Digital DICOM in Dentistry

Influence of the digital file format on radiographic diagnostic in dentistry: a scoping review

Given today's higher demand for online transmission of radiographic images, clinicians and regulatory agencies should be given the evidence they need to guide them in choosing the best image file format to be adopted. To this end, the present scoping review aims to explore, map, and evaluate the literature, with the object of reporting the influence of image file formats on dental diagnostic tasks by assessing intraoral radiographic images. This scoping review complies with PRISMA-ScR. It was customized to assess the risk of bias of the included studies, and was registered on the Open Science Framework platform. The data extraction protocol was developed based on the PCC acronym. An electronic search was conducted in six databases (Pubmed, Web of Science, Scopus, Embase, Lilacs, Cochrane) in December 2023. Original articles were screened, having observational, diagnostic accuracy, and consisting of in vivo or ex vivo laboratory studies investigating the influence of file formats on different diagnostic tasks in dentistry. Eighteen studies, published between the years 1996 and 2022, were included. The following data were extracted from the selected articles: article title, authors' citation, publication date, country, diagnostic task, image file formats tested, compression level, and main conclusion. The most widely investigated diagnostic task was caries lesions (n = 10), led by root resorptions (n = 3), root fractures (n = 2), periapical lesions (n = 2), and periodontal disease (n = 1). The most commonly used radiographic techniques were periapical (n = 12) and bitewing (n = 6). The most frequently investigated image file formats were JPEG (all studies) and TIFF (n = 10 studies). BMP, PNG, and JPEG2000 were also included in 7, 3 and 3 studies, respectively. No studies included the DICOM file format. In regard to the subjective assessment of the several dental diagnostic tasks, the studies mostly showed that the influence of the file formats was not significant (n = 10/55.5%). As for the quality assessment of the included papers, more than 70% of the studies featured a low risk of bias. Current evidence on image file formats and dental radiographic diagnosis is reliable. Any image file format can be used without impairing diagnostic accuracy.

3D revisualization: a new method to revisit segmented data

3D visualization and segmentation are increasingly widely used in physical, biological and medical science, facilitating advanced investigative methodologies. However, the integration and reproduction of segmented volumes or results across the spectrum of mainstream 3D visualization platforms remain hindered by compatibility constraints. These barriers not only challenge the replication of findings but also obstruct the process of cross-validating the accuracy of 3D visualization outputs. To address this gap, we developed an innovative revisualization method implemented within the open-source framework of Drishti, a 3D visualization software. Leveraging four animal samples alongside three mainstream 3D visualization platforms as case studies, our method demonstrates the seamless transferability of segmented results into Drishti. This capability effectively fosters a new avenue for authentication and enhanced scrutiny of segmented data. By facilitating this interoperability, our approach underscores the potential for significant advancements in accuracy validation and collaborative research efforts across diverse scientific domains.

Evaluating the Anterior Loop of the Mental Nerve Using Cone Beam CT Scans in the Jordanian Population

INTRODUCTION

Knowledge of anatomical landmarks is crucial for effective dental treatments, especially in surgical procedures. The mental nerve (MN), a branch of the inferior alveolar nerve, features a critical landmark known as the anterior loop (AL), often overlooked by surgeons. This study aims to assess the occurrence of the MN AL, its type, and its length within a sample of the Jordanian population by utilizing cone beam computed tomography (CBCT) scans.

METHODS

This retrospective observational study included the acquisition of CBCT images from a total of randomly selected 268 patients who sought treatment for a range of dental conditions (such as tooth extraction, orthodontic therapy, and dental implants) at hospitals affiliated with the Jordanian Royal Medical Services. Reformatted images were utilized to detect the AL type, length, and the association between the nerve type and mental foramen (MF) position.

