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Liu XX, Li G. Diagnostic performance of approximal caries in bitewing radiographs from different monitors and room illuminances. Dentomaxillofac Radiol 2025; 54:125-131. [PMID: 39602601 DOI: 10.1093/dmfr/twae061] [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: 07/27/2024] [Revised: 10/12/2024] [Accepted: 11/13/2024] [Indexed: 11/29/2024] Open
Abstract
OBJECTIVE To compare the accuracy, duration, and certainty of diagnosing approximal caries in bitewing radiographs displayed in 3 monitors under 2 luminance conditions. METHODS A total of 39 teeth without evident caries were selected from 11 patients undergoing partial jaw resection. Before the operation, 13 bitewing radiographs were captured by a digital imaging system. Eight observers evaluated the images under dark (9 lux) and bright (200 lux) conditions, using 2 medical-grade monitors and a commercial monitor. Using histological results as the gold standard, the areas under the receiver operating characteristic curves under different conditions were compared using the Z-test. Multivariate analysis of variance was conducted to assess the impact of various factors on diagnostic duration, while ordinal logistic regression was used to examine factors influencing diagnostic certainty level. It was considered significant when P < .05. RESULTS No significant difference was found in the diagnostic accuracy or duration for diagnosis of approximal caries under 2 luminance conditions with the 3 distinct monitors (P > .05). Ambient light, clinical experience, and the pathological grade of approximal caries have influence on the degree of diagnostic confidence (P < .05). CONCLUSIONS Different monitors and ambient luminance didn't influence the diagnostic accuracy or evaluation duration. Ambient luminance, clinical experience, and the depth of caries affect the degree of diagnostic confidence. ADVANCES IN KNOWLEDGE The study employing bitewing radiographs from real patients indicates that ambient luminance, clinical experience, and the depth of caries affect the degree of diagnostic confidence.
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Affiliation(s)
- Xiao-Xuan Liu
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Beijing, 100081, China
- National Center for Stomatology, Beijing, 100081, China
- National Clinical Research Center for Oral Diseases, Beijing, 100081, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, 100081, China
- Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, China
- NHC Key Laboratory of Digital Stomatology, Beijing, 100081, China
- NMPA Key Laboratory for Dental Materials, Beijing, 100081, China
| | - Gang Li
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Beijing, 100081, China
- National Center for Stomatology, Beijing, 100081, China
- National Clinical Research Center for Oral Diseases, Beijing, 100081, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, 100081, China
- Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, China
- NHC Key Laboratory of Digital Stomatology, Beijing, 100081, China
- NMPA Key Laboratory for Dental Materials, Beijing, 100081, China
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Munhoz EA, Xavier CRG, Salles RP, Capelozza ALA, Bodanezi AV. Convenient model of hard tissue simulation for dental radiographic research and instruction. World J Methodol 2024; 14:88850. [PMID: 38577207 PMCID: PMC10989409 DOI: 10.5662/wjm.v14.i1.88850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/20/2023] [Accepted: 01/19/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The authors describe a technique for building an alternative jawbone phantom using dental gypsum and rice for research and dental radiology instruction. AIM To investigate the potential of an alternative phantom to simulate the trabecular bone aspect of the human maxilla in periapical radiographs. METHODS Half-maxillary phantoms built from gypsum-ground rice were exposed to X-rays, and the resulting images (experimental group) were compared to standardized radiographic images produced from dry human maxillary bone (control group) (n = 7). The images were blindly assessed according to strict criteria by three examiners for the usual trabecular aspects of the surrounding bone, and significant differences between groups and in assessment reliability were compared using Fisher's exact and kappa tests (α = 0.05). RESULTS The differences in the trabecular aspects between groups were not statistically significant. In addition, interobserver agreement among observers was 0.43 and 0.51 for the control and experimental groups, respectively, whereas intraobserver agreement was 0.71 and 0.73, respectively. CONCLUSION The tested phantom seemed to demonstrate potential for trabecular bone image simulation on maxillary periapical radiographs.
