Diagnostic accuracy of conventional versus digital radiography in detection of external root resorption

External root resorption is a clinical problem that often is difficult to detect. Since external root resorption is not detectable clinically, radiographic examination is very important. The objective of this study was to compare diagnostic efficacy of conventional film versus direct digital radiography in detecting simulated root resorptive cavities in vitro. This study was based on observational diagnostic methods. A total of 39 extracted teeth including 10 anterior teeth, 6 canines, 8 premolars, 5 maxillary molars and 10 mandibular molars were selected. Except palatal root of upper molars, each root was divided to apical and coronal halves. Half of these sites were considered as control. Buccal cavities were randomly prepared in the remaining sites by # 1/2, #2, and #4 round burs. Each tooth was imaged twice using a CCD based digital system and an E speed film. Radiographs were taken with 0 And 20 degrees mesial angulation .Six image groups were interpreted by 2 experienced oral and maxillofacial radiologists and one endodontist. Conventional radiographs were observed at 2X magnification by a magnifying glass. Sensitivity, speciflcity, false negative and false positive percentage and also accuracy on each method were analyzed in comparison with golden standard. Agreement among these techniques was expressed as the kappa score. Results: The most sensitive technique was conventional radiography at 2X magnification .Sensitivity of digital radiography and enhanced digital radiography were almost equivalent. The most specific technique was also conventional radiography at 2X magnification followed by enhanced digital radiography. Among all, the highest diagnostic accuracy was in conventional radiography at 2X magnification followed by enhanced digital radiography. Taking images with mesial angulation increased sensitivity and decreased speciflcity in all techniques. Therefore, it did not influence the diagnostic accuracy of conventional and enhanced digital radiography. There was an increased agreement between digital radiographic techniques and digital imaging with enhancement options.[k=0.68]. In detecting external root resorption, diagnostic efficacy of conventional radiography at 2X magnification was more than those in enhanced and unenhanced digital radiograph

[Evaluation of the diagnostic efficacy of intra oral digital radiography with and without zoom option software in the detection of occlusal dentinal caries: an in vitro study]

The purpose of this study was to evaluate the diagnostic precision of zoom option of Cygnus Ritter CCD intraoral digital sensor compared to original digital radiography in the detection of occlusal dentinal caries. Eighty-six extracted premolars with no apparent clinical caries were selected. Two methods were used for radiography; namely, digital radiography using a Cygnus Ritter CCD sensor and then zoom option was applied to the original radiographs. Four maxillofacial radiologists observed the original digital and the same radiographs with zoom option to detect occlusal dentinal caries subsequently recording it in a five-grade scale. Microscopic sections evaluated by a pathologist were used as the gold standard for caries detection. The data were analyzed with a proportion test and processed with SPSS maxillofacial 14 soft ware. Statistical analysis showed a sensitivity of 52.2% [71] [CI: 95%] for zoom option in the detection of occlusal dentinal caries [P<0.05]. The specificity was shown as 68.8% [143] [P>0.05]. The ppv was calculated as 52.2% [179] [P<0/.05] and npv as 68.8% [236] [P<0.05] and the accuracy was 62.2% [214] [P<0.05]. The zoom option of Cygnus Ritter CCD sensor showed a significantly higher diagnostic sensitivity, ppv, npv and accuracy compared to original digital radiographs, but the zoom option of that sensor did not show a significantly higher diagnostic specificity compared to original digital radiographs

consistency of panoramic radiography selection criteria by dentists in Tehran with the FDA guidelines

Use of panoramic radiography in some cases is easier and more cost-effective than other radiographies. However, it has some limitations as well. Considering the importance of radiography in dentistry, the present study sought to assess the consistency of selection of panoramic radiography by general dentists in Tehranwith FDA guidelines during 2010-2011. In this descriptive cross-sectional study, 500 general dentists were selected using randomized cluster sampling and evaluated by a questionnaire. The questionnaire asked for demographic data and had 27 questions regarding the selection criteria for panoramic radiography. Dentists had the following answer choices for each criterion: [Strongly leads to prescription], [probably leads to prescription], [has no effect on prescription], [probably prevents prescription] and [strongly prevents prescription]. The answers were collected and descriptively analyzed. To evaluate the effect of different factors on dentists' answers, binary logistic regression with enter method was used. Of the understudy dentists, 44% were females and 56% were males with a mean age of 36.84 yrs. Based on the results of regression analysis, panoramic radiography was prescribed by dentists in case of concerns regarding the carcinogenicity of radiation, good oral hygiene and for evaluation of growth and development before the age of 6 which are not in accord with the FDA guidelines. Also, for primary assessment of periodontal status, poor oral hygiene, disseminated pain, determination of alveolar crest height in the anterior region and pregnancy, panoramic radiography was prescribed by dentists which is completely in agreement with the FDA guidelines [P<0.05]. Easy application of panoramic radiography and its accessibility were the reasons for its prescription in 55.5% and 47.6% of cases, respectively. Some reasons of prescription were in accord with the FDA guidelines while some others were in contrast to them

Initial presentation of acute lymphoblastic leukemia with osteoporosis and multiple spontaneous bone fractures

Acute lymphoblastic leukemia [ALL] is the most common childhood malignancy. Skeletal abnormalities have been described in association with ALL including osteoprosis and bone fractures. Different factors including the disease itself or soluble products of malignant cells and treatment agents like cytotoxic drugs, methotroxate, corticosteroids and radiotherapy may be responsible for defective bone homeostasis in these patients. Orthopedic conditions and pain may be the first manifestation of acute leukemia and it is important for physicians to recognize the skeletal manifestation of acute childhood leukemia because of a delay in diagnosis has adverse effect on survival. We present a child with ALL that refer with multi bone fractures as a first manifestation of the disease

Coronary artery origin anomalies with especial emphasis on delayed diagnosis of anomalous origin of the left coronary artery from pulmonary artery, a report from south of Iran

The aim of this study was to determine the clinical course and outcome of coronary artery anomalies including anomalous origin of the left coronary artery from the pulmonary artery [ALCAPA] diagnosed by coronary artery angiography [CAA] at our institution. The term coronary artery anomaly refers to a wide range of congenital abnormalities, involving the origin, course and the structure of epicardial coronary arteries. Anomalous origin of the left coronary artery from the pulmonary artery [ALCAPA] is an extremely rare, but potentially fatal congenital coronary anomaly. The review included 21280 patients undergoing CAA at Medical Centers of Shiraz University between years 1997 -2006. The hospital records of all patients with diagnosis of ALCAPA reviewed for analysis. Data were expressed as percentages. There were 149 [0.7%] cases of coronary anomalies, including 9 [6.04%] proven cases of ALCAPA. In ALCAPA group, five patients presented with congestive heart failure [CHF] and a non-specific systolic murmur on examination. Isolated mitral valve regurgitation [MR], cerebrovascular accident due to embolization of a mural thrombus, and chest pain were the main presentations in three patients. Two of the patients were under follow up with presumptive diagnosis of coronary artery fistula. The patients aged between 4 months and 35 years. Surgical correction done for all the patients with ALCAPA by direct reimplantation in 8 patients and Takeuchi technique in one. We had one early hospital mortality in our group. ALCAPA should be considered in differential diagnosis of any patient presenting with dilated cardiomyopathy, CHF, MR or chest pain syndrome. Awareness of such pathology can prevent or decrease the morbidity and mortality of a potentially fatal congenital heart disease