RESULTS

This study involved 268 patients. The distribution of MF positions and the characteristics of the inferior dental nerve were evaluated, with no significant gender differences observed. The predominant location for the MF in both males and females in both sides was position IV, with 52% of females and 56-59% (left-right sides) of males presenting this trait. The inferior dental nerve types also showed no significant gender variation, with 42-43% (left-right sides) of females having type III and a similar distribution among males. Measurements of the midline-mental foramen and inter-foramen distances revealed slight variations between genders, with significant differences noted in the right AL length for type III nerves, favoring males (p=0.034). A notable correlation was found between the type of inferior dental nerve and the MF position, particularly with type I nerves predominantly associating with position IV mental foramina (p≤0.004).

CONCLUSION

CBCT scans are essential in the precise evaluation of the AL, aiding in the prevention of nerve injuries during dental procedures. Our results highlight the diversity of the AL in the Jordanian population and the importance of individualized treatment plans. Future research with larger cohorts is advised to refine these insights, aiming to improve treatment outcomes and patient care.

Human examination and artificial intelligence in cephalometric landmark detection-is AI ready to take over?

OBJECTIVES

To compare the precision of two cephalometric landmark identification methods, namely a computer-assisted human examination software and an artificial intelligence program, based on South African data.

METHODS

This retrospective quantitative cross-sectional analytical study utilized a data set consisting of 409 cephalograms obtained from a South African population. 19 landmarks were identified in each of the 409 cephalograms by the primary researcher using the two programs [(409 cephalograms x 19 landmarks) x 2 methods = 15,542 landmarks)]. Each landmark generated two coordinate values (x, y), making a total of 31,084 landmarks. Euclidean distances between corresponding pairs of observations was calculated. Precision was determined by using the standard deviation and standard error of the mean.

RESULTS

The primary researcher acted as the gold-standard and was calibrated prior to data collection. The inter- and intrareliability tests yielded acceptable results. Variations were present in several landmarks between the two approaches; however, they were statistically insignificant. The computer-assisted examination software was very sensitive to several variables. Several incidental findings were also discovered. Attempts were made to draw valid comparisons and conclusions.

CONCLUSIONS

There was no significant difference between the two programs regarding the precision of landmark detection. The present study provides a basis to: (1) support the use of automatic landmark detection to be within the range of computer-assisted examination software and (2) determine the learning data required to develop AI systems within an African context.

DICOM file format has better radiographic image quality than other file formats: an objective study

This study aimed to assess the influence of the file format on the image quality parameters (image noise, brightness, and uniformity) of periapical radiographs acquired with different digital systems. Radiographic images of an acrylic phantom were acquired with two digital systems - Digora Toto and Express, and exported into five different file formats - TIFF, BMP, DICOM, PNG, and JPEG. Image noise, image brightness (mean of gray values), and image uniformity (standard deviation of gray values) were evaluated in all images. A two-way analysis of variance with Tukey's test as a post-hoc test was used to compare the results, considering the file formats and radiographic systems as the studied factors. A significance level of 5% was adopted for all analyses. The DICOM image file format presented lower image noise, higher brightness (higher mean gray values), and greater image uniformity (p<0.001) than the other file formats, which did not differ from each other for both digital radiography systems (p>0.05). The Express system revealed lower image noise and greater image uniformity than the Digora Toto system regardless of the image file format (p<0.001). Moreover, the Express showed higher brightness than the Digora Toto for all image file formats (p<0.001), except for the DICOM image file format, which did not significantly differ between the digital radiography systems tested (p>0.05). The DICOM image file format showed lower image noise, higher brightness, and greater image uniformity than the other file formats (TIFF, BMP, PNG, and JPEG) in both digital radiography systems tested.

Is Dental Panoramic Radiography Reliable to Assess Position of Bicortical Fixation Screws in Mandibular Fractures? Case Report

Background:

Panoramic radiography is widely used as a diagnostic tool before oral surgeries and can be considered the foremost follow-up image after. It provides a broad observation of the maxillomandibular complex at a lower cost and radiation dose. But cone-beam computed tomography (CBCT) examination, after panoramic radiograph evaluation, can produce a change in the diagnostic thinking of maxillofacial surgeons leading to alterations in treatment plans.