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Affiliation(s)
- Etiene Andrade Munhoz
- Department of Dentistry, Health Science Centre, Federal University of Santa Catarina, Florianopolis 88040-379, Brazil
| | - Claudio Roberto Gaiao Xavier
- Department of Stomatology, Radiology and Oral Surgery, School of Dentistry, University of São Paulo, Bauru 17012-901, Brazil
| | - Roberto Ponce Salles
- Department of Stomatology, Radiology and Oral Surgery, School of Dentistry, University of São Paulo, Bauru 17012-901, Brazil
| | - Ana Lúcia Alvares Capelozza
- Department of Stomatology, Radiology and Oral Surgery, School of Dentistry, University of São Paulo, Bauru 17012-901, Brazil
| | - Augusto Vanni Bodanezi
- Department of Dentistry, Health Science Centre, Federal University of Santa Catarina, Florianopolis 88040-379, Brazil
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Hegde S, Gao J, Vasa R, Cox S. Factors affecting interpretation of dental radiographs. Dentomaxillofac Radiol 2023; 52:20220279. [PMID: 36472942 PMCID: PMC9974235 DOI: 10.1259/dmfr.20220279] [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: 08/24/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To identify the factors influencing errors in the interpretation of dental radiographs. METHODS A protocol was registered on Prospero. All studies published until May 2022 were included in this review. The search of the electronic databases spanned Ovid Medline, PubMed, EMBASE, Web of Science and Scopus. The quality of the studies was assessed using the MMAT tool. Due to the heterogeneity of the included studies, a meta-analysis was not conducted. RESULTS The search yielded 858 articles, of which eight papers met the inclusion and exclusion criteria and were included in the systematic review. These studies assessed the factors influencing the accuracy of the interpretation of dental radiographs. Six factors were identified as being significant that affected the occurrence of interpretation errors. These include clinical experience, clinical knowledge, and technical ability, case complexity, time pressure, location and duration of dental education and training and cognitive load. CONCLUSIONS The occurrence of interpretation errors has not been widely investigated in dentistry. The factors identified in this review are interlinked. Further studies are needed to better understand the extent of the occurrence of interpretive errors and their impact on the practice of dentistry.
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Affiliation(s)
- Shwetha Hegde
- Academic Fellow, Dentomaxillofacial Radiology, Sydney Dental School, University of Sydney, Sydney, Australia
| | - Jinlong Gao
- Senior Lecturer, Sydney Dental School, Institute of Dental Research, Westmead Centre for Oral Health, University of Sydney, Sydney, Australia
| | - Rajesh Vasa
- Head of Translational Research and Development, Applied Artificial Intelligence, Deakin University, Melbourne, Australia
| | - Stephen Cox
- Head of Discipline, Discipline of Oral Surgery, Sydney Dental School, University of Sydney, Sydney, Australia
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Bardal R, Mobini M, Mirzaee M. In vitro comparison of two photostimulable phosphor plate systems for early detection of occlusal dentin caries with and without a sharpening filter. J Dent Res Dent Clin Dent Prospects 2021; 14:223-227. [PMID: 33575011 PMCID: PMC7867687 DOI: 10.34172/joddd.2020.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 07/07/2020] [Indexed: 11/14/2022] Open
Abstract
Background. Dental caries is the most important reason for tooth loss. Clinical examination is the most commonly used technique for occlusal caries diagnosis. The diagnostic power of digital systems is a matter of controversy in this field. The present study aimed to determine the diagnostic accuracy of two photostimulable phosphor plate (PSP) systems for early occlusal dentin caries in vitro.
Methods. Sixty-nine extracted molar and premolar teeth were used in this study. The teeth were mounted in triple blocks, and standard radiographs were taken by the Digora and Acteon digital radiographic systems. The original and filter 1-enhanced radiographs were evaluated by two experienced observers twice at an interval of two weeks, and dentin caries was recorded in Tables prepared for the study. The teeth were then sectioned in a buccolingual direction and evaluated under a stereomicroscope. The observers’ reports were compared with microscopic findings as the gold standard. SPSS 23 was used to calculate the kappa coefficient, sensitivity, specificity, and area under the ROC curve (AUC). Statistical significance was set at P<0.05.
Results. The internal and the external agreements in both imaging systems were good to excellent. The means of sensitivity, specificity, and AUC in the Acteon system were 34.1, 92.9, and 0.674, with 30.8, 94.8, and 0.659, respectively, in the Digora system.
Conclusion. The accuracy of early occlusal caries diagnosis was poor on both systems, and no significant difference was observed between the two systems at a 95% confidence interval. Although the AUC was slightly higher in the original images, there was no significant difference between them; however, due to their high specificity, they can prevent unnecessary treatments in the clinic.
