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PubMed1985

Comparison between standardized periapical and bitewing radiographs in assessing alveolar bone loss.

Readability and alveolar bone level were compared in 455 sets of standardized radiographs each consisting of four periapical (PA) and two bitewing (BW) films. BW radiographs showed significantly higher proportions of unreadable sites in the canines and the mesial surface of first premolars (P less than 0.0001), while PA radiographs exhibited significantly higher proportions of unreadable sites in the distal surface of second molars (P less than 0.0001). Alveolar bone level was assessable in a total of 10016 sites, and the comparison showed identical readings in 82% of the sites. In the maxilla, a significantly higher proportion of sites exhibited larger bone loss measurements (P less than 0.0001) and more sites with significantly higher mean values (P less than 0.005) in BW than in PA films. Mandibular sites showed the opposite trend. The majority of the sites revealed a Pearson's correlation coefficient (r) ranging between 0.60 and 0.82. No significant difference between mean bone loss measurements in the two types of radiographs for all the sites was found. It was concluded that the two radiographic techniques may be used interchangeably in epidemiologic studies.

Adolescent↗
PubMed1979

Retreatment of endodontic fillings.

Effects of endodontic retreatment on quality of seal and periapical healing were assessed among 660 previously root-filled roots. The roots were divided into either of two groups according to presence or absence of pathologic alterations in the periapical area. The retreatments, which were carried out by dental students, involved a thorough chemomechanical debridement of the root-canal system aiming to control infection. Following a 2-year observation period 556 roots were reexamined clinically and radiographically. The results showed that root-fillings with technical shortcomings could, following retreatment, be markedly improved as regards effectiveness of seal and distance to the apex. A large number of lumina discernible apical to root-filling could also be treated and filled. Seventy-eight percent of the cases with pathologic lesion present periapically prior to retreatment either completely healed or displayed an obvious size-reduction of the process. Retreatments carried out because of technical inadequacies alone were successful in 94% of the cases. It was concluded that renewed endodontic treatment whenever possible is the method of choice when treating defective endodontic fillings complicated with pathologic processes periapically. Apical surgery may be attempted if no signs of healing are apparent following observation.

Adult↗
PubMed1983

Radiographic evaluation of endodontic therapy and the influence of observer variation.

In radiographic evaluation of the results of endodontic therapy the development or persistence of periapical radiolucencies often serve as criteria for therapeutic failure. In the present study the influence of inter- and intraexaminer variation on these results was investigated. Three endodontists and three radiologists interpreted periapical conditions and quality of root filling seal in radiographs of 119 endodontically treated roots. Consensus on the presence of periapical lesion was reached in 27% of cases classified as pathologic. In 6% reports of increased width of the periodontal membrane space accorded. The examiners agreed completely on normal periapical conditions in 37% of the cases. On assessing the quality of root filling seal the opinions of observers differed even more. Complete agreement on cases with adequate and defective seal was reached in 25% and 12%, respectively. For the individual examiner the widened periodontal membrane space was the diagnosis most difficult to reproduce. The present study indicates that the large variation noted among clinical and radiographic studies on the results of endodontic therapy could partly be explained by difficulties in defining and maintaining criteria for radiological evidence of periapical disease.

Clinical Competence↗
PubMed1997

Evaluation of a dental subtraction radiography system.

The aim of this in vitro study was to evaluate the ability of a dental subtraction radiography system to quantitatively detect differences in density between radiographic image pairs. Four periapical radiographs were taken of the upper first permanent molars on five human skulls using the Digora radiographic imaging system. The 4 images were a "baseline" image and 3 containing test objects consisting of either 0.5, 1 or 2 mm thick aluminium cylinders, 2.5 mm in diameter. Semi-automated image processing software was used to "warp" the 3 images with test objects into the same geometric/density registration as the corresponding baseline image using a process called patch minimization. "Difference" images were than produced and their contrast stretched. For regions of interest, with and without test objects present, the difference in density between the baseline and "test object" images was calculated using a reference aluminium step wedge. The test objects were clearly visible in all the "difference" images. The mean difference between the actual and estimated volume of the test object was 0.31 (95% CI [-0.55, 1.17]) mm3 Al. There was a strong association (r = 0.83) between the actual and estimated aluminium volumes. It is concluded that this system provides adequate precision for clinical evaluation.

Absorptiometry, Photon↗
PubMed1996

Root end filling materials: a review.

When non-surgical attempts prove unsuccessful or are contraindicated, surgical endodontic therapy is needed to save the tooth. The procedure usually consists of exposure of the involved area, root end resection, root end preparation and insertion of a root end filling material. Numerous materials have been suggested as root end filling materials. This article is a review of the literature on the suitability of various root end filling materials based on their leakage assessment, marginal adaptation, cytotoxicity, and usage test in experimental animals and humans.

Animals↗
PubMed1976

Stimulus-evoked pain in teeth.

When pain occurs in teeth as a result of external stimulation it is more likely to be due to physical factors affecting the enamel and dentine than to pulp disease. The mechanisms are described, clinical conditions are mentioned and a speculative attempt is made to correlate them by introducing the idea of streaming potentials in the dentine and pulp. The pain perception threshold is considered in relation to different teeth, age, sex, lateral dominance, personality, and the area of electrode contact. The latter has proved interesting, for manipulation of it has led to possibly important findings on the nature of convergence in the trigeminal system, two-point discrimination, referred pain and somatopic representation of dental pulps in the medulla oblongata.

Age Factors↗
PubMed1994

Comparison of periapical and detailed narrow-beam radiography for diagnosis of periodontal pathology.

