ORCA-EFCD consensus report on clinical recommendations for caries diagnosis. Paper III: caries diagnosis at the individual level.

The aim of the present consensus paper was to provide recommendations for clinical practice on the individual etiological and modifying factors to be assessed in the individual diagnosis of caries, and the methods for their assessment, supporting personalized treatment decisions. The executive councils of the European Organisation for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD) nominated ten experts each to join the expert panel. The steering committee formed three work groups which were asked to provide recommendations on 1) caries detection and diagnostic methods, 2) caries activity assessment and 3) forming individualised caries diagnoses. The experts responsible for "individualised caries diagnosis" searched and evaluated the relevant literature, drafted this manuscript and made provisional consensus recommendations. These recommendations were discussed and refined during the structured process in the whole work group. Finally, the agreement for each recommendation was determined using an anonymous eDelphi survey. The threshold for approval of recommendations was determined at 70% agreement. Ten recommendations were approved and agreed by the whole expert panel, covering medical history, caries experience, plaque, diet, fluoride and saliva. While the level of evidence was low, the level of agreement was typically very high, except for one recommendation on salivary flow measurement, where 70% agreed. It is recommended that all aspects of caries lesion progression and activity, recent caries experience, medical conditions and medications, plaque, diet, fluoride and saliva should be synthesized to arrive at an individual diagnosis. The expert panel merged evidence from existing guidelines and scientific literature with practical considerations and provided recommendations for their use in daily dental practice.

ORCA-EFCD consensus report on clinical recommendations for caries diagnosis. Paper II: caries lesion activity and progression assessment.

INTRODUCTION: This consensus paper provides recommendations for oral health professionals on why and how to assess caries activity and progression with special respect to the site of a lesion. METHODS: An expert panel was nominated by the executive councils of the European Organization for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD). The steering committee built three working groups that were asked to provide recommendations on 1) caries detection and diagnostic methods, 2) caries activity and progression assessment and 3) obtain individualized caries diagnoses. The experts of work group 2 phrased and agreed on provisional general and specific recommendations on caries lesion activity and progression, based on a review of the current literature. These recommendations were then discussed and refined in a consensus workshop followed by an anonymous Delphi survey to determine the agreement on each recommendation. RESULTS: The expert panel agreed on general (n=7) and specific recommendations (n=6). The specific recommendations cover coronal caries on pits and fissures, smooth surfaces, proximal surfaces, as well as root caries and secondary caries/ caries adjacent to restorations and sealants (CARS). 3/13 recommendations yielded perfect agreement. CONCLUSION: The most suitable method for lesion activity assessment is the visual-tactile method. No single clinical characteristic is indicative of lesion activity; instead, lesion activity assessment is based on assessing and weighing several clinical signs. The recall intervals for visual and radiographic examination need to be adjusted to the presence of active caries lesions and recent caries progression rates. Modifications should be based on individual patient characteristics.

ORCA-EFCD consensus report on clinical recommendation for caries diagnosis. Paper I: caries lesion detection and depth assessment.

OBJECTIVES: The aim of the present consensus paper was to provide recommendations for clinical practice considering the use of visual examination, dental radiography and adjunct methods for primary caries detection. MATERIALS AND METHODS: The executive councils of the European Organisation for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD) nominated ten experts each to join the expert panel. The steering committee formed three work groups that were asked to provide recommendations on (1) caries detection and diagnostic methods, (2) caries activity assessment and (3) forming individualised caries diagnoses. The experts responsible for "caries detection and diagnostic methods" searched and evaluated the relevant literature, drafted this manuscript and made provisional consensus recommendations. These recommendations were discussed and refined during the structured process in the whole work group. Finally, the agreement for each recommendation was determined using an anonymous Delphi survey. RESULTS: Recommendations (N = 8) were approved and agreed upon by the whole expert panel: visual examination (N = 3), dental radiography (N = 3) and additional diagnostic methods (N = 2). While the quality of evidence was found to be heterogeneous, all recommendations were agreed upon by the expert panel. CONCLUSION: Visual examination is recommended as the first-choice method for the detection and assessment of caries lesions on accessible surfaces. Intraoral radiography, preferably bitewing, is recommended as an additional method. Adjunct, non-ionising radiation methods might also be useful in certain clinical situations. CLINICAL RELEVANCE: The expert panel merged evidence from the scientific literature with practical considerations and provided recommendations for their use in daily dental practice.