Objective:

We aim to report a case with incidentally discovered radiographic findings where diagnostic changes were caused by switching from panoramic to CBCT imaging.

Conclusion:

Radiographic assessment of the position and angulation of screws by panoramic x-ray should be approached with extreme caution. The image of choice is CBCT if nerve injury is suspected.

Implant insertion using an orientation template and a full-guiding template - A prospective model analysis in a cohort of dentists participating in an implantology curriculum

BACKGROUND

Dental implantology has become an established option for treating tooth loss over the recent decades. Before inserting an implant in a clinical situation, theoretical and practical training is recommended. Different methods are available to give assistance in determining the correctly planned implant position. In this study, two different guiding methods were assessed considering their accuracy for implant insertion in a group of dentists.

METHODS

After three-dimensional planning of the implant positions, two surgical templates were manufactured as follows: in region 34 a stereolithographic template was used to perform a full-guided implant insertion, in region 44 a CAD/CAM milled template was used to determine the implant position and subsequently, perform a free-hand insertion. In total, 86 implants were placed in mandibular models by 43 dentists participating in a postgraduate curriculum. The differences between planned and achieved implant positions were measured and statistically analyzed.

RESULTS

The implants inserted fully-guided showed a lower deviation of the three-dimensional angulation (2.266 ± 1.443 degrees vs. 7.954 ± 4.372 degrees) and the cumulated mismatch of the implant position (0.547 ± 0.237 mm vs. 1.160 ± 0.427 mm) compared to the free-handed mode. For the angulation and the mismatch at the implant base the differences were statistically significant (p < 0.001).

CONCLUSIONS

Within the limits of the study it can be summarized that the full-guided implant insertion leads to a higher transfer accuracy compared to the free-hand method in a cohort of dentist inexperienced in dental implantology. However, the clinical effect has to be discussed as the study was performed using artificial mandibles and ideal conditions.

Influence of the image file format of digital periapical radiographs on the diagnosis of external and internal root resorptions

OBJECTIVES

To evaluate the influence of different image file formats of digital radiographic images on the diagnosis of external (ERR) and internal root resorption (IRR).

MATERIALS AND METHODS

Thirty-four human teeth were selected. For ERR, 20 teeth were used (10 control and 10 with simulated ERR), and for IRR, 14 teeth were used (before and after IRR simulation). Digital periapical radiographs were acquired using the Digora Toto system and exported in four different image file formats: TIFF, BMP, PNG, and JPEG, totaling 192 radiographs. Five examiners evaluated the images using the JPEGView software and scored the detection of ERR or IRR on a 5-point scale. Sensitivity, specificity, accuracy, and the area under the ROC curve were obtained for the diagnosis of ERR and IRR in the different image file formats. Two-way ANOVA compared the diagnostic values between the file formats and the Kappa test assessed intra- and inter-examiner agreement. The significance level was set at 5% (α = 0.05).

RESULTS

The mean values of intra-examiner agreement were substantial (0.740) for ERR and almost perfect (0.836) for IRR and, inter-examiner was fair (0.263) and moderate (0.421), respectively. No statistically significant differences were found among the different file formats for the diagnostic values of ERR and IRR.

CONCLUSION

The file format of digital radiographs does not influence the diagnosis of ERR and IRR.

CLINICAL RELEVANCE

Digital radiographic images may be susceptible to computational factors; however, they can be stored in multiple file formats without affecting the diagnosis of dental root resorptions.

