Additional intraoral radiographs may change the judgment regarding the final position of orthodontic mini-implants

ABSTRACT Objective: This study aimed to assess if additional vertical bitewing (VBW) and/or occlusal (OC) radiographs may change initial judgment based only on periapical radiograph (PAR) about the final position of orthodontic mini-implants (OMI). Methods: Subjective and objective analyses were performed. Radiographic images of 26 OMI were divided into four groups: PAR, PAR+VBW, PAR+OC and ALL (PAR+VBW+OC). For subjective analysis, five observers were asked to assess if the position of OMI was favorable to its success, using questionnaires with a four-point scale for responses: 1= definitely not favorable, 2= probably not favorable, 3= probably favorable, or 4= definitely favorable. Each group containing sets of images was presented to them in four different viewing sessions. Objective evaluation compared horizontal distances between OMI tip and the root nearest to the device in PAR and VBW. Results: Most of observers (3 out of 5) changed their initial judgment based on PAR about OMI position when additional radiographs were analyzed. Differences between groups (i.e. PAR vs. PAR+VBW; PAR vs. PAR+OC; and, PARvs.ALL) were statistically significant for these observers. For those that changed their judgment about OMI position, confidence level could significantly increase, decrease or even be maintained, not indicating a pattern. There was no agreement for distances between OMI tip and the root nearest to the device in PAR and VBW. Conclusion: Considering the limitations of the study, it is concluded that additional radiographic images may change the judgement about OMI final position without necessarily increasing the degree of certainty of such judgment.

RESUMO Objetivo: avaliar se a adição de radiografias interproximais verticais (IV) e/ou oclusais (OC) pode alterar o julgamento inicial sobre a posição final dos mini-implantes ortodônticos (MI) baseado somente na radiografia periapical (PA). Métodos: foram realizadas análises subjetivas e objetivas. Imagens radiográficas de 26 regiões contendo MI foram divididas em quatro grupos: PA, PA+IV, PA+OC e TODAS (PA+IV+OC). Na análise subjetiva, cinco observadores foram convidados a avaliar se a posição do MI era favorável para o seu sucesso, utilizando questionários com uma escala de quatro pontos para respostas: 1 = definitivamente não favorável; 2 = provavelmente não favorável; 3 = provavelmente favorável; ou 4 = definitivamente favorável. Cada grupo contendo conjuntos de imagens foi apresentado aos observadores em quatro sessões diferentes. Adicionalmente, uma avaliação objetiva comparou as distâncias horizontais entre a ponta do MI e a raiz dentária mais próxima ao dispositivo na PA e IV. Resultados: a maioria dos observadores (3 de 5) mudou seu julgamento inicial sobre a posição do MI baseado na PA quando radiografias adicionais foram analisadas. Diferenças entre os grupos (ou seja, PA vs PA+IV; PA vs PA+OC; e PAvsTODAS) foram estatisticamente significativas para esses observadores. Para aqueles que mudaram seu julgamento sobre a posição do MI, o nível de confiança das respostas aumentou, diminuiu ou foi mantido, não indicando um padrão. Houve diferença estatisticamente significante entre as distâncias da ponta do MI para a raiz mais próxima ao dispositivo na PA e IV. Conclusão: considerando-se as limitações desse estudo, concluiu-se que imagens radiográficas adicionais podem alterar o julgamento sobre a posição final de MI sem, necessariamente, aumentar o grau de certeza de tal julgamento.

Effect of Clinical Experience on Accuracy and Reliability of Radiographic Caries Detection / Efecto de la Experiencia Clínica en la Precisión y Concordancia de Detección de Caries en Radiografías

ABSTRACT: The purpose of this study was to investigate the accuracy and interobserver reliability of examiners with different levels of clinical experience, when diagnosing radiographic proximal caries lesions. Bitewing radiographs were selected from a patient attending Operative Dentistry Clinic, Universidad de Chile. Radiographic examination was performed by three different groups: A: third year dentistry students, B: fourth year dentistry students, and C: dentist recently graduated. Thirty-two proximal surfaces were scored as: 0, sound; 1: enamel caries; and 2: dentinal caries. The data were analysed and accuracy and interexaminer reliability were calculated. Accuracy values for enamel caries were: A (0.54), B (0.55) and C (0.58), and dentinal caries were: A (0.55), B (0.61) and C (0.63). Interexaminer reliability denoted marginal agreement for all groups, A (0.249), B (0.213) and C (0.282) for enamel caries and A (0.058), B (0.102), and C (0.344) for dentinal caries. The results of this study indicate that the accuracy and interexaminer reliability of bitewing radiographic examination were influenced by the clinical experience when detecting radiographic proximal caries, however low values of accuracy and interexaminer reliability were noted, reinforcing the necessity of improving education and training in radiographic caries detection.