General dental practitioner opinions on Selection criteria for dental radiography: a qualitative focus group study.

Introduction In the UK, general dental practitioners are exposed to multiple sets of clinical guidelines, including those relating to selection of x-ray examinations. A focus group was convened to explore issues around current guidelines and how a future edition might be improved.Method A purposive sample of seven general dental practitioners in the North West of England took part in a focus group. A sound recording was transcribed and analysed by thematic content analysis.Results Nine themes arose from the discussion: awareness of the Selection criteria for dental radiography(SCDR); utility of the latest edition; presentation of a new edition; the format of a new edition; evidence base; practice standards and evidence levels; the General Dental Council and Care Quality Commission; radiation doses; and dissemination.Discussion Awareness of theSCDRwas high, although participants were not aware of its full contents. The document was regarded as practitioner unfriendly and participants preferred accessible flowcharts available online and through mobile devices. Participants assume that appraisal of evidence has been done appropriately and accounted for in producing recommendations. Participants used clinical guidelines to protect themselves from the threat of legal action and investigation by the regulator.Conclusion The authors make ten recommendations for the future production of guidelines.

Late Dental Toxicities After Proton Chemoradiation for Rhabdomyosarcoma: A Pediatric Case Report.

Purpose: Radiation therapy is an independent risk factor for adverse sequelae to the oral cavity and dentition in childhood cancer survivors. However, dental toxicities after radiation therapy often are underreported and there are minimal published data on disturbances in tooth development after proton beam therapy (PBT). We present the long-term clinical and radiographic dental findings 8 years after treatment completion for a patient treated with PBT and chemotherapy for rhabdomyosarcoma. Materials and Methods: Clinical follow-up data of patients treated with PBT within the Proton Overseas Programme (POP) is stored in a National Database and curated by a dedicated outcomes unit at the Christie NHS PBT center. This case report was identified from the extraction and analysis of data for pediatric head and neck cancer patients in this database for a service evaluation project. Results: The permanent dentition in this patient aged 3.5 years at the time of treatment was severely affected with abnormal dental development first observed 3.5 years after treatment completion. PBT delivered mean doses of 30 Gy(RBE = 1.1) to the maxilla and 25.9 Gy(RBE = 1.1) to the mandible. Conclusion: Significant dental development abnormalities occurred in this pediatric patient, despite doses in areas being lower than the proposed thresholds in the literature. Improved descriptions of dental toxicities and routine contouring of the maxilla and mandible are needed to correlate dosimetric data. The dose to teeth should be kept as low as reasonably possible in younger patients until the dose thresholds for dental toxicities are known.

Effectiveness of hard inserts in sports mouthguards: a systematic review.

Objectives To improve the protective capacity of conventional ethylene-vinyl acetate mouthguards, some authors have suggested reinforcement with a hard material to distribute impact energy more widely. The research question for this systematic review was: 'does the inclusion of a hard insert in mouthguards improve the protection of anterior teeth from a direct blow?'Data sources Three bibliographic databases (PubMed/Medline, Ovid/Embase and the Cochrane CENTRAL databases) were searched up to 20 February 2021. Additional searches included hand searching of key articles and journals.Data selection A systematic search of the literature included studies where the intervention was the incorporation of hard material into sports mouthguards and where the comparator was conventional mouthguard material. Eligibility required the use of anatomical specimens or anatomical analogues which included or represented anterior maxillary teeth. Twelve eligible publications were identified.Data extraction Data extraction was first carried out independently by two reviewers. Discrepancies were resolved by discussion.Data synthesis Results of individual studies were conflicting and methodological diversity created difficulty in making a synthesis of results. All studies employed low-energy impacts that did not represent the potentially high-energy impacts encountered in sport.Conclusion The efficacy of hard inserts in sports mouthguards has not been demonstrated.

Determination of a cone-beam CT low-dose protocol for root fracture diagnosis in non-endodontically treated anterior maxillary teeth.

