiographs with different conditions of brightness and contrast using the an artificial intelligence software. Dentomaxillofac Radiol 2023; 52:20230065. [PMID: 37869886 DOI: 10.1259/dmfr.20230065] [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: 10/24/2023] Open
Abstract
OBJECTIVES To evaluate the reliability and reproducibility of an artificial intelligence (AI) software in identifying cephalometric points on lateral cephalometric radiographs considering four settings of brightness and contrast. METHODS AND MATERIALS Brightness and contrast of 30 lateral cephalometric radiographs were adjusted into four different settings. Then, the control examiner (ECont), the calibrated examiner (ECal), and the CEFBOT AI software (AIs) each marked 19 cephalometric points on all radiographs. Reliability was assessed with a second analysis of the radiographs 15 days after the first one. Statistical significance was set at p < 0.05. RESULTS Reliability of landmark identification was excellent for the human examiners and the AIs regardless of the type of brightness and contrast setting (mean intraclass correlation coefficient >0.89). When ECont and ECal were compared for reproducibility, there were more cephalometric points with significant differences on the x-axis of the image with the highest contrast and the lowest brightness, namely N(p = 0.033), S(p = 0.030), Po(p < 0.001), and Pog'(p = 0.012). Between ECont and AIs, there were more cephalometric points with significant differences on the image with the highest contrast and the lowest brightness, namely N(p = 0.034), Or(p = 0.048), Po(p < 0.001), A(p = 0.042), Pog'(p = 0.004), Ll(p = 0.005), Ul(p < 0.001), and Sn(p = 0.001). CONCLUSIONS While the reliability of the AIs for cephalometric landmark identification was rated as excellent, low brightness and high contrast seemed to affect its reproducibility. The experienced human examiner, on the other hand, did not show such faulty reproducibility; therefore, the AIs used in this study is an excellent auxiliary tool for cephalometric analysis, but still depends on human supervision to be clinically reliable.
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Affiliation(s)
| | - Thaísa Pinheiro Silva
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, São Paulo, Brazil
| | | | | | | | | | | | - Wilton Mitsunari Takeshita
- Diagnosis and Surgery, São Paulo State University (Unesp), School of Dentistry, Araçatuba, São Paulo, Brazil
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Pinheiro A, Franco R, Makeeva I, Bueno J, Miamoto P, Franco A. 30 years of the ABFO study: Reproduction in a Brazilian sample. Morphologie 2023:S1286-0115(23)00029-2. [PMID: 37149420 DOI: 10.1016/j.morpho.2023.04.001] [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: 01/19/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/08/2023]
Abstract
The ABFO study on third molar development is a benchmark in the scientific literature of dental age estimation. In its 30th anniversary, the study has been reproduced in the present external validation. Standardized comparative outcomes were obtained and discussed across studies. The sample consisted of 1.087 panoramic radiographs of Brazilian females (n=542, 49.87%) and males (n=545, 50.13%) between 14 and 22.9 years. All available third molars were classified into developmental stages following Mincer's adaptation of Demirjian's system (8 sequential stages, from A to H). The mean chronological age of individuals within each stage was assessed. The probability of an individual being ≥ 18 years was calculated for each third molar, sex and stage. Maxillary and mandibular third molars showed a similar development with an agreement between stages of about 90%. In general, males developed 0.5 years (6 months) earlier than females. The probability of being an adult increased considerably when at least one third molar is in stage G. Maxillary third molars had higher coefficients of determination (right: 0.704; left: 0.702), showing that statistical models with these teeth could explain better the age estimation outcomes. The reproducibility of the ABFO study on third molar development led to reference tables and probability measures for the studied Brazilian population.
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Affiliation(s)
- A Pinheiro
- Faculdade São Leopoldo Mandic, R. Jose-Rocha-Junqueira 13, 13.045-755 Campinas, SP, Brazil
| | - R Franco
- Department of Community and Preventive Dentistry, Federal University of Uberlândia, 38.400-902 Uberlândia, Minas Gerais, Brazil
| | - I Makeeva
- Department of Therapeutic Stomatology, Institute of Dentistry, Sechenov University, 119146 Moscow, Russia
| | - J Bueno
- Division of Oral Radiology, Faculdade São Leopoldo Mandic, Brazil
| | - P Miamoto
- Division of Forensic Odontology and Anthropology, Scientific Police of Santa Catarina, 88085-002 Florianopolis, Santa Catarina, Brazil
| | - A Franco
- Faculdade São Leopoldo Mandic, R. Jose-Rocha-Junqueira 13, 13.045-755 Campinas, SP, Brazil.