RESUMEN:El objetivo de este trabajo fue evaluar la precisión y concordancia entre examinadores con distinto nivel de experiencia clínica, al diagnosticar lesiones de caries proximales en radiografías. Un set de radiografías bitewing fue seleccionado de un paciente que acudió a la Clínica de Operatoria de la Facultad de Odontología, Universidad de Chile. El examen radiográfico fue realizado por tres grupos distintos: A: estudiantes de Odontología de tercer año, B: estudiantes de Odontología de cuarto año, y C: dentistas recientemente graduados. Treinta y dos superficies proximales fueron analizadas y evaluadas como: 0, sana; 1: lesión de caries de esmalte, 2: lesión de caries dentinaria. Los datos obtenidos fueron analizados y la precisión y concordancia entre examinadores fueron calculadas. Los valores de precisión en lesiones de esmalte fueron: A (0,54), B (0,55) y C (0,58), y para lesiones dentinarias fueron: A (0,55), B (0,61) y C (0,63). La concordancia entre examinadores denotó ser marginal para todos los grupos, A (0,249), B (0,213) y C (0,282) en lesiones de esmalte y A (0,058), B (0,102), y C (0,344) en lesiones dentinarias. Los resultados de este estudio indican que la precisión y la concordancia entre examinadores está influenciada por la experiencia clínica, sin embargo los valores encontrados fueron bajos, lo que refuerza la necesidad de mejorar la educación y entrenamiento en detección de lesiones de caries en radiografías

Detection of proximal caries using quantitative light-induced fluorescence-digital and laser fluorescence: a comparative study

PURPOSE: The purpose of this study was to evaluate the in vitro validity of quantitative light-induced fluorescence-digital (QLF-D) and laser fluorescence (DIAGNOdent) for assessing proximal caries in extracted premolars, using digital radiography as reference method. MATERIALS AND METHODS: A total of 102 extracted premolars with similar lengths and shapes were used. A single operator conducted all the examinations using three different detection methods (bitewing radiography, QLF-D, and DIAGNOdent). The bitewing x-ray scale, QLF-D fluorescence loss (ΔF), and DIAGNOdent peak readings were compared and statistically analyzed. RESULTS: Each method showed an excellent reliability. The correlation coefficient between bitewing radiography and QLF-D, DIAGNOdent were −0.644 and 0.448, respectively, while the value between QLF-D and DIAGNOdent was −0.382. The kappa statistics for bitewing radiography and QLF-D had a higher diagnosis consensus than those for bitewing radiography and DIAGNOdent. The QLF-D was moderately to highly accurate (AUC = 0.753 – 0.908), while DIAGNOdent was moderately to less accurate (AUC = 0.622 – 0.784). All detection methods showed statistically significant correlation and high correlation between the bitewing radiography and QLF-D. CONCLUSION: QLF-D was found to be a valid and reliable alternative diagnostic method to digital bitewing radiography for in vitro detection of proximal caries.

Comparison of three diagnostic techniques for detecting occlusal dental caries in primary molars: An in vivo study.

Aim: To compare the accuracy and repeatability of three diagnostic systems; visual inspection, bitewing radiography, and CarieScan PRO for occlusal caries diagnosis in primary molars. Materials and Methods: 216 occlusal surfaces of primary molars examined in turn by two examiners using each of three diagnostic systems (visual inspection, bitewing radiography, and CarieScan PRO). Examiners indicated operative intervention (validation method) for 104 teeth which were used for statistical analysis. The validation method was cavity preparation when the two examiners agreed about the presence of dentinal caries. Sensitivity, specificity, likelihood ratio, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each diagnostic technique. Inter‑ and intra‑examiner repeatability was calculated for each diagnostic system using the Cohen’s kappa statistics. Results: Visual inspection showed the highest sensitivity (0.93). The highest sensitivity and NPVs were provided by CarieScan PRO (0.97 and 0.95, respectively) however this was offset by a lower specificity (0.82) compared to other techniques. The CarieScan PRO gave the highest values of Cohen’s kappa statistics. Conclusion: This study showed low sensitivity but substantial specificity with visual inspection. Bitewing radiography performed poorly overall when compared with the other two systems. The CarieScan PRO technique gave the highest overall combination of sensitivity and specificity for detection of occlusal caries.