OBJECTIVES: The aim of this study was to determine a "low-dose protocol" which provides acceptable diagnostic accuracy for detection of root fractures in unrestored anterior maxillary teeth, using an ex vivo model. METHODS: 48 maxillary anterior teeth, half with horizontal or oblique root fractures, were imaged using CBCT in an anthropomorphic model. Nine X-ray exposure combinations were used, including the manufacturer's standard ("reference") exposure and high-resolution settings ("HiRes"), by varying kV, exposure time, and rotation angle. Measurements of Dose Area Product (DAP) were recorded. Five dental radiologists assessed the scans for root fractures and judged image quality. Parameters of diagnostic accuracy were calculated, including area under the Receiver Operating Characteristic curve (Az). Objective measures of image quality were made at the same exposure combinations using an image quality phantom. RESULTS: Although there was a significant linear relationship between DAP and mean Az, only the lowest DAP exposure combination had a mean Az significantly different to the reference exposure. There was no significant effect on other diagnostic accuracy parameters when using HiRes compared with the reference exposure. There was a significant positive relationship between DAP and contrast resolution. HiRes did not significantly improve contrast resolution and made a small improvement to spatial resolution. CONCLUSIONS: Scope existed for radiation dose reduction compared with the manufacturer's guidance. There was no improvement in diagnostic accuracy using HiRes settings. A cautious recommendation for this CBCT machine is that it is possible to achieve a dose reduction of about 20% compared with the reference exposure parameters.

A meta-review of effective doses in dental and maxillofacial cone beam CT using the ROBIS tool.

OBJECTIVES: To apply the ROBIS tool for assessment of risk of bias (RoB) in systematic reviews (SRs) in a meta-review on effective doses (EDs) in dental and maxillofacial cone beam CT. METHODS: Three electronic databases and reference lists of included SRs were searched. Eligible SRs were classified as having low, high or unclear RoB. Findings of SRs were synthesised and data from primary studies combined to relate ED to field of view (FOV) and operating potential (kV). RESULTS: Seven SRs were included: three displayed low RoB, three high and one had unclear RoB. Only one SR related ED to image quality. Deficiencies in reporting of eligibility criteria, study selection and synthesis of results in SRs were identified. FOV height had a significant relationship with ED, explaining 27.2% of its variability. Median ED for three FOV categories differed significantly. Operating potential had a weak relationship with ED, with no significant difference in median ED between three operating potential groups. CONCLUSION: The ROBIS tool should have a role for meta-reviews of different aspects of radiology. The disappointing results for RoB might be remedied by developing standards to improve the quality of reporting of primary dosimetry studies and of SRs. Future dosimetry studies should always relate ED to image quality or diagnostic accuracy. ADVANCES IN KNOWLEDGE: This meta-review is the first to implement ROBIS for SRs of ED and identified that trustworthiness of some SRs is questionable. The percentage change in average ED per cm increase in FOV height could be calculated, emphasizing the importance of FOV as a determinant of ED in CBCT.

Mandibular canal versus inferior alveolar canal: A Delphi study.

The general principles of anatomical terminology indicate that the "mandibular canal" should be named the "inferior alveolar canal" as it accommodates the inferior alveolar neurovascular bundles. Therefore, we performed a Delphi study to evaluate the current understanding and use of the terminology in different geographical regions and areas of expertise and to determine the appropriate terminology for this bony canal. A Delphi panel was formed and questions sent and answered via email about: field of expertise (anatomy, oral surgery/oral and maxillofacial (OMF) surgery, oral radiology/OMF radiology, plastic surgery, ENT surgery, or dentistry with the exception of oral/OMF surgery and oral/OMF radiology), years of experience in the field of expertise, country currently working in, "what is the name of the bony canal that contains the inferior alveolar neurovascular bundle," and "what should the structure above be called, in general?" A total of 52 participants responded to the questionnaire. Half or more of the experts in anatomy, oral/OMF surgery, and ENT/plastic surgery considered "mandibular canal" to be the most appropriate name for this bony canal. In contrast, more than half of all experts in oral/OMF radiology and dentistry, that is, most fields of dentistry, considered "either mandibular canal or inferior alveolar canal" to be the appropriate name. The results of the Delphi study and general principles suggest that an alternative term for the "mandibular canal" should be "inferior alveolar canal."

Questionnaire surveys - sources of error and implications for design, reporting and appraisal.