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Ruiz DC, Farias-Gomes A, Fontenele RC, Gaêta-Araujo H, Haiter-Neto F, Freitas DQ, Groppo FC. Influence of extensive use of a photostimulable phosphor receptor on the diagnosis of proximal carious lesions: An in vitro study. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 135:539-547. [PMID: 36566136 DOI: 10.1016/j.oooo.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/17/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the influence of the extensive use of a photostimulable phosphor (PSP) receptor on the diagnosis of proximal carious lesions. STUDY DESIGN Forty posterior teeth were paired and mounted in 20 phantoms. Using a PSP receptor of the Express intraoral system, 1 radiograph of each phantom was acquired, totaling 20 radiographs (group 1). After 400 acquisitions, another radiograph of each phantom was obtained, totaling 20 new radiographs (group 2). This procedure was also done after 800 (group 3), 1,200 (group 4), and 1,600 (group 5) acquisitions, resulting in 100 radiographs. Another 40 radiographs (20 phantoms × 2 groups) were obtained with a second PSP sensor to evaluate the diagnostic replicability of the receptors. All 140 radiographs were assessed independently by 5 examiners for the presence of proximal caries. Area under the receiver operating characteristic curve, sensitivity, and specificity were calculated and compared among the groups by analysis of variance. The Student t test evaluated the diagnostic replicability of the receptors. The significance level was set at 5% (P < .05). RESULTS The diagnostic outcomes for proximal caries did not differ among the groups (P ≥ .37). The diagnostic values did not differ among the radiographs acquired with the 2 PSP receptors (P ≥ .75). CONCLUSIONS The diagnosis of proximal carious lesions was not affected by extensive use of the PSP receptor.
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Affiliation(s)
- Débora Costa Ruiz
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil.
| | - Amanda Farias-Gomes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | | | - Hugo Gaêta-Araujo
- School of Dentistry, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | - Francisco Haiter-Neto
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Francisco Carlos Groppo
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil; Department of Physiological Sciences, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
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Goetten IFDS, Oenning ACC, Silva RF, Nuzzolese E, Lourenço Junior E, Franco A. Diagnostic accuracy of the third molar maturity index (I 3M) to assess the age of legal majority in Northern Brazil-population-specific cut-off values. Int J Legal Med 2022; 136:1507-1514. [PMID: 35708869 DOI: 10.1007/s00414-022-02857-3] [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: 04/19/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022]
Abstract
International guidelines for dental age assessment have recommended the use of methods based on available population-specific data. The Third Molar Maturity Index (I3M) was previously validated in several populations worldwide. This was the first study to evaluate the I3M in a northern Brazilian population and to test the diagnostic accuracy of the method to distinguish between minors and adults. The sample consisted of 1.070 panoramic radiographs retrospectively collected from females (n = 595) and males (n = 475) with ages between 16 and 22 years. I3M's original cut-off value of 0.08 was used to classify individuals below and above the age of 18. Receiver operating characteristic (ROC) curves were plotted to assess the accuracy (ACC) of the method. In females and males separately, the overall ACC was 73.1% and 80%, respectively. The overall ACC for the combined sample was 76.1%. For northern Brazilian males, the best cut-off value remained 0.08, while for females, an adjustment to 0.12 showed optimal outcomes. The new cut-off value led to an ACC of 98.5% for females, which reflected an increase of 25.5% compared to the original cut-off value. The original cut-off value proposed by I3M was applicable to the present sample of northern Brazilian individuals. Adjustments to 0.12, however, may be encouraged to enhance the performance of the method among females.
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Affiliation(s)
| | | | | | - Emilio Nuzzolese
- Section of Legal Medicine, Laboratory of Human Identification, University of Turin, Turin, Italy
| | | | - Ademir Franco
- Division of Forensic Dentistry, Faculdade Sao Leopoldo Mandic, Campinas, Brazil.
- Department of Therapeutic Stomatology, Institute of Dentistry, Sechenov University, Moscow, Russia.
- Centre of Forensic and Legal Medicine and Dentistry, University of Dundee, Nethergate DD1 4HN, Level 7, Dundee, T7015, UK.
