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Parameters of radiologic care: An official report of the American Academy of Oral and Maxillofacial Radiology
Abstract
The American Academy of Oral and Maxillofacial Radiology developed these Parameters of Care to provide national guidelines for the use of radiographs prescribed for the diagnosis of disease, treatment planning, and follow-up care of patients with abnormalities of the oral and maxillofacial region. The Parameters cover radiographic techniques, imaging of the temporomandibular joint, imaging of diseases of the jaws, and imaging of dental implant sites. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:498-511)
... In addition, there is a lack of knowledge on the part of professionals and patients regarding the dose of radiation used in the acquisition of images and an excessive fear of the risks caused by exposure to X-rays [3] . The existing parameters for the rationalized use of radiation should be reviewed and updated from time to time in order to reduce radiation in the population [5] . ...
... Intraoral radiography <1. 5 Ludlow et al. [1] Panoramic Radiography 2.7-24. 3 Ludlow et al. [1] Okano et al. [9] Garcia Silva et al. [10] Palomo et al. [11] Garcia Silva et al. [12] Lateral Teleradiography <6 Ludlow et al. [1] CBCT (small FOV) ...
... Will the 3D image modify or add information to the diagnosis and treatment plan? From these answers, the practitioner will have the basis for a safe indication and will follow the CBCT indication rules specifying that the exam should only be done when conventional methods are not sufficient and/or when it brings additional information about each case [5] . ...
Currently there is a great acceptance in medicine and dentistry that clinical practice should be “evidence-based” as much as possible. That is why multiple works have been published aimed at decreasing radiation doses in the different types of imaging modalities used in dentistry, since the greater effect of radiation, especially in children, forces us to take necessary measures to rationalize its use, especially with Cone Beam computed tomography (CBCT), the method that provides the highest doses in dentistry. This review was written using such an approach with the purpose of rationalizing the radiation dose in our patients. In order to formulate recommendations that contribute to the optimization of the use of ionizing radiation in dentistry, the SEDENTEXCT project team compiled and analyzed relevant publications in the literature, guidelines that have demonstrated their efficiency in the past, thus helping to see with different perspectives the dose received by patients, and with this, it is recommended taking into account this document so as to prescribe more adequately the complementary examinations that we use on a daily basis.
... Estas condiciones pueden ir asociadas a anomalías en el conducto auditivo externo y en el oído medio. Aquí se recomienda un estudio imagenológico de los tejidos duros mediante TC o con varias proyecciones radiográficas (2,13,35) . ...
... Sus causas pueden ser infección, trauma o como secuela quirúrgica. La TC es el examen apropiado para evaluar la extensión y naturaleza de la anquilosis (2,12,35) . ...
... El trauma agudo de la ATM puede ser evaluado mediante TC, o bien con radiografías (radiografía panorámica y Rx posteroanterior a boca abierta) (2) . En ocasiones la RM puede mostrar un rasgo de fractura sin desplazamiento, condición de la cápsula articular, presencia de edema y lesiones en tejidos blandos (1,35) . ...
Evaluación de los desórdenes internos de la articulación tempromandibular por medio de imágenes de resonancia magnética,
... Despite the invention of digital intraoral radiography by Frances Mouyens 1984, film-based radiographs are still more common and valuable diagnostic tools (1,2) However, it requires the use of careful technique and precautions to maximize the diagnostic and interpretative value of the radiograph while at the same time minimizing patient exposure to radiation, (3,4) present-day improvement in radiology is directed at improving the quality of the image and reducing the radiation dose received by the patient. (5) Many factors control the image quality in dental radiography, such as film type, technique and film processing, the correct processing of the radiographic film is critical to ensure the lowest radiation exposure and good quality radiographic (6) , Among other factors, accurate processing of radiograph plays a critical role in obtaining an acceptable diagnostic image with the lowest radiation exposure, Following image processing instructions issued by the manufacturer supposed to serve these two purposes (7,8) . Self--55 ) 9 201 ) ( 2 ( 7 …. ...
