Influence of the presence of dental implants on the accuracy and difficulty level of diagnosis of furcation involvement in molars: An in vitro CBCT study.

OBJECTIVE: The aim of this study was to investigate the possible interference of image artifacts (IA) generated by dental implants in the evaluation of furcation involvement (FI) in molars. METHODS: Tomographic scans of first molars (1M) were performed in dry skulls in the absence and presence of titanium (TI) and zirconia (ZI) dental implants. FI grades were simulated in the alveoli of the 1Ms. Diagnostic accuracy of FI and level of difficulty were verified. Chi-squared test and logistic regression analysis were used. RESULTS: There was no difference in the diagnostic accuracy of FI between the arches (p = .117). The highest diagnostic accuracy value for the implant variable was found in the absence of implants (88.3%) and the lowest in the presence of two ZI implants (66.7%). The highest diagnostic accuracy value for FI was observed in grade 0 (G0). There was no significant difference between the arches regarding the evaluators' perception of difficulty (p > .05). Assessments were considered difficult in 12.7% of the TI implants and in 29% of the ZI implants. Regarding the number of dental implants, assessments were considered difficult in 24.4% cases including one implant and 17.4% cases including two implants. The logistic regression model showed a significant p-value only for one and two ZI implants (p = .0061 and p = .0096, respectively). CONCLUSION: The presence of dental implants in the region adjacent to the area of investigation of FI decreased the diagnostic accuracy while increasing the perception of difficulty by the examiners, especially in cases with ZI implants.

Smartphone use as an aid in evaluating conventional radiographs.

This study aimed to evaluate the accuracy of smartphones for digitizing, sharing, and viewing conventional radiographic images. Eighty conventional radiographs of 40 teeth with metallic mesio-occlusodistal restorations (40 radiographs showing perfectly adapted restorations and 40 showing restorations with a 0.4-mm proximal gap) were digitized using a smartphone and then evaluated using 2 viewing methods: a light box (LB) and a smartphone screen (SS). Three examiners assessed all radiographs for the presence of marginal gaps using a dichotomous yes/no scale. To analyze examiner reproducibility, 10% of the samples was reassessed. The sensitivity, specificity, and overall accuracy were calculated for each examiner and viewing method. The McNemar test was used to compare examiners' diagnoses based on the 2 viewing methods. The level of statistical significance was set at P < 0.05. The level of agreement was κ > 0.8 for all examiners and both viewing methods. The LB group presented greater sensitivity, specificity, and overall accuracy than the SS group, but no statistically significant differences were found between the methods (P > 0.05). The results achieved were promising, suggesting that the smartphone can be presented as a new aid for radiographic evaluation (LB accuracy, 0.899 to 0.911; SS accuracy, 0.823 to 0.873). Smartphones offer similar accuracy to the traditional viewing method for evaluation of metallic restorations on conventional radiographs.

Is cone beam computed tomography accurate for postoperative evaluation of implants? An in vitro study.

OBJECTIVE: The aim of this study was to evaluate the accuracy of cone beam computed tomography (CBCT) for evaluation of the bone-implant interface in comparison with periapical radiography. STUDY DESIGN: Titanium implants were inserted in 74 bovine rib blocks in intimate contact with bone walls and with a gap of 0.125 mm (simulating failure in the osseointegration process). Periapical radiographs were taken with conventional film, and CBCT scans were acquired with i-CAT (0.2 mm and 0.125 mm voxel) and Kodak (0.2 mm and 0.076 mm voxel) units. Three examiners evaluated the images using a 5-point scale. Diagnostic accuracy was analyzed through sensitivity, specificity, and the area under the receiver operating characteristic (ROC) curve (AUC) with 95% confidence intervals (CIs). Intra- and interexaminer agreements were analyzed through Kendall's concordance test. RESULTS: Intra- and interexaminer agreements showed satisfactory results. The greatest accuracy was observed with conventional radiography (AUC = 0.963; CI 95% = 0.891-0.993). I-CAT 0.125-mm images showed good accuracy (AUC = 0.885; CI 95% = 0.790-0.947), with no significant difference compared with conventional radiography. Kodak images had high specificity and low sensitivity, presenting more false-negative results. CONCLUSIONS: Conventional radiography showed the highest accuracy for assessment of the bone-implant interface. However, CBCT (i-CAT; 0.125-mm voxel), if available or if performed for preoperative assessment of another implant site, may provide similar accuracy.