Questionnaire surveys of dentists are a commonly used research method which can yield important results. Nevertheless, in order to give reliable information, surveys must be carefully designed to avoid bias. The challenge of planning, designing and implementing a questionnaire study is often underestimated. While headline response rate is commonly used as an indication of survey quality, there are four potential areas of survey error. These are coverage, sampling, measurement and response. These four areas of error are discussed, with examples from the current literature, to assist readers in critically appraising questionnaire studies. We make 12 key recommendations to researchers to help avoid bias in their research; approaches to response enhancement are also considered. Reporting guidelines for questionnaire studies are suggested which improve transparency and assist in understanding of research methodologies and results. We have termed these guidelines: Reporting Items for Surveys and Questionnaires (RISQ). In conclusion, there is no single solution that can guarantee a successful study. Conversely, failure to pay careful attention to any one of many crucial aspects of survey design can be the downfall of an otherwise robust study.

Anatomy of the mandibular canal and surrounding structures: Part I: Morphology of the superior wall of the mandibular canal.

INTRODUCTION: Previous studies of the mandibular canal (MC) have raised questions about the structure of its superior wall that have not been answered. The goal of this anatomical and radiological study was to investigate how CBCT imaging could predict the structure of the superior wall of the MC. METHODS: Twenty sides from ten dry mandibles derived from six females and four males were used for this study. The mandibles were examined with CBCT. The specimens were then prepared by the methods of our previous study and observed inferiorly. The inferior views were classified into four groups by gross observation of the surface of the superior wall of the MC: class I (trabecular pattern), class II (osteoporotic pattern), class III (dense/irregular pattern), and class IV (smooth pattern). Coronal section CBCT images were classed according to whether the superior wall of the MC was visible. RESULTS: Class I was most common in dentulous sections in both genders, and class IV was most common class in edentulous sections in both genders. The superior wall was visible in 59.1% in dentulous and 84.9% in edentulous sections, and non-visible in the remainder. CONCLUSION: Tooth presence and sex are important factors influencing the superior wall of the MC. When the superior wall cannot be seen on CBCT, it is more likely to belong to class II (osteoporotic) than other classes.

Does anthropomorphic model design in ex vivo studies affect diagnostic accuracy for dental root fracture using CBCT?

OBJECTIVES: The evidence for diagnostic accuracy using cone beam computed tomography (CBCT) for dental applications depends heavily on ex vivo research, but there is little knowledge of whether the model used affects the diagnostic accuracy results. The objective of this study was to determine the impact of different designs of anthropomorphic models on diagnostic accuracy for the specific task of dental root fracture detection. METHODS: Horizontal or oblique root fracture was induced in 24 of 48 permanent maxillary incisors. The 48 teeth were scanned by CBCT using standard clinical exposure factors on five occasions, each with a different model design. Scans were viewed by five dental and maxillofacial radiologists, who each made a forced diagnosis of fracture or no fracture in each root and a judgment on root fracture using a five-point confidence scale. Sensitivity (Se), specificity (Sp) and areas under receiver operating characteristic (ROC) curve (Az) were calculated for each observer for each model. RESULTS: There were no significant differences between the diagnostic accuracy measurements recorded using different models. There were, however, numerous significant differences between observers using the same anthropomorphic model. CONCLUSIONS: Despite the differences in X-ray attenuation between the five model designs, the results suggest that the anthropomorphic model does not affect the results of diagnostic accuracy studies on root fracture using this CBCT machine at standard clinical exposures. This provides some confidence in the previously published evidence. The interobserver diagnosis differences indicate that research using only two observers could provide misleading results.

An investigation into dose optimisation for imaging root canal anatomy using cone beam CT.

OBJECTIVES: To identify a dose as low as diagnostically acceptable and a threshold level of image quality for cone beam CT (CBCT) imaging root canals, using maxillary first molar (M1M) second mesiobuccal (MB2) canals of varying complexity for two CBCT scanners. METHODS: Dose-area product (DAP) and contrast-to-noise ratio (CNR) were measured for two scanners at a range of exposure parameters. Subjective-image-quality assessment at the same exposures was performed for three M1Ms of varying MB2 complexity, positioned in an anthropomorphic phantom. Nine raters (three endodontists, three dental radiologists and three junior staff) assessed canal visibility, using a 5-point confidence scale rating. RESULTS: Identification of simple-moderate MB2 canal complexity was achieved at a range of protocols, with DAP values of ≥209.3 and ≥203.2 mGy cm² and CNRs of 3 and 7.6 for Promax®3D and Accuitomo-F170® respectively. For complex canal anatomy, target subjective image quality was not achieved, even at the highest DAP values for both scanners. Junior staff classified significantly more images as undiagnostic compared with senior staff (p = 0.043). CONCLUSIONS: In this first study to address optimisation of CBCT imaging of root canal anatomy, a similar threshold dose for both scanners was identified for M1Ms with simple-moderate MB2 canal complexity. Increasing dose to enhance visualisation of more complex canal anatomy was ineffective. Selection of standard protocols (while avoiding lower kV/mA protocols) instead of high-resolution scans was a practical means of reducing patient dose. CNR is not a transferable measure of image quality.