Poor image quality in self processed films is not an uncommon problem despite following the manufacturer's instructions, this matter has its influence on the ultimate diagnosis when the radiographic examination is the backbone in this diagnosis. The present study was carried out to investigate this problem and to provide a guideline measure to overcome it. One hundred fifty films were processed using three different manipulations: message, shaking and a combination of both, the resultant film quality was measured and comparison was made the results showed that combination of message and shaking procedure yield significantly better results regarding image quality in comparison to the other two procedures.
... Computed tomography (CT) has been utilized as a trustworthy method for evaluating bone amount and quality. 43 During a CT scan for maxilla and mandible, the radiation dose absorbed by the patient is 2000 while cone beam CT for dento-alveolar focus field of view is 5 to 38.3. 44,45 This restricts its use for regular diagnostic procedures or periodic examinations. ...
The aim of this study is testing the hypothesis that short implants might satisfy the desired outcomes of a successful implant therapy as longer implants in atrophied jaws. This present study was conducted on 21 patients with limited bone height below the floor of the maxillary sinus. Group I, 7 patients received short implants. Group II, 7 patients received long implants in combination with crestal sinus approach technique without the use of augmentation material. Group III, 7 patients received long implants in combination with crestal sinus approach technique with the use of augmentation material. The patients were evaluated for implant stability, pocket depth and keratinized mucosa marginal bone loss (MBL), endo sinus bone gain and bone density (BD). Regarding pocket depth, keratinized mucosa width and implant stability at 7 months result showed no reliable difference between all groups. Radiographically by CBCT, no significant difference in MBL and bone density between all groups immediately after surgery and at 12 months post operatively. However significant difference in endo sinus bone gain was found between group II and III. Short implant placement is an effective alternative option to long implant placement with maxillary sinus augmentation. Clinical article (J Int Dent Med Res 2023; 16(1):253-262)
... Multislice computed tomography (CT) has been used as a reliable tool to assess bone quantity and quality. However, the cost and the radiation dose absorbed by the patient during a CT scan are higher than that in other imaging modalities 19 . This limits its application for routine diagnostic workup or periodic examinations 20 Cone beam CT (CBCT) has been used as a specific tool for head and neck imaging. ...
Background: Primary stability is one of the fundamental criteria for obtaining osseointegration. It depends on different factors, the implant design, surgical technique, bone density, and on the microscopic and macroscopic morphology of the implant used3. High primary stability is easily obtained in dense bone, thus providing contact osteogenesis. Osseodensification technique is an innovative technique to increase the bone density during the drilling process in which the drill designing allows the creation of an environment that increases the initial primary stability through densification of the osteotomy site walls by means of non-subtractive drilling. This study was directed to Investigate the efficacy of osseodensification as a new bone drilling concept in low density bone and to compare the effect of osseodensification versus conventional drilling on the primary stability and osseointegration of implant. Materials and Methods: seven female subjects aged from 40 to 59 years who fulfilled the inclusion criteria were selected. 14 implants placed in a split mouth design as follow Osseodensification group:7 implants were placed using Densah bur kit in one side. Conventional group: 7implants were placed using conventional bur kit in the other side. Patients were followed up clinically and radiographically by CBCT for 12 months Results: No valuable difference existed between the two groups regarding the primary and secondary stability, plaque index, bleeding on probing, pocket depth and marginal bone loss except bone density, statistically significant difference in bone density in favor of osseodensification group immediately after surgery. Conclusion: Osseodensification showed enhancement of bone density by the novel Densah bur that work safely in low density bone and decrease the possibility of creating bone dehiscence. CBCT advantageous preoperatively for determining the bone density also postoperatively can adequately measure the bone architecture and density around implants. Based on advantageous present study results, osseodensification technique is reliable method to enhance the rapid healing and maintain the marginal bone integrity after load.
... Because of the different techniques and visualization software of the 2D and the 3D imaging. [13] ...