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Machado MVF, Soares MQS, Baz AMSA, Junqueira JLC, Franco A. A large sample-sized study on dental development of children treated at the Central Dental Clinic (OCEx) of the Brazilian Army. Clin Oral Investig 2022; 26:5439-5447. [PMID: 35484357 DOI: 10.1007/s00784-022-04511-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/24/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To test and compare the performance of two radiographic methods for dental age estimation on a large sample of Brazilian boys and girls. MATERIAL AND METHODS The sample consisted of 1.990 panoramic radiographs of Brazilian children (age: 3-15.9 years) equally balanced based on sex. The sample was distributed into ten age categories, each with up to 200 children. Age estimation was performed with Willems' (2001) and Demirjian's (1973) methods. Estimated (EA) and chronological (CA) ages were compared. The performances of the methods were quantified based on sex and age category. RESULTS The overall differences between CA and EA for Willems' method in boys and girls were 0.06 and - 0.02, respectively. For Demirjian's method, the differences were 0.60 and 0.74, respectively. The overestimations of Demirjian's method were statistically significant (p < 0.001). Willems' method reached the best outcomes among children between 3 and 12 years, while Demirjian's best performances were between the ages of 7 and 10 years. CONCLUSION Willems' method led to differences between CA and AE that were acceptable for clinical and forensic practice. CLINICAL RELEVANCE Age estimation may guide clinical decisions based on treatment timing. Validating international tools is necessary to promote evidence-based practice and country-specific application. This study overcame the limitations of previous research to provide a more realistic perspective of the performance of age estimation methods in Brazilian children. Willems' method had a superior performance compared to Demirjian's method and led to outcomes that were better than most studies with the Brazilian population.
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Affiliation(s)
| | | | | | | | - Ademir Franco
- Division of Forensic Dentistry, Faculdade Sao Leopoldo Mandic, Campinas, Brazil. .,Centre of Forensic and Legal Medicine and Dentistry, University of Dundee, Dundee, UK.
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Radiographic diagnosis of proximal caries is not affected by exposure protocols and presence of high-density material on systems with automatic exposure compensation. Oral Radiol 2021; 38:356-362. [PMID: 34529235 DOI: 10.1007/s11282-021-00565-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: 03/14/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To investigate the performance of radiographic systems with automatic exposure compensation (AEC) on the caries diagnosis in images acquired with different exposure parameters and in the presence of high-density material. Also, the image quality was assessed. METHODS Forty posterior teeth (80 proximal surfaces) were radiographed using a phosphor plate and a CMOS system. Images were acquired with different exposure times (0.06, 0.10 and 0.16 s) and kilovoltages (60 and 70kVp), in the absence and presence of high-density material in the X-rayed region (control and high-density groups). Five radiologists assessed the caries using a 5-point scale. Diagnostic values were compared using two-way ANOVA. RESULTS For both radiographic systems, there were no significant differences in the area under the ROC curve (0.60-0.73), sensitivity (0.79-0.87) and specificity (0.29-0.48) between the control and high-density groups, exposure times or kilovoltages (p > 0.05). For image quality, scores assigned to the control and high-density groups were similar in each exposure protocol in both systems. CONCLUSIONS The presence of high-density material, exposure time and kilovoltage did not affect the caries diagnosis in any of the systems tested. It is recommended to use protocols with lower doses to reduce the patient's exposure.
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Gasqui MA, Pérard M, Decup F, Monsarrat P, Turpin YL, Villat C, Gueyffier F, Maucort-Boulch D, Roche L, Grosgogeat B. Place of a new radiological index in predicting pulp exposure before intervention for deep carious lesions. Oral Radiol 2021; 38:89-98. [PMID: 33954908 DOI: 10.1007/s11282-021-00530-w] [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: 12/10/2020] [Accepted: 04/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND During interventions for deep caries lesions without severe symptoms, preserving pulpal vitality is important to ensure treatment success, improve organ prognosis, and decrease cost-effectiveness. Current pre-operative radiographs allow visual estimation but not accurate measurement of lesion depth. PURPOSE Investigate the ability of ratio 'remaining/total dentin thickness' (RDT/TDT, as determined on pre-operative radiographs) to predict pulp exposure during excavation. METHODS This retrospective study (January 2018-June 2020) analyzed data on 360 patients. Four independent raters examined standard pre-operative radiographs and their contrasted versions. Lines put at the dentino-enamel junction, the floor of the carious lesion, and the pulp chamber wall allowed deriving RDT/TDT. Inter-rater agreements and concordance were assessed. A logistic regression accounting for measurement errors provided odds ratios that estimated the ability of the RDT/TDT to predict pulp exposure. RESULTS The median RDT/TDT ratio ranges were 16.8-26.5% on standard and 16.2-24.6% on contrasted radiographs. Inter-rater agreements on RDT/TDT were rather poor and inter-rater reliability was low and similar in standard and contrasted radiographs: the concordance correlation coefficients (95% CIs) were estimated at 0.46 (0.40; 0.51) and 0.46 (0.40; 0.52), respectively. The risk of pulp exposure increased by 2.5 times [odds ratio (95% CI) 2.57 (2.06; 3.20)] per 10-point decrease of the ratio on standard radiographs vs. 4.15 (3.15; 5.46) on contrasted radiographs. CONCLUSION RDT/TDT ratio is potentially helpful in predicting pulp exposure. However, the measurement errors on RDT and TDT being non-negligible and the interrater agreements poor, there is still place for advances through development of an automated process that will improve reliability and reproducibility of pulp exposure risk assessment. CLINICAL TRIAL Trial registration number. ClinicalTrials.gov NCT04607395, October 29, 2020.