Civil liability related to imaging exams in Brazil

To analyze all court lawsuits in Brazil in relation to civil liability involving radiographic and tomographic images up to February 2014. METHODS: All Brazilian courts were surveyed for "civil liability," "error," "radiology," "radiography," and "tomography," returning 3923 second-instance lawsuits. Out of them were excluded labor legislation, health insurance coverage of radiological examinations, and criminal liability cases and 359 were selected. Compliance with expert reports, involvement of imaging exams, the defendant professional, the reasons of claims and convictions, and indemnity were evaluated. RESULTS: Of the 359 selected lawsuits, physicians were defendants in 71%, radiologist physicians in 10.6% and dentists in 18.4%. The prevalence of physicians found liable was related to the lack or delay in requesting the imaging exams 49.6%, and among radiologist physicians, misdiagnosis 47.1%. Considering the dentists, imaging exams had mostly an indirect involvement, and failure of the proposed treatment 73.8% was the most prevalent cause of dentists found liable; no radiologist was sued. Regarding indemnity, 50% of lawsuits resulted in compensation up to R$ 20,000 US$ 8,583. CONCLUSIONS: Misdiagnosis was the main cause of claims and radiologists were found liable. The medical field showed the largest absolute number of claims and physicians were found liable, but the highest proportion was directed to dentists...

Influência da resolução de voxel na detecção de canais acessórios em dentes mono e polirradiculares por meio da tomografia computadorizada de feixe cônico / Influence of voxel resolution in the detection of accessory canals in mono and polirradicular teeth by cone beam computed tomography

O conhecimento do sistema de canais radiculares (SCR) e o correto diagnóstico de canais acessórios são de extrema importância para o sucesso do tratamento endodôntico. Objetivo: avaliar a influência de diferentes resoluções de voxel das imagens de tomografia computadorizada de feixe cônico (TCFC) para o diagnóstico de canais acessórios, em dentes mono e polirradiculares. Métodos: cem dentes humanos extraídos (59 incisivos inferiores e 41 primeiros molares superiores) foram randomizados e posicionados para aquisição de imagens de TCFC em dois protocolos de voxel (0,2 e 0,3 mm) (i-Cat - Imaging Sciences International). As imagens foram analisadas por dois examinadores cegados e calibrados, os quais identificaram a presença ou não de canais acessórios, tanto nos molares superiores (raiz mesiovestibular) como nos incisivos inferiores. Os dados foram analisados descritivamente, avaliando-se a frequência e porcentagens de diagnósticos em relação ao dente e à resolução de voxel da imagem. A concordância entre as avaliações de imagens de voxel 0,2 e 0,3 mm também foi analisada. Resultados: as análises por meio das imagens com voxel 0,2 mm detectaram maior número de canais acessórios, em ambos os tipos de dentes. Foram diagnosticados 26 (44%) dentes incisivos e 33 (80%) molares com presença de canais acessórios, nas imagens de voxel 0,2 mm. A concordância entre as avaliações dos diferentes protocolos de voxel foi de aproximadamente 80%. Conclusão: a resolução do voxel influencia na detecção de canais acessórios, em dentes mono e polirradiculares, sendo o voxel com 0,2 mm capaz de identificar maior número de canais quando comparado ao voxel 0,3 mm.

Reproducibility of cephalometric measures obtained by dental radiologists / Reprodutibilidade de Medidas Cefalométricas por Especialistas em Radiologia

Objetivo: A análise cefalométrica é utilizada por dentistas no auxílio ao diagnóstico, planejamento e acompanhamento dos tratamentosortodôntico, ortopédico e cirúrgico. Entretanto, a cefalometria não éuma ferramenta precisa e há erros significativos nas medidas obtidaspor examinadores diferentes ou pelo mesmo avaliador em momentosdistintos. O objetivo deste estudo foi avaliar a reprodutibilidade das medidas cefalométricas de três especialistas em radiologia odontológica e compará-las com os resultados obtidos por trêsclínicas de radiologia. Materiais e métodos: Os examinadores traçaram os cefalogramas de 39 telerradiografias convencionais da amostra utilizada por Silveira e Silveira (2006). Resultados:O teste de ANOVA revelou uma boa reprodutibilidade para 17 dos 32 fatores nas análises realizadas pelos dentistasespecialistas. Houve concordância entre os especialistas para 53,1% dos fatores, enquanto que para as clínicas de radiologia a concordância foi de somente 12,5%. Conclusão: Os resultados mostraram que os três especialistas em radiologia obtiveram maior concordância nas aanálises cefalométricas realizadas do que aquelas recebidas pelas clínicas de radiologia estudadas previamente.

Objectives: Cephalometric analysis is used by dentists to assist in thediagnosis, planning and follow-up of orthodontic, orthopedic and surgical treatments. However, cephalometry is not a precise tool, and there are significant errors in the measures obtained by the same or different examiners. The purpose of this study was to evaluate the reproducibility of cephalometric measures obtained by three specialists in oral radiology, and to compare them with the results obtained by three radiology clinics. Materials and Methods : Examiners traced cephalograms from 39 conventional cephalograms from the sample used by Silveira and Silveira (2006). ANOVA revealed good reproducibility of 17 of the 32 factors in the analyses conducted by dental specialists. Results: Agreement between dental specialists was found for 53.1% of the factors, whereas agreement for the results obtained by radiology clinics was only 12.5%. Conclusion: Results showed that tracings by the 3 radiology specialists had greater agreement than those by the radiology clinics under study.