Osteoporosis risk assessment in primary dental care-The attitudes of Swedish dentists, patients and medical specialists.

OBJECTIVE: To explore and identify the attitudes of dentists, patients and medical specialists regarding implementation of osteoporosis risk assessment into Swedish primary dental care. BACKGROUND: Osteoporosis is a major health problem leading to fragility fractures. As shown in academic-based research, dental radiological examination can be used for osteoporosis risk assessment. A substantial number of patients undergo radiographic examinations in primary dental care each year, but little is known about implementation of osteoporosis risk assessment in this setting. MATERIALS AND METHODS: A qualitative research approach using focus group discussions and manifest content analysis was applied. Five focus groups with dentists and representatives from patient support groups and a single individual interview with one medical specialist were included in the sample. RESULTS: From the manifest content analysis, three categories emerged: (a) barriers to change in practice, (b) benefits to change in practice, and (c) needs and requirements prior to change in practice. Most participants felt that there was insufficient knowledge of osteoporosis as well as a heavy existing workload. A concern was expressed about medical practitioners' willingness to take on responsibility for patients referred by dentists. Representatives from patient support groups highlighted a lack of knowledge about osteoporosis among both the general public and the medical professionals. Clear guidelines and improved communication channels between stakeholders would have to be established to ensure a smooth treatment path for patients. CONCLUSION: Despite interest in osteoporosis risk assessment in primary dental care, there are political, workflow and educational barriers that must be overcome for successful implementation.

Through the quality kaleidoscope: reflections on research in dentomaxillofacial imaging.

The REduce research Waste And Reward Diligence statement has highlighted how weaknesses in health research can produce misleading results and waste valuable resources. Research on diagnostic efficacy in the field of dentomaxillofacial radiology (DMFR) is no exception to these criticisms and could be strengthened by more robust study designs, consistent use of a core set of outcome measures and completeness in reporting. Furthermore, we advocate that everyone participating in collaborative research on clinical interventions subscribes to the importance of methodological quality in how imaging methods are used. The aim of this paper, therefore, is to present a guide to conducting high-quality research on diagnostic efficacy in DMFR.We initially propose a framework inspired by the hierarchical model of efficacy of Fryback and Thornbury, highlighting study designs, measures of analysis, completeness of reporting and established guidelines to assist in these aspects of research. Bias in research, and measures to prevent or limit it, are then described.It is desirable to climb the Fryback and Thornbury "ladder" from technical efficacy, via accuracy and clinical efficacy, to societal efficacy of imaging methods. Efficacy studies on the higher steps of the ladder may be difficult to perform, but we must strive to answer questions of how useful our methods are in patient management and assess benefits, risks, costs, ethical and social issues. With the framework of six efficacy levels as the structure and based on our experience, we present information that may facilitate quality enhancement of diagnostic efficacy research in DMFR.

Thyroid shielding in cone beam computed tomography: recommendations towards appropriate use.

The objective of this paper is to provide recommendations towards the appropriate use of thyroid shielding in dental cone beam CT (CBCT). Based on current evidence of thyroid radiosensitivity, dosimetric data in the presence and absence of shielding, and a depiction of potential adverse effects of thyroid shielding, a concise set of recommendations was prepared. According to current risk models, thyroid sensitivity is particularly high at a young age, and much higher for females. In the literature, involving adult male, female and paediatric reference phantoms, the use of a tightly fitted thyroid collar with a lead-equivalent thickness of at least 0.25 mm has consistently shown a significant reduction (average: 45.9%) of the equivalent dose to the thyroid. It can therefore be recommended that thyroid shielding should be routinely used for children undergoing CBCT scanning and is recommended for adults up to the age of 50. The increase of the X-ray tube current from automatic exposure control systems due to thyroid shielding can be avoided by placing the shielding collar after acquiring the scout images. Should real-time tube current modulation be implemented in dental CBCT imaging in the future, perspectives regarding the appropriate use of shielding may change according to current trends in CT. In view of the manifestation of metal artefacts, shielding is best avoided if radiological evaluation of tissues below the lower border of the mandible is needed.