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Affiliation(s)
- Marie-Agnès Gasqui
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - Matthieu Pérard
- Faculté d'Odontologie, Université de Rennes 1, Rennes, France
- Institut des Sciences Chimiques de Rennes, UMR CNRS 6226, Rennes, France
- Pôle d'Odontologie, CHU Rennes, Rennes, France
| | - Franck Decup
- Faculté d'Odontologie, Université Paris Descartes, Montrouge, France
- Pathologie Imagerie et Biothérapies orofaciales, EA2496, Université Paris Descartes, 92120, Montrouge, France
- Service d'Odontologie, Assistance Publique des Hôpitaux de Paris, Hôpital Charles-Foix, Ivry, France
| | - Paul Monsarrat
- Faculté d'Odontologie, Université Paul Sabatier, Toulouse, France
- STROMALab, Université de Toulouse, CNRS ERL 5311, EFS, INP-ENVT, Inserm, UPS, Toulouse, France
- Centre Hospitalo-Universitaire, Toulouse, France
| | - Yann-Loïg Turpin
- Faculté d'Odontologie, Université de Rennes 1, Rennes, France
- Pôle d'Odontologie, CHU Rennes, Rennes, France
| | - Cyril Villat
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - François Gueyffier
- Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
- Hôpital cardiologique, Hospices Civils de Lyon, Lyon, France
| | - Delphine Maucort-Boulch
- Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Laurent Roche
- Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Brigitte Grosgogeat
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France.
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Walsh T, Macey R, Riley P, Glenny AM, Schwendicke F, Worthington HV, Clarkson JE, Ricketts D, Su TL, Sengupta A. Imaging modalities to inform the detection and diagnosis of early caries. Cochrane Database Syst Rev 2021; 3:CD014545. [PMID: 33720395 PMCID: PMC8441255 DOI: 10.1002/14651858.cd014545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The detection and diagnosis of caries at the earliest opportunity is fundamental to the preservation of tooth tissue and maintenance of oral health. Radiographs have traditionally been used to supplement the conventional visual-tactile clinical examination. Accurate, timely detection and diagnosis of early signs of disease could afford patients the opportunity of less invasive treatment with less destruction of tooth tissue, reduce the need for treatment with aerosol-generating procedures, and potentially result in a reduced cost of care to the patient and to healthcare services. OBJECTIVES To determine the diagnostic accuracy of different dental imaging methods to inform the detection and diagnosis of non-cavitated enamel only coronal dental caries. SEARCH METHODS Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 31 December 2018); Embase Ovid (1980 to 31 December 2018); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 31 December 2018); and the World Health Organization International Clinical Trials Registry Platform (to 31 December 2018). We studied reference lists as well as published systematic review articles. SELECTION CRITERIA We included diagnostic accuracy study designs that compared a dental imaging method with a reference standard (histology, excavation, enhanced visual examination), studies that evaluated the diagnostic accuracy of single index tests, and studies that directly compared two or more index tests. Studies reporting at both the patient or tooth surface level were included. In vitro and in vivo studies were eligible for inclusion. Studies that explicitly recruited participants with more advanced lesions that were obviously into dentine or frankly cavitated were excluded. We also excluded studies that artificially created carious lesions and those that used an index test during the excavation of dental caries to ascertain the optimum depth of excavation. DATA COLLECTION AND ANALYSIS Two review authors extracted data independently and in duplicate using a standardised data extraction form and quality assessment based on QUADAS-2 specific to the clinical context. Estimates of diagnostic accuracy were determined using the bivariate hierarchical method to produce summary points of sensitivity and specificity with 95% confidence regions. Comparative accuracy of different radiograph methods was conducted based on indirect and direct comparisons between methods. Potential sources of heterogeneity were pre-specified and explored visually and more formally through meta-regression. MAIN RESULTS We included 104 datasets from 77 studies reporting a total of 15,518 tooth sites or surfaces. The most frequently reported imaging methods were analogue radiographs (55 datasets from 51 studies) and digital radiographs (42 datasets from 40 studies) followed by cone beam computed tomography (CBCT) (7 datasets from 7 studies). Only 17 studies were of an in vivo study design, carried out in a clinical setting. No studies were considered to be at low risk of bias across all four domains but 16 studies were judged to have low concern for applicability across all domains. The patient selection domain had the largest number of studies judged to be at high risk of bias (43 studies); the index test, reference standard, and flow and timing domains were judged to be at high risk of bias in 30, 12, and 7 studies respectively. Studies were synthesised using a hierarchical bivariate method for meta-analysis. There was substantial variability in the results of the individual studies, with sensitivities that ranged from 0 to 0.96 and specificities from 0 to 1.00. For all imaging methods the estimated summary sensitivity and specificity point was 0.47 (95% confidence interval (CI) 0.40 to 0.53) and 0.88 (95% CI 0.84 to 0.92), respectively. In a cohort of 1000 