The diagnostic performance of the detailed narrow-beam (DNB) technique of the Scanora multimodal X-ray system was compared with periapical radiography for detecting periodontal pathology. In total, 253 sites in 133 patients were examined. Receiver operating characteristics (ROC) of both imaging modalities were analyzed in relation to the ratings of five observers for the whole dentition, three dental regions and five types of periodontal lesion. ROC analysis demonstrated that the overall diagnostic performance of DNB radiography was better (P < 0.05) than that of periapical radiography. DNB radiography was significantly superior (P < 0.01) for detecting marginal widening of periodontal membrane space, but there was no significant difference between the two techniques for crestal erosion, vertical bone loss, furcation involvement or calculus. The regional differences found in overall diagnostic performance of the two imaging modalities were not significant. The sensitivity for periapical radiography was 71% and for DNB radiography 85%, and the specificities 82% and 81% respectively. It is concluded that DNB radiography is a good radiographic examination for periodontal disease, and an acceptable alternative to periapical radiography.

Adult↗
PubMed2005

Comparison of observer reliability in assessing alveolar bone height on direct digital and conventional radiographs.

OBJECTIVES: Radiographs are an important adjunct in the assessment of periodontal disease in clinical practice and research. The purpose of this study is to compare intraexaminer and interexaminer reproducibility in assessing alveolar bone height on direct digital and conventional radiographs. MATERIALS AND METHODS: Matched sets of conventional radiographs and digital radiographs were taken on 23 subjects. Bone levels were measured on radiographs as the distance from the cementoenamel junction to the alveolar crest in millimetres at the mesial and distal surfaces of all available teeth excluding third molars. Two examiners measured bone levels twice on each type of imaging system independent of one another. Correlations and paired t-test values were computed. RESULTS: Intraexaminer relative agreement (r-value) on both digital and conventional radiographs ranged from 0.73 to 0.98, P<0.05; however, differences between measurements (absolute agreement) for each examiner were non-significant, P>0.05. Interexaminer relative agreement on both digital and conventional radiographs ranged from 0.70 to 0.95, P<0.05, and measurement differences between the two examiners were also significant, P<0.05. One examiner tended to score higher measurements than the other, P<0.05. CONCLUSIONS: Alveolar bone measurements are reproducible on both digital and conventional radiographs. Intraexaminer reproducibility is superior to interexaminer reproducibility. Direct digital radiographs did not enhance examiner agreement over conventional radiographs.

Adolescent↗
PubMed2006

The effect of dose reduction on the detection of anatomical structures on panoramic radiographs.

OBJECTIVES: The aim was to evaluate the effect of dose reduction on diagnostic accuracy using different screen-film combinations and digital techniques for panoramic radiography. METHODS: Five observers assessed 201 pairs of panoramic radiographs (a total of 402 panoramic radiographs) taken with the Orthophos Plus (Sirona, Bensheim, Germany), for visualization of 11 anatomical structures on each side, using a 3-point scale -1, 0 and 1. Two radiographs of each patient were taken at two different times (conventional setting and setting with decreased dose, done by increasing tube potential settings or halving tube current). To compare the dose at different tube potential settings dose-length product was measured at the secondary collimator. Films with medium and regular intensifying screens (high and low tube potential settings) and storage phosphor plates (low tube potential setting, tube current setting equivalent to regular intensifying screen and halved) were compared. The five observers made 27 610 assessments. Intrarater agreement was expressed by Cohen's kappa coefficient. RESULTS: The results demonstrated an equivalence of regular screens (low tube potential setting) and medium screens (high and low tube potential settings). A significant difference existed between medium screens (low tube potential setting, mean score 0.92) and the group of regular film-screen combinations at high tube potential settings (mean score 0.89) and between all film-screen combinations and the digital system irrespective of exposure (mean score below 0.82). There were no significant differences between medium and regular screens (mean score 0.88 to 0.92) for assessment of the periodontal ligament space, but there was a significant difference compared with the digital system (mean score below 0.76). The kappa coefficient for intrarater agreement was moderate (0.55). CONCLUSIONS: New regular intensifying screens can replace medium screens at low tube potential settings. Digital panoramic radiographs should be taken at low tube potential levels with an exposure equivalent at least to a regular intensifying screen.

Alveolar Process↗
PubMed2004

Effective and organ doses from scanography and zonography: a comparison with periapical radiography.

OBJECTIVES: To compare absorbed and effective doses from scanographic and zonographic examinations performed in the Scanora unit with intraoral periapical radiography. METHODS: Absorbed dose measurements were made on an anthropomorphic phantom head with LiF thermoluminescent dosemeters in the regions of the pituitary gland, eye lenses, parotid glands, submandibular glands, thyroid gland and skin. Energy imparted was calculated from the measurements of air collision kerma and effective doses by using the quotient 24 mSv J-1 between energy imparted and effective dose. The upper and lower third molar region was examined with intraoral radiographs and with ramus scanograms, dental scanograms and dental zonograms. Radiation dose measurements were also performed for Scanora panoramic radiography (jaw and dental). RESULTS: The effective doses for the ramus and dental scanograms were 0.01 mSv, similar or lower than for intraoral radiography. Zonography yielded the highest effective dose (0.03 mSv). Except for the skin doses, the salivary glands received the highest doses. Salivary gland doses were slightly higher from narrow beam than from intraoral radiography. CONCLUSIONS: Detail narrow beam radiography with the Scanora is an alternative to periapical radiography and is preferred, from a radiation dose point of view, over zonography.

Humans↗