Potential neurovascular damage as a result of dental implant placement in the anterior maxilla.

Introduction A patient requested dental implant therapy to replace his missing upper left central incisor. Pre-operative cone beam computed tomography (CBCT) imaging revealed a complex neurovascular supply to the anterior maxilla.Discussion Imaging demonstrated accessory neurovascular canals around the nasopalatine foramen which directly communicate with canalis sinuosus. They are, therefore, most likely to carry branches of the anterior superior alveolar nerve and vessels. One of these canals was directly in the path of proposed dental implant placement. A review of the dental literature suggests that such anatomical variation is relatively common. Some authors have proposed that injury to these structures is a cause of intractable pain following dental implant placement. Following discussion with the patient, it was agreed that the provision of an adhesive bridge was a realistic alternative in this case.Conclusion The availability of CBCT imaging in recent years has shown that complex neurovascular anatomy in the anterior maxilla is not uncommon. Evidence is lacking regarding the relevance of this to dental implant placement but it is possible that injury to these structures explains some cases of postoperative intractable pain.

An analysis of effective dose optimization and its impact on image quality and diagnostic efficacy relating to dental cone beam computed tomography (CBCT)

The potential of high resolution, three-dimensional (3D) images which overcome limitations such as superimposition and anatomical noise of two-dimensional (2D) conventional imaging, has made cone beam computed tomography (CBCT) an increasingly popular imaging modality in many dental applications. It is in light of the increasingly prevalent use of CBCT, particularly in a primary dental care setting, that the goal of this review is to investigate what evidence-based guidance is available to the clinician to justify and reduce radiation risk of this higher dose imaging modality while maintaining diagnostically acceptable images. To this end, the literature on radiation dose and related patient risk was comprehensively investigated, before an analysis of the ways in which dose can be optimized and the implications that optimization has on image quality was discussed. Finally, although it is accepted that CBCT has the potential to improve diagnosis, it is uncertain if its use has positive ramifications on issues of diagnostic efficacy, including clinical decision-making and patient outcome. In order to investigate these issues, the levels of evidence of the existing studies and their validity were assessed. On review of the available literature, it is evident that there is limited practical advice available to dentists regarding dose optimization and any existing protocols may not be readily transferable to every CBCT machine, the manufacturers' role is not often conducive to dose limitation and that the bulk of evidence is at lower levels of evidence. Furthermore, there is minimal supporting evidence to suggest an impact of CBCT on diagnostic thinking and consequent choice of treatment and no evidence of a positive effect of CBCT on patient outcome.

The impact of Cone Beam CT on financial costs and orthodontists' treatment decisions in the management of maxillary canines with eruption disturbance.

Background: Examination with Cone Beam CT (CBCT) is common for localizing maxillary canines with eruption disturbance. The benefits and costs of these examinations are unclear. Objectives: To measure: 1. the proportion of orthodontists' treatment decisions that were different based on intraoral and panoramic radiography (M1) compared with CBCT and panoramic radiography (M2); and 2. the costs of producing different treatment plans, regarding patients with maxillary canines with eruption disturbance. Subjects and methods: Orthodontists participated in a web-based survey and were randomly assigned to denote treatment decisions and the level of confidence in this decision for four patient cases presented with M1 or M2 at two occasions for the same patient case. Results: One hundred and twelve orthodontists made 445 assessments based on M1 and M2, respectively. Twenty-four per cent of the treatment decisions were different depending on which method the raters had access to, whereof one case differed significantly from all other cases. The mean total cost per examination was €99.84 using M1 and €134.37 using M2, resulting in an incremental cost per examination of €34.53 for M2. Limitations: Benefits in terms of number of different treatment decisions must be considered as an intermediate outcome for the effectiveness of a diagnostic method and should be interpreted with caution. Conclusions: For the patient cases presented in this study, most treatment decisions were the same irrespective of radiological method. Accordingly, this study does not support routine use of CBCT regarding patients with maxillary canine with eruption disturbance.

New Regulations on X-Ray Use: Likely Implications of IRR17 and IRMER18.

Professor Keith Horner, co-editor of FGDP(UK)'s selection criteria for dental radiography, analyses what the ionising radiation regulations 2017 and draft ionising radiation (medical exposure) regulations 2018 mean for dentists and dental practice teams.