tooth surfaces with a prevalence of enamel caries of 63%, this would result in 337 tooth surfaces being classified as disease free when enamel caries was truly present (false negatives), and 43 tooth surfaces being classified as diseased in the absence of enamel caries (false positives). Meta-regression indicated that measures of accuracy differed according to the imaging method (Chi2(4) = 32.44, P < 0.001), with the highest sensitivity observed for CBCT, and the highest specificity observed for analogue radiographs. None of the specified potential sources of heterogeneity were able to explain the variability in results. No studies included restored teeth in their sample or reported the inclusion of sealants. We rated the certainty of the evidence as low for sensitivity and specificity and downgraded two levels in total for risk of bias due to limitations in the design and conduct of the included studies, indirectness arising from the in vitro studies, and the observed inconsistency of the results. AUTHORS' CONCLUSIONS The design and conduct of studies to determine the diagnostic accuracy of methods to detect and diagnose caries in situ are particularly challenging. Low-certainty evidence suggests that imaging for the detection or diagnosis of early caries may have poor sensitivity but acceptable specificity, resulting in a relatively high number of false-negative results with the potential for early disease to progress. If left untreated, the opportunity to provide professional or self-care practices to arrest or reverse early caries lesions will be missed. The specificity of lesion detection is however relatively high, and one could argue that initiation of non-invasive management (such as the use of topical fluoride), is probably of low risk. CBCT showed superior sensitivity to analogue or digital radiographs but has very limited applicability to the general dental practitioner. However, given the high-radiation dose, and potential for caries-like artefacts from existing restorations, its use cannot be justified in routine caries detection. Nonetheless, if early incidental carious lesions are detected in CBCT scans taken for other purposes, these should be reported. CBCT has the potential to be used as a reference standard in diagnostic studies of this type. Despite the robust methodology applied in this comprehensive review, the results should be interpreted with some caution due to shortcomings in the design and execution of many of the included studies. Future research should evaluate the comparative accuracy of different methods, be undertaken in a clinical setting, and focus on minimising bias arising from the use of imperfect reference standards in clinical studies.
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Affiliation(s)
- Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Richard Macey
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Philip Riley
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Anne-Marie Glenny
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Heatlh Research Services, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Janet E Clarkson
- Division of Oral Health Sciences, Dundee Dental School, University of Dundee, Dundee, UK
| | | | - Ting-Li Su
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Anita Sengupta
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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11
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GalvÃo NS, Nascimento EHL, GaÊta-Araujo H, Freitas DQ, Haiter-Neto F, Oliveira ML. Automatic exposure compensation and subjective image enhancement in the radiographic diagnosis of caries. Braz Oral Res 2020; 34:e082. [PMID: 32785477 DOI: 10.1590/1807-3107bor-2020.vol34.0082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/23/2020] [Indexed: 11/22/2022] Open
Abstract
This study aims to assess the influence of high-density material on the radiographic diagnosis of proximal caries in digital systems with automatic exposure compensation, and to evaluate the effect of subjective adjustment of brightness and contrast to undertake this diagnostic task. Twenty bitewing radiographs of forty posterior human teeth with non-cavitated carious lesions, confirmed by micro-CT, were obtained with two digital systems. A porcelain-fused-to-metal crown attached to a titanium implant was inserted into the exposed area, and all the radiographs were repeated. Five radiologists assessed the radiographs and diagnosed proximal carious lesions. Afterwards, the observers were asked to adjust image brightness and contrast, based on their subjective perception, and to reassess the images. Thirty percent of each experimental group was reassessed to test intraobserver reproducibility, totaling 208 images per observer. Intraobserver and interobserver agreements ranged from fair to substantial. Sensitivity, specificity, predictive values, and area under the ROC curve were calculated and compared for each radiographic system, using ANOVA (α = 0.05). Overall, presence of high-density material and adjustment of brightness and contrast did not significantly influence the radiographic diagnosis of proximal caries (p ≥ 0.05). Regarding Digora Optime, adjustment of brightness and contrast significantly increased (p < 0.05) the diagnostic accuracy of proximal carious lesions in the presence of high-density material. In conclusion, the presence of high-density material in the X-rayed region does not influence radiographic diagnosis of proximal caries. However, when it is present in the X-rayed area, subjective adjustment of brightness and contrast is recommended for use with the Digora Optime digital system.