Evaluation of alveolar crest bone loss via premolar bitewing radiographs: presentation of a new method

PURPOSE: This study aimed to assess the interdental bone level in premolar bitewing radiographs while retracting the cheeks. METHODS: Seventy-two horizontal bone defects were created on dried mandibles and maxillae. The distance from the bone level to the cement-enamel junction of premolars was detected by a modified digital caliper (considered the gold standard). The reliability of all radiographs was assessed by intraclass correlation coefficient (ICC), and the validity was compared to the gold standard using the analysis of variance test. P-values less than 0.05 were considered statistically significant. RESULTS: This study showed that the reliability of radiographs without a cheek simulator and with 0.16 second exposure time was significantly higher than that of the two other groups (ICC=0.96 compared to 0.93 and 0.88, respectively). The results from the radiographs without a cheek simulator and with 0.16 second exposure time were more similar to the gold standard measures than those of the two other groups, although the difference was not statistically significant. CONCLUSIONS: Retracting the buccal soft tissue plays an important role in increasing the accuracy of radiographs in detecting the interdental alveolar bone level and produces more accurate results than increasing the exposure time, although it does not have a significant role in reliability of results.

Diagnóstico clínico e radiográfico na detecção de cáries proximais em molares decíduos e permanentes / Concordance between clinical and radiographic diagnosis for approximal caries in primary molars and first permanent molars

O objetivo deste estudo foi comparar a concordância dos exames clínico e radiográfico na detecção de cáries proximais em molares decíduos e primeiros molares permanentes. Foram selecionadas 200 crianças na faixa etária de 3 a 11 anos de idade, atendidas na Faculdade de Odontologia, da Universidade Federal do Maranhão. Todas as crianças deveriam apresentar os dentes posteriores com as cristas marginais íntegras, independente do estado das superfícies proximais. O exame clínico foi conduzido por um examinador com o auxílio de fio dental e sonda exploradora. A técnica "bite-wing" foi utilizada nas tomadas radiográficas, e a avaliação radiográfica foi realizada por um examinador utilizando negatoscópio e lupa. As características clínicas e radiográficas foram avaliadas, segundo critérios padronizados. Os dados foram analisados pelo teste McNemar com nível de significância de 5%. O exame radiográfico identificou um maior número de cáries proximais em esmalte (p<0,0001) e dentina (p<0,05), quando comparado ao exame clínico. Ao investigar o grau de concordância entre os exames, o exame radiográfico foi mais eficaz no diagnóstico de cáries proximais (p=0,0001). Conclui-se que o exame radiográfico detectou maior número de lesões cariosas proximais em relação ao clínico, sendo considerado um importante diagnóstico complementar para esse tipo de lesão.

This study aimed to compare the clinical and radiographic diagnosis for approximal caries in primary molars and first permanent molars. Two hundred children from 3 to 11 years old assisted by University Of Maranhão School Of Dentistry, were selected. All children should present the posterior teeth with intact marginal ridges, regardless of the status of proximal surfaces. Clinical examination was performed by an examiner using dental floss and dental explorer. The "bite-wing" technique was used in the radiographic examination, and radiographic analysis was performed by an examiner using a light box and a magnifying glass. The clinical and radiographic characteristics were evaluated according to standardized criteria. Data were analyzed by McNemar test with a significance level of 5%. The radiographic examination identified a higher number of proximal caries in enamel (p<0.0001) and dentin (p<0.05) compared to the clinical examination. Regarding the concordance between clinical and radiographic diagnosis, the radiographic examination was more effective in the diagnosis of proximal caries (p=0.0001). It was concluded that radiographic examination detected a higher number of proximal carious lesions in relation to clinical diagnosis, being considered as an important complement for diagnose this type of lesion.