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Affiliation(s)
- Roghieh Bardal
- Department of Oral and Maxillofacial Radiology, Dental Caries Prevention Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mahshid Mobini
- Department of Oral and Maxillofacial Radiology, Dental Caries Prevention Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Matin Mirzaee
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
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Geibel MA, Carstens S, Braisch U, Rahman A, Herz M, Jablonski-Momeni A. Radiographic diagnosis of proximal caries-influence of experience and gender of the dental staff. Clin Oral Investig 2017; 21:2761-2770. [PMID: 28233170 DOI: 10.1007/s00784-017-2078-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 02/07/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to examine the influence of experience and gender on the radiographic detection of proximal caries lesions and on therapeutic decisions. MATERIALS AND METHODS A survey of 220 examiners (students and employees at three universities and dentists in the field) was taken using a standardized written questionnaire concerning radiographic diagnosis and therapy planning. An expert opinion of four dentists was determined as radiographic reference. A mixed effect logistic regression model was used for statistical evaluation and the odds ratio and p values were calculated (α = 0.05). RESULTS Examiners with experience had an almost four times greater chance of a correct assessment, if proximal caries lesion was present or not, than examiners with low experience (OR 3.7 (95% CI 2.4-5.8)). No gender-specific differences were discovered (OR women vs. men 0.9 (95% CI 0.6-1.4)). There was a relationship between the severity of the burnout effect on the x-ray and false positive caries diagnosis. Overall, 43% of respondents would plan invasive treatment in the enamel on a patient at low risk of caries and 78% on a high-risk patient. The results showed that the more experienced practitioners would be more likely to postpone restorative therapy on proximal caries until the lesion reached a later stage. CONCLUSIONS The results of this study suggest that examiner's experience influences the radiographic diagnosis of proximal lesions. No gender-specific differences could be found. CLINICAL RELEVANCE Examiner's professional experience is an important factor when radiography is included for detection and treatment planning of proximal lesions.
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Affiliation(s)
- Margrit-Ann Geibel
- Department of Dentomaxillofacial Surgery, University of Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Germany.
| | - S Carstens
- Department of Dentomaxillofacial Surgery, University of Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - U Braisch
- Institute of Epidemiology and Medical Biometry, University of Ulm, Schwabstraße 13, 89075, Ulm, Germany
| | - A Rahman
- Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - M Herz
- Department of Conservative Dentistry and Periodontology, Tuebingen University Hospital, Osianderstraße 2-8, 72076, Tuebingen, Germany
| | - A Jablonski-Momeni
- Department of Pediatric and Community Dentistry, Philipps University, Georg-Voigt-Straße 3, 35033, Marburg, Germany
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Approximal Caries Detection by DIFOTI: In Vitro Comparison of Diagnostic Accuracy/Efficacy with Film and Digital Radiography. Int J Dent 2012; 2012:326401. [PMID: 23213335 PMCID: PMC3508587 DOI: 10.1155/2012/326401] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 10/12/2012] [Indexed: 11/25/2022] Open
Abstract
The aim of the present study was to compare the diagnostic accuracy/efficacy of digital imaging fiber-optic transillumination (DIFOTI) with film and digital radiography, in detection of approximal caries lesions. One hundred and twelve approximal surfaces were scored for caries, using DIFOTI images film and digital radiographs. All three sets of images were examined twice by 8 observers, with a minimal interval of one week between examinations. Validation of histological sections served as a reference standard. Reproducibility, based on intra- and interobserver agreement, was similar for all three methods. At diagnostic threshold D1 (enamel and dentin caries), DIFOTI showed significantly higher sensitivity, but differences in specificity between methods were nonsignificant. Diagnostic accuracy in the form of area under the receiver operating characteristic curve (AUC) was significantly higher for DIFOTI. At diagnostic threshold D3 (dentin caries), the differences in sensitivity and AUC among methods were nonsignificant, but DIFOTI showed significantly lower specificity. Compared with the radiographs, DIFOTI showed closer agreement, expressed as weighted kappa values, with the reference standard. The results show that under in vitro conditions, the diagnostic accuracy of DIFOTI in detecting early approximal enamel lesions is greater than that of film and digital radiography, while the potential for detecting lesions in dentin is similar for all three methods.
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Yasar F, Yesilova E, Apaydın B. The effects of compression on the image quality of digital panoramic radiographs. Clin Oral Investig 2011; 16:719-26. [PMID: 21732088 DOI: 10.1007/s00784-011-0587-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 06/22/2011] [Indexed: 10/18/2022]
Abstract
Size reduction through compression is an important issue that needs to be investigated for possible effects on image quality. The aim of the present study was to evaluate the subjective image quality of digital panoramic radiographs which were lossless and lossy compressed for the visualization of various anatomical structures. Fifty-five digital panoramic radiographs in Tagged Image File Format (Tiff) were used in the study. Two types of lossy (Joint Photographic Experts Group (Jpeg)) and one type of lossless (Lempel-Ziv-Welch) compression were applied to the original radiographs. These radiographs were evaluated by two observers separately for the visibility of some anatomical structures with visual grading. Mean quality number for each radiograph was obtained. The differences between the mean quality numbers in each compression and original image mode were evaluated with Friedman test. Pair-wise comparisons revealed that there were statistically significant differences between all groups (p = 0.000) for all comparisons except for Jpeg_1 and Jpeg_2 groups. Kappa statistics was used to evaluate inter- and intra-observer agreements. Intra-observer agreements were ranging from 0.229 to 1.000 and inter-observer agreements were ranging from 0.154 to 1.000. The observers had better inter- and intra-observer agreements in highly compressed Jpeg_1 images. The anatomical structures evaluated in this study had better visibility in Tiff images than Jpeg images except for mandibular canal and mental foramen. While Jpeg compressed images offer high inter- and intra-observer agreements, the visibility of anatomical structures are better in Tiff images except for mandibular canal and mental foramen.