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Affiliation(s)
- Neiandro Santos GalvÃo
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | | | - Hugo GaÊta-Araujo
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Francisco Haiter-Neto
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, SP, Brazil
| | - Matheus Lima Oliveira
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade Estadual de Campinas, Piracicaba, SP, Brazil
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12
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Effect of digital enhancement on the radiographic assessment of vertical root fractures in the presence of different intracanal materials: an in vitro study. Clin Oral Investig 2020; 25:195-202. [PMID: 32506327 DOI: 10.1007/s00784-020-03353-x] [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: 04/16/2019] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To evaluate the effect of enhancement tools of intraoral digital radiographs on the assessment of vertical root fracture (VRF) and to quantify the resultant image noise. MATERIALS AND METHODS Thirty single-rooted human teeth (15 control and 15 fractured) were each radiographed in four intracanal conditions: no filling, gutta-percha, metal post, and fiberglass post, totaling 120 original images. Two filters were applied to the original images-Sharpen filter (SF) and Edge Enhancement filter (EE), and brightness and contrast were adjusted in four combinations (B&C1 to 4), resulting in 840 images. Five oral radiologists analyzed the images for VRF detection. Pixel intensity was obtained in two regions from the radiographs. Diagnostic values were calculated and compared by two-way ANOVA, and the SD values of pixel intensity values were compared by one-way ANOVA (α = 0.05). RESULTS There were no significant differences in accuracy for VRF detection between the experimental groups (p > 0.05). Teeth with metal post presented the lowest sensitivity (p < 0.05) for all experimental conditions, except for SF and EE (p > 0.05). B&C2, B&C3, and B&C4 had higher specificity than SF (p ≤ 0.05) for all intracanal conditions. Analysis of pixel intensity showed that all enhanced images presented statistically significant higher noise compared to those of the original images (p ≤ 0.05). CONCLUSION Digital enhancement tools in digital radiography increase image noise; however, they can be used without compromising VRF detection. CLINICAL RELEVANCE The use of digital enhancement does not impair the detection of VRF and, therefore, can be applied for this purpose according to the observer preference.
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13
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Fontenele RC, Nejaim Y, Farias Gomes A, Gaêta-Araujo H, Haiter-Neto F, Freitas DQ. Does the addition of a lead foil to digital radiographic receptors influence image contrast and approximal caries lesions diagnosis? Dentomaxillofac Radiol 2020; 49:20190384. [DOI: 10.1259/dmfr.20190384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives: To access the influence of the addition of a lead foil to intraoral digital radiographic receptors on image contrast and approximal caries lesions diagnosis. Methods: 40 posterior teeth were distributed in silicone phantoms composed of two premolars, two molars and a non-test canine. Radiographic images of the phantoms were obtained with and without the incorporation of a lead foil, using the Digora Optime and Digora Toto systems. Four observers scored the images for the presence of caries lesions, using a 5-point scale. Images of an aluminum step wedge were acquired with and without the incorporation of a lead foil. Gray values and standard deviation of gray values were calculated in different thickness of the step wedge and, then, contrast variation was calculated. Results: Presence of a lead foil did not influence caries lesions diagnostic values, regardless of the type of digital system (p > 0.05). In general, the objective analysis was not influenced by the presence of a lead foil in any of the tested systems (p > 0.05). However, Digora Toto images showed greater gray values, lower standard deviation of gray values and lower contrast variation, regardless of the presence of the lead foil (p < 0.05). Conclusions: The addition of a lead foil to intraoral digital receptors did not influence image contrast nor caries lesions diagnosis.
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Affiliation(s)
| | - Yuri Nejaim
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil
| | - Amanda Farias Gomes
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil
| | - Hugo Gaêta-Araujo
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil
| | - Francisco Haiter-Neto
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil
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14
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Detection of Simulated Periapical Lesion in Intraoral Digital Radiography with Different Brightness and Contrast. Eur Endod J 2019; 4:133-138. [PMID: 32161900 PMCID: PMC7006595 DOI: 10.14744/eej.2019.46036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/17/2019] [Indexed: 11/20/2022] Open
Abstract
Objective: To assess the detection of simulated periapical lesions in digital intraoral radiography with different levels of brightness and contrast combinations, and to investigate the observers’ preference of image quality for this diagnostic task. Methods: Digital radiographs were acquired prior to periapical lesion simulation and after each one of four defects enlargement. Original images were adjusted in 4 brightness and contrast combinations. Five observers evaluated the images according to the presence of periapical lesion on a 5-point scale. In a second moment, the observers ordinated the images subjectively, according to quality, from the best to the worst to detect the bone defect. The area under the receiver operating characteristic curve was calculated for the diagnostic values and compared by two-way ANOVA. The significance level was set at 5% (P<0.05). Results: No differences were found between the diagnostic values of the five combinations of brightness and contrast (P>0.05). The overall results showed low values of area under the Receiver Operating Characteristic (ROC) curve and sensitivity of the periapical radiography in the detection of periapical lesions of sizes from 1 to 3, which rose substantially in size 4. For image quality, combinations with the lowest brightness and highest contrast were preferred by the observers in 58% of the cases. Conclusion: Brightness and contrast adjustments do not influence the detection of simulated periapical lesions in digital intraoral radiography. Lower brightness and higher contrast images were preferred for this diagnostic task.