Cárie Proximal em Dentes Decíduos Posteriores: Diagnóstico e Fatores Associados / Approximal Caries in Primary Posterior Teeth: Diagnosis and Associated Factors

Objetivo: O objetivo desse estudo foi avaliar as lesões de cárie proximais posteriores em dentes decíduos, comprovar a melhora no diagnóstico clínico com o uso da imagem radiográfica interproximal e verificar associações com variáveis demográficas, socioeconômicas, clínicas e com o relato de frequência de escovação e do uso do fio dental. Método: Cinquenta crianças com idades entre cinco e oito anos, atendidas na Clínica Infantil da Faculdade de Odontologia da Universidade Federal de Pelotas, foram submetidas ao exame clínico e radiográfico interproximal bilateral realizado pelo único operador treinado, seguindo técnica padronizada. Dados demográficos e de higiene bucal foram coletados da entrevista com a mãe. O diagnóstico da imagem radiográfica foi conduzido por dois avaliadores calibrados (Kappa 0,85), a partir dos critérios de Rolla et al.,1996 modificados. Os resultados foram analisados utilizando de estatística descritiva e teste T (α=0.05). Resultados: Houve incremento de lesões de cárie proximais posteriores com o exame radiográfico, de 5,48 para 6,14 (p=0,001), ou seja, 25% das lesões. Dessas, 84,6% eram lesões em esmalte e 10,8% lesões em dentina. As lesões de cárie proximais posteriores em dentes decíduos mostraram-se associadas com a faixa etária (p=0,005), aumentando de 4,29 (5-6 anos) para 7,48 (7-8anos), com o estágio de irrupção dos primeiros molares permanentes (p=0,018), com a presença de sangramento gengival (p=0,040) e com a escolaridade materna (p=0,049). Não houve associação com o sexo, renda e com o relato da frequência de escovação e do uso do fio dental. Conclusão: Mesmo considerando a dificuldade técnica, a radiografia interproximal incrementa o diagnóstico clínico de lesões proximais posteriores em crianças

Objective: The aim of this study was to evaluate the posterior approximal caries in primary teeth, show improvement in clinical diagnosis with the use of radiography bitewing and explore associations with demographic, socioeconomic, clinical and reporting of frequency of brushing and flossing. Method: Fifty children (5 to 8 years old), attending in the Pediatric Clinic of the College of Dentistryû Federal University of Pelotas, were clinically examined and a bilateral bitewing radiographic was taken by one previously trained operator with a standard technique. Demographic data and information on oral hygiene were collected from an interview answered by the childrenÆs mothers. The diagnostic assessment from the radiographic images was conducted by 2 calibrated examiners (Kappa 0.85), following Rolla et al., 1996 modified criteria. Results were analyzed with descriptive statistics and t test (α=0.05). Results: Posterior approximal caries identification increased with the bitewing examination, from 5.48 to 6.14 (p=0.001). From the 25% lesions detected with the radiographic exam, 84.6% were enamel lesions and 10.8% were dentine lesions. Posterior approximal caries in primary teeth showed statistically significant association with: age range (increasing from 4.29 at 5-6 years to 7.48 at 7-8 years, p=0.005); first permanent molars eruption stage (p=0.018); the gingival bleeding (p=0.040); and with mother´s educational level (p=0.049). Associations with gender, family income, frequency of brushing and use of dental floss were not observed (p>0.05). Conclusion: Even considering the difficulties of the technique, bitewing radiographs improve the clinical diagnosis of posterior approximal carious lesions in children

Lesões dentinárias sob esmalte não-cavitado: um estudo de prevalência / Dentine lesions under non-cavitated enamel: a prevalence study

Objetivo: Verificar a prevalência de lesões dentinárias sob esmalte não-cavitado ou minimamente desmineralizado em molares permanentes extraídos de adolescentes da região metropolitana do Recife, PE, Brasil. Metodologia: Foram analisados 215 elementos dentários (primeiros e segundos molares permanentes), apresentando esmalte não-cavitado, sem trincas, defeitos de esmalte ou manchas, de doadores de óbito recente, entre 12 e 18 anos, da região metropolitana de Recife, PE, cujos representantes legais assinaram o Termo de Doação e o Termo de Consentimento Livre e Esclarecido. Para classificação clínica dos molares como hígidos (em esmalte) consideraram-se os critérios da Organização Mundial da Saúde. Na radiografia interproximal, classificou-se como lesão dentinária sob esmalte não-cavitado ou cárie oculta, a imagem radiolúcida visível em dentina sob esmalte oclusal diagnosticado como hígido, sem restauração ou selante. Resultados: Verificou-se uma prevalência de lesões dentinárias sob esmalte não-cavitado de 13% para os molares investigados no estudo, principalmente nos primeiros molares inferiores (58%). Conclusão: O resultado obtido permitiu concluir que nesta amostra a prevalência de lesões dentinárias foi alta, sendo importante associar o exame radiográfico ao exame clínico para que este tipo de lesão possa ser identificada e acompanhada de forma precoce.