Application of additive manufacturing in customized titanium mandibular implants for patients with oral tumors

The application of additive manufacturing (AM) technology has been widely used in various medical fields, including craniomaxillofacial surgery. The aim of the present study was to examine the surgical efficiency and post-operative outcomes of patient-specific titanium mandibular reconstruction using AM. Major steps in directly designing and manufacturing 3D customized titanium implants are discussed. Furthermore, pre-operative preparations, surgical procedures and post-operative treatment outcomes were compared among patients who received mandibular reconstruction using a customized 3D titanium implant, titanium reconstruction plates or vascularized autologous fibular grafting. Use of a customized titanium implant significantly improved surgical efficiency and precision. When compared with mandibular reconstruction using the two conventional approaches, patients who received the customized implant were significantly more satisfied with their facial appearance, and exhibited minimal post-operative complications in the 12-month follow-up period. Patients who underwent mandibular reconstruction using a customized titanium implant displayed improved mandibular contour symmetry, restored occlusal function, normal range of mouth opening and no temporomandibular joint related pain; all complications frequently experienced by patients who undergo conventional approaches of mandibular reconstruction.

The Capacity of Periodontal Gel to Occupy the Spaces Inside the Periodontal Pockets Using Computational Fluid Dynamic

The aim of the current work is to demonstrate the capacity of a new periodontal gel to occupy the spaces inside the periodontal pockets through Computational Fluid Dynamic (CFD). The test gel consists of two resorbable medical grade polymers (PEO, Poly Ethylen Oxide and HPMC, Hydroxy Propyl Metyl Cellulose), Type I Collagen, SAP (Vitamin C), and PBS (Saline Solution), while the control gel is 14% doxyclin controlled release gel, which is used for treating periodontal pockets with probing ≥5 mm after scaling and root plaining. The study examined the fluid dynamic analysis (Computational Fluid Dynamic—CFD) of two different gels, used in dentistry to treat periodontitis, in relation to both the geometry of the periodontal pocket and the function of two different types of needles that are used to distribute the preparation. The periodontal pocket was determined by reading DICOM images taken from the patient’s CAT scan. The results show that the H42^® gel comes out uniformly compared to the other gel. Moreover, it is possible to observe how the rheological properties of the gel allow the fluid to spread evenly within the periodontal pocket in relation to the geometry of the needle. In particular, H42^® gel exits in a constant way both from the first and the second exit. In fact, it was observed that by changing the geometry of the needle or the type of periodontal gel, the distribution of the gel inside the pocket was no longer homogeneous. Thus, having the correct rheological properties and correct needle geometries both speeds up the gel and optimizes the pressure distribution. Currently, the literature is still lacking, therefore further studies will be needed to confirm these results.

The potential of additive manufacturing technologies and their processing parameters for the fabrication of all-ceramic crowns: A review

OBJECTIVE

This article aims to provide a review of the additive manufacturing technologies and the processing parameters that have been investigated for the fabrication of all ceramic crowns.

OVERVIEW

Additive manufacturing has crept its way into the field of dentistry for the fabrication of resin and metal prosthesis. To evaluate the current status of additive manufacturing for the fabrication of all ceramic crowns, literature review was targeted to include publications pertaining to the fabrication of dental ceramics and all ceramic crowns. With respect to the additive manufacturing of dental ceramics, five technologies have been investigated to date: stereolithography, material extrusion, powder based fusion, direct inkjet printing, and binder jetting. The processing parameters and experimental outcomes were collated and described for each of the aforementioned technologies.

CONCLUSION

Additive manufacturing has demonstrated promising experimental outcomes and corroborated to the fabrication all ceramic crowns. However, the technology is yet to witness a commercial breakthrough within this domain.

CLINICAL SIGNIFICANCE

Additive manufacturing mitigates raw material wastage and tooling stresses that are associated with milling of ceramics. Continued research and development can lead to its approbation as an alternate technology for manufacturing all ceramic restorations.