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15
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Moreira-Souza L, Michels M, Lagos de Melo LP, Oliveira ML, Asprino L, Freitas DQ. Brightness and contrast adjustments influence the radiographic detection of soft tissue calcification. Oral Dis 2019; 25:1809-1814. [PMID: 31206959 DOI: 10.1111/odi.13148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/17/2019] [Accepted: 06/04/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the influence of subjective enhancement of brightness and contrast of digital panoramic radiographs on the detection of soft tissue calcifications. MATERIALS AND METHODS In this observational study, 500 digital panoramic radiographs were evaluated by two examiners in consensus, who scored the images for the presence of calcifications for each right and left side of the image. After 30 days, all images were revaluated under subjective manipulation of digital brightness and contrast. Calcifications were classified based on the diagnostic hypothesis: sialolith, tonsillolith, calcified atheroma, phlebolith, rhinolith, maxillary sinus antrolith, synovial chondromatosis, lymph node calcification, stylohyoid ligament, triticeous cartilage, or/and upper horn of thyroid cartilage calcification. For intra-examiner agreement, 20% of the sample was reevaluated. The Kappa test and McNemar test were used (α = 0.05). RESULTS In original images, calcifications were observed in 44.2% of the patients, and in enhanced images, this number was 70.8%. Many calcifications were detected only in enhanced images, mainly in the diagnostic hypotheses of calcified atheroma and stylohyoid ligament. Intra-examiner agreement was excellent for the detection of soft tissue calcifications (0.82) and for the classification (0.81). CONCLUSION Subjective enhancement of brightness and contrast alters the detection of soft tissue calcifications in digital panoramic radiograph.
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Affiliation(s)
- Larissa Moreira-Souza
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Mariane Michels
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Larissa Pereira Lagos de Melo
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Matheus Lima Oliveira
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Luciana Asprino
- Division of Oral and Maxillofacial Surgery, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Deborah Queiroz Freitas
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
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16
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Farias Gomes A, Nejaim Y, Fontenele RC, Haiter-Neto F, Freitas DQ. Influence of the incorporation of a lead foil to intraoral digital receptors on the image quality and root fracture diagnosis. Dentomaxillofac Radiol 2019; 48:20180369. [PMID: 30982341 DOI: 10.1259/dmfr.20180369] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the quality of images obtained with the addition of a lead foil to intraoral digital receptors. METHODS Radiographic images of 34 single-rooted human teeth - 19 with vertical root fracture (VRF) and 15 of the control group - were obtained with and without the addition of a lead foil, using the VistaScan, Express, Digora Optime and Digora Toto systems. Images were evaluated by five observers regarding the diagnosis of VRF, using a 5-point scale. In a second moment, an observer preference analysis related to the presence of the lead foil was performed. Images of an acrylic phantom were also obtained with and without the addition of a lead foil, and the quantities of uniformity, grey value and standard deviation of grey values were obtained. RESULTS There were no significant differences in the VRF diagnostic values, considering the presence of the lead foil. Regarding the image quality preference, the observers preferred images acquired with the lead foil for all systems tested, but with greater values for Digora Optime (61.33%) and Express (61.33%). The presence of the lead foil did influence the image uniformity in all systems tested ( p < 0.05). Moreover, the lead foil increased the mean of grey values for Digora Optime and Express images ( p < 0.05), however it did not influence the SD in any of the digital systems ( p > 0.05). CONCLUSION The addition of a lead foil to intraoral digital receptors produces a positive effect in the image quality objectively detected by means of uniformity and subjective visual preference.