Purpose: This study aimed to record the prevalence of dentine lesions under non-cavitated or minimally demineralized enamel in molar teeth of adolescents from the Recife metropolitan area, PE, Brazil. Methods: Sample was composed of 215 first and second permanent molars selected according the inclusion criteria: non-cavitated enamel, and absence of cracks, enamel defects, or stains. The teeth were collected from recently deceased adolescents, between 12 and 18 years-old, from the Recife metropolitan area, PE, whose legal representatives signed a donation term and an informed consent form. The World Health Organization criteria were used to classify molar teeth as having sound enamel. In bitewing radiographs, dentine lesion under non-cavitated enamel (hidden caries) was diagnosed as a translucent radiographic image visible in dentine under sound occlusal enamel, without any restoration or sealant. Results: The prevalence of dentin lesions under non-cavitated enamel molars was 13%. Most cases comprised lower first permanent molars (58%). Conclusions: These results suggest that the prevalence of dentine lesions in molars was high in this sample. It is important to associate radiographic exams with clinical exam to identify and follow-up this type of lesion in early stages.

Elastomeric impression as a diagnostic method of cavitation in proximal dentin caries in primary molars

The purpose of this study was to validate the elastomeric impression after temporary tooth separation as a method of cavitation detection in proximal caries lesions in primary molars with outer half dentin radiolucency. Fifty-one children (4-10 years old), presenting radiolucency in the outer half of the dentin at the proximal surfaces of primary molars and proximal anatomic contact with the adjacent tooth (without restoration/cavitated caries lesion) were enrolled in the study. Temporary tooth separation was performed with an orthodontic rubber ring placed around the contact point during 2-3 days. Thereafter, impression of the proximal surfaces was made. The elastomeric impressions were classified as "non-cavitated" or "cavitated" surfaces. Visual inspection after tooth separation was considered as the gold standard. Examiner reliability of visual inspection after tooth separation was determined (kappa 0.92). Impression examination was repeated every 5 participants to evaluate the reproducibility of the method. The frequency of cavitated lesions was 65 percent, and 67 percent of those were inactive. Sensitivity, specificity, positive and negative predictive values were 0.88 percent (95 percentCI 0.73-0.95), 0.89 percent (95 percentCI 0.67-0.97), 0.94 percent (95 percentCI 0.79-0.98) and 0.80 percent (95 percentCI 0.58-0.92), respectively. Impression examination showed total agreement regarding cavitation. The evaluation of elastomeric impression after tooth separation is a useful clinical resource in cavitation detection for clinicians and researchers when visual inspection is doubtful.

Surgical crown lengthening: a 12-month study - radiographic results

OBJECTIVE: The purpose of this study was to perform a radiographic follow-up evaluation after a 12-month healing period, following crown lengthening surgery. MATERIAL AND METHODS: Twenty-three periodontally healthy subjects (mean age 32.5 years) that required crown lengthening surgery in premolars were recruited. In a total of 30 premolars, full thickness flaps, osseous resection, and flap suturing were performed. The restorative margin was defined in the pre-surgical phase and maintained unaltered during the healing period, serving as a reference point. Standardized bitewing radiographs were taken before and after osseous reduction, and at 2, 3, 6, and 12-month healing periods. RESULTS: Intact lamina dura was observed at both mesial and distal alveolar crests only from the 3rd month. At 12-months, all alveolar crests presented lamina dura. The overall mean distance from the restorative margin to the alveolar crest achieved after osseous resection was 3.28±0.87 mm at mesial and 2.81±0.51 mm at distal sites. No significant radiographic changes in the bone crest were observed during a 12-month healing period. CONCLUSION: The findings of this study suggest that the radiographic proximal bone level observed on bitewing radiographs following crown lengthening surgery can be used as a reference to predict the future level of the healed alveolar crest.

The evaluation of three methods for the diagnosis of initial posterior approximal caries / 实用口腔医学杂志

Objective: To evaluate the diagnostic efficacy of the bitewing radiograph(BWR),clinic examination(CE) and laser fluorescence examination (LF) for detection of initial posterior approximal caries . Methods:A total of 162 approximal surfaces from 81 extracted posterior teeth were examined by BWR, CE and LF. The histological diagnosis of sectioned teeth was used as the validating criterion (gold standard) to assess the sensitivity, specificity, accuracy and reproducibility. Results: The sensitivity and accuracy of BWR was higher than those of CE or LF at the level of enamel caries. Conclusions: BWR is an accurate diagnostic method for initial posterior approximal caries in present clinic practice. The inferior efficacy of LF is mainly due to its poor reproducibility of approximal surfaces.