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Affiliation(s)
- Füsun Yasar
- Maxillofacial Radiology Department, Dentistry Faculty, Selcuk University, Kampüs, Konya 42079, Turkey.
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Mileman PA, van den Hout WB. Evidence-based diagnosis and clinical decision making. Dentomaxillofac Radiol 2009; 38:1-10. [DOI: 10.1259/dmfr/18200441] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kositbowornchai S, Basiw M, Promwang Y, Moragorn H, Sooksuntisakoonchai N. Accuracy of diagnosing occlusal caries using enhanced digital images. Dentomaxillofac Radiol 2005; 33:236-40. [PMID: 15533977 DOI: 10.1259/dmfr/94305126] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To compare the accuracy of detecting occlusal caries lesions on original images vs images digitally enhanced for sharpness, zoom and pseudocolour. METHODS Four hundred images of 100 extracted third molars were examined for the presence or absence of occlusal caries by four observers, using a 5-point confidence scale. The observers had no prior knowledge of the distribution of the caries. The definitive diagnosis of caries was based on a histological assessment after sectioning the teeth. The diagnostic accuracy for each imaging mode was expressed by the area of the receiver operating characteristic (ROC) curve. Differences between the areas under the ROC curves were assessed using an analysis of variance. RESULTS The original image had a mean ROC curve of 0.75 (95% confidence interval (CI) 0.65-0.85). The ROC curves for sharpness, zoom and pseudocolour were 0.73 (95% CI 0.63-0.83), 0.76 (95% CI 0.61-0.81) and 0.70 (95% CI 0.60-0.80), respectively. These differences were not statistically significant (P=0.96). The Cohen's kappa indicated good agreement among observers. CONCLUSIONS In this in vitro study, the three enhanced images used did not affect the detection of occlusal caries.
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Affiliation(s)
- S Kositbowornchai
- Department of Oral Diagnosis, Faculty of Dentistry, Khon Kaen University, 40002 Thailand. suwadee@ kku.ac.th
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Mileman PA, van den Hout WB, Sanderink GCH. Randomized controlled trial of a computer-assisted learning program to improve caries detection from bitewing radiographs. Dentomaxillofac Radiol 2003; 32:116-23. [PMID: 12775666 DOI: 10.1259/dmfr/58225203] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To investigate whether using a computer-assisted learning (CAL) calibration program improves the accuracy of dental students in caries detection from bitewing radiographs. METHODS Dental students were assigned to an experimental (n=33) and control (n=34) group using a randomized block design. The experimental group used the CAL program with feedback to calibrate themselves against experts in radiographic caries detection and a histological gold standard of the actual clinical condition. Feedback was provided visually of the actual tooth surface condition and in the form of graphics showing diagnostic accuracy performance measures. Performance was tested before the program (for the control group) and after the program (for the experimental group) by assessing surfaces (n=56) from a new independent digital test set of evaluation radiographs for the presence, histologically, of dentine caries (n=23). The summary receiver operating characteristic (SROC) method for summarizing true positive ratio (TPR) (sensitivity) and false positive ratio (FPR) (1-specificity) was used to analyse the dichotomous data. Differences between the control and experimental groups were tested for (a) the area under the SROC curve (A(z)) and (b) the TPR, FPR and diagnostic odds ratio (DOR) using the Mann-Whitney test (P<0.05). RESULTS The mean TPR for dentine caries detection was 76.3% (SD 13.0%) for the experimental group and 66.9% (SD 14.8%) for the control group (P=0.005). Mean FPRs were similar (experimental 28.1% and control 28.7%; P>0.5). The area under the SROC curve A(z) was 0.832 for the experimental group and 0.773 for the control group (P=0.002). The mean DOR for dentine caries in the experimental group (12.4) was better than that in the control group (8.8) (P=0.003). CONCLUSIONS The CAL program does improve diagnostic performance. Improving the cognitive feedback provided by the program should be considered before implementation.
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Affiliation(s)
- P A Mileman
- Department of Oral Radiology, Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands.
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