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Affiliation(s)
- Amanda Farias Gomes
- Department of Oral Diagnosis - Dental Radiology, Piracicaba Dental School, State University of Campinas, São Paulo, Brazil
| | - Yuri Nejaim
- Department of Oral Diagnosis - Dental Radiology, Piracicaba Dental School, State University of Campinas, São Paulo, Brazil
| | - Rocharles Cavalcante Fontenele
- Department of Oral Diagnosis - Dental Radiology, Piracicaba Dental School, State University of Campinas, São Paulo, Brazil
| | - Francisco Haiter-Neto
- Department of Oral Diagnosis - Dental Radiology, Piracicaba Dental School, State University of Campinas, São Paulo, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis - Dental Radiology, Piracicaba Dental School, State University of Campinas, São Paulo, Brazil
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Effect of brightness and contrast variation for detectability of root resorption lesions in digital intraoral radiographs. Clin Oral Investig 2018; 23:3379-3386. [PMID: 30535816 DOI: 10.1007/s00784-018-2764-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate the performance of periapical radiography assessed under different radiographic brightness and contrast variations in the detection of simulated internal (IRR) and external (ERR) root resorption lesions. Additionally, observers' preferences related to image quality for these diagnostic tasks were evaluated. METHODS Thirty single-root teeth were divided into two groups (n = 15): IRR, in which lesions were simulated using mechanical and biochemical processes; and ERR, in which cavities standardized with drills of different sizes were performed on the root surfaces. Digital radiographs were obtained and subsequently adjusted in 4 additional combinations, resulting in 5 brightness/contrast variations (V1-V5). Five radiologists evaluated the radiographs. The observers' preference on the image quality was also recorded. RESULTS For both conditions, there were no differences in the accuracy and specificity between the five brightness/contrast variations (p > 0.05), but the sensitivity for ERR was significantly lower in V4 (+ 15% brightness/-15% contrast) in the large size (p < 0.05). The observers classified V2 (- 15% brightness/+15% contrast) as the "best" image quality for IRR and ERR evaluation. CONCLUSIONS For IRR and ERR lesions, brightness and contrast variation does not affect the diagnostic performance of digital intraoral radiography within the tested range. The observers prefer images with a reasonable decrease in brightness and increase in contrast. CLINICAL RELEVANCE Brightness and contrast enhancement tools are commonly applied in digital radiographic assessment. The use of these tools for detection of root resorptions can be applied according to the observer preference without influence on diagnostic accuracy.
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Obuchowicz R, Nurzynska K, Obuchowicz B, Urbanik A, Piórkowski A. Caries detection enhancement using texture feature maps of intraoral radiographs. Oral Radiol 2018; 36:275-287. [PMID: 30484214 PMCID: PMC7280345 DOI: 10.1007/s11282-018-0354-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 09/30/2018] [Indexed: 11/15/2022]
Abstract
Objectives Dental caries are caused by tooth demineralization due to bacterial plaque formation. However, the resulting lesions are often discrete and thus barely recognizable in intraoral radiography images. Therefore, more advanced detection techniques are in great demand among dentists and radiographers. This study was performed to evaluate the performance of texture feature maps in the recognition of discrete demineralization related to caries plaque formation. Methods Digital intraoral radiology image analysis protocols incorporating first-order features (FOF), co-occurrence matrices, gray tone difference matrices, run-length matrices (RLM), local binary patterns (LBP), and k-means clustering (CLU) were used to transform the digital intraoral radiology images of 10 patients with confirmed caries, which were retrospectively reviewed in a dental clinic. The performance of the resulting texture feature maps was compared with that of radiographic images by radiologists and dental specialists. Results Significantly improved detection of caries spots was achieved by employing the CLU and FOF texture feature maps. The caries-affected area with sharp margins was well defined using the CLU approach. A pseudo-three-dimensional effect was observed in outlining the demineralization zones inside the cavity with the FOF 5 protocol. In contrast, the LBP and RLM techniques produced less satisfactory results with unsharp edges and less detailed depiction of the lesions. Conclusions This study illustrated the applicability of texture feature maps to the recognition of demineralized spots on the tooth surface debilitated by caries and identified the best performing techniques.
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Affiliation(s)
- Rafał Obuchowicz
- Department of Diagnostic Imaging, Jagiellonian University Medical College, 19 Kopernika Street, 31-501, Cracow, Poland.
| | - Karolina Nurzynska
- Institute of Informatics, Faculty of Automata Control, Electronics, and Computer Science, Silesian University of Technology, Akademicka 16, 44-100, Gliwice, Poland
| | - Barbara Obuchowicz
- Department of Conservative Dentistry with Endodontics, Jagiellonian University Collegium Medicum, Montelupich 4, 31-155, Cracow, Poland
| | - Andrzej Urbanik
- Department of Diagnostic Imaging, Jagiellonian University Medical College, 19 Kopernika Street, 31-501, Cracow, Poland
| | - Adam Piórkowski
- Department of Geoinformatics and Applied Computer Science, AGH University of Science and Technology, Mickiewicza 30, 30-059, Cracow, Poland
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