Cone beam computed tomography in implant dentistry: recommendations for clinical use

BACKGROUND

In implant dentistry, three-dimensional (3D) imaging can be realised by dental cone beam computed tomography (CBCT), offering volumetric data on jaw bones and teeth with relatively low radiation doses and costs. The latter may explain why the market has been steadily growing since the first dental CBCT system appeared two decades ago. More than 85 different CBCT devices are currently available and this exponential growth has created a gap between scientific evidence and existing CBCT machines. Indeed, research for one CBCT machine cannot be automatically applied to other systems.

METHODS

Supported by a narrative review, recommendations for justified and optimized CBCT imaging in oral implant dentistry are provided.

RESULTS

The huge range in dose and diagnostic image quality requires further optimization and justification prior to clinical use. Yet, indications in implant dentistry may go beyond diagnostics. In fact, the inherent 3D datasets may further allow surgical planning and transfer to surgery via 3D printing or navigation. Nonetheless, effective radiation doses of distinct dental CBCT machines and protocols may largely vary with equivalent doses ranging between 2 to 200 panoramic radiographs, even for similar indications. Likewise, such variation is also noticed for diagnostic image quality, which reveals a massive variability amongst CBCT technologies and exposure protocols. For anatomical model making, the so-called segmentation accuracy may reach up to 200 μm, but considering wide variations in machine performance, larger inaccuracies may apply. This also holds true for linear measures, with accuracies of 200 μm being feasible, while sometimes fivefold inaccuracy levels may be reached. Diagnostic image quality may also be dramatically hampered by patient factors, such as motion and metal artefacts. Apart from radiodiagnostic possibilities, CBCT may offer a huge therapeutic potential, related to surgical guides and further prosthetic rehabilitation. Those additional opportunities may surely clarify part of the success of using CBCT for presurgical implant planning and its transfer to surgery and prosthetic solutions.

CONCLUSIONS

Hence, dental CBCT could be justified for presurgical diagnosis, preoperative planning and peroperative transfer for oral implant rehabilitation, whilst striving for optimisation of CBCT based machine-dependent, patient-specific and indication-oriented variables.

Use of cone beam computed tomography in implant dentistry: current concepts, indications and limitations for clinical practice and research

Diagnostic radiology is an essential component of treatment planning in the field of implant dentistry. This narrative review will present current concepts for the use of cone beam computed tomography imaging, before and after implant placement, in daily clinical practice and research. Guidelines for the selection of three-dimensional imaging will be discussed, and limitations will be highlighted. Current concepts of radiation dose optimization, including novel imaging modalities using low-dose protocols, will be presented. For preoperative cross-sectional imaging, data are still not available which demonstrate that cone beam computed tomography results in fewer intraoperative complications such as nerve damage or bleeding incidents, or that implants inserted using preoperative cone beam computed tomography data sets for planning purposes will exhibit higher survival or success rates. The use of cone beam computed tomography following the insertion of dental implants should be restricted to specific postoperative complications, such as damage of neurovascular structures or postoperative infections in relation to the maxillary sinus. Regarding peri-implantitis, the diagnosis and severity of the disease should be evaluated primarily based on clinical parameters and on radiological findings based on periapical radiographs (two dimensional). The use of cone beam computed tomography scans in clinical research might not yield any evident beneficial effect for the patient included. As many of the cone beam computed tomography scans performed for research have no direct therapeutic consequence, dose optimization measures should be implemented by using appropriate exposure parameters and by reducing the field of view to the actual region of interest.

Technical Challenges of Enterprise Imaging: HIMSS-SIIM Collaborative White Paper

This white paper explores the technical challenges and solutions for acquiring (capturing) and managing enterprise images, particularly those involving visible light applications. The types of acquisition devices used for various general-purpose photography and specialized applications including dermatology, endoscopy, and anatomic pathology are reviewed. The formats and standards used, and the associated metadata requirements and communication protocols for transfer and workflow are considered. Particular emphasis is placed on the importance of metadata capture in both order- and encounter-based workflow. The benefits of using DICOM to provide a standard means of recording and accessing both metadata and image and video data are considered, as is the role of IHE and FHIR.