... The computer-assisted decisions are essential in dental practice to help dentists diagnose and plan for treatments. Dental imaging is a valuable tool that facilitates diagnosis and treatment plans, which is impossible through clinical examination and patient history only [1]. A Dental X-ray is a two-dimensional radiograph that captures the patient's entire mouth from ear to ear in a single image, including the upper and lower jaws and surrounding alveolar bone [2]. ...
The computer-assisted radiologic informative report has received increasing research attention to facilitate diagnosis and treatment planning for dental care providers. However, manual interpretation of dental images is limited, expensive, and time-consuming. Another barrier in dental imaging is the limited number of available images for training, which is a challenge in the era of deep learning. This study proposes a novel self-distillation (SD) enhanced self-supervised learning on top of the masked image modeling (SimMIM) Transformer, called SD-SimMIM, to improve the outcome with a limited number of dental radiographs. In addition to the prediction loss on masked patches, SD-SimMIM computes the self-distillation loss on the visible patches. We apply SD-SimMIM on dental panoramic X-rays for teeth numbering, detection of dental restorations and orthodontic appliances, and instance segmentation tasks. Our results show that SD-SimMIM outperforms other self-supervised learning methods. Furthermore, we augment and improve the annotation of an existing dataset of panoramic X-rays.
... is unknown to the dentist, it can be resolved by using the appropriate referral guidelines. For over 20 years, referral guidelines have existed and have been published in several regions and countries (1,(11)(12)(13)(14)(15) . These guidelines provide guidance for dentists and other medical practitioners on the correct choice of radiological examination for an individual patient instead of being prescriptive. ...
The study aims to investigate dentists' knowledge and consideration of radiation in relation to their referral practices and use of referral guidelines for imaging in Saudi Arabia. A cross-sectional study was conducted among dentists in different occupational positions in Saudi Arabia. The analysis showed that 68% of the dentists knew of imaging referral guidelines to consult before ordering an imaging exam. However, more than a quarter of the sample did not use them. More than half of responders estimated the average effective dose correctly for intraoral radiography, 44.8% for panoramic radiography, 53.4% for cone beam dental computed tomography (CT) and 47.8% for a study of dental implants/jaws using CT. Limited radiation knowledge and lack of use of proper referral guidelines among dentists indicate that the imaging referral justification process must be improved. The study concluded that radiation knowledge plays a critical role regarding image justification in dental clinics.
... Dental practitioners widely use crown and bridge restorations after operative and endodontic treatments. 1 In order to diagnose previously applied restorations, radiographs are commonly used since many diseases or conditions may not be detected during a clinical examination alone. 2,3 Based on this, detection of restorations from a radiograph is important in order to avoid secondary caries, crestal bone loss, or periapical lesions, and many more diseases. [4][5][6] Panoramic X-ray radiographs allow the detection of jaw and teeth disorders with a single film and are also a valuable diagnostic tool in the dentist's armamentarium. ...
Aim: Although many studies in various fields employ deep learning models, only few such studies exist in dental imaging. This paper aims to evaluate the effectiveness of Convolutional Neural Network (CNN) algorithms for the detection and diagnosis of the quantitative level of dental restorations using panoramic radiographs by preparing a novel dataset.
Materials and methods: 20,973 panoramic X-ray radiographs, all labeled into five distinct categories by three dental experts, were used. AlexNet, VGG-16 and variants of ResNet models were trained with the dataset and evaluated for the classification task. Additionally, 10-fold cross-validation (i.e. nine-folds were separated for training and one-fold for validation) and data augmentation were carried out for all experiments.
Result: The most successful result came from ResNet-101 with 92.7% accuracy. Its macro-average AUC was also the highest with 0.989. Other accuracy results obtained for the dataset were 75.5% for AlexNet, 85.0% for VGG-16, 92.1% for ResNet-18, 91.7% for ResNet-50 and 92.1% for Inception ResNet V2.
Conclusion: Accuracy of 92.7% is a very promising result for a computer-aided diagnosis system. This result proved that the system could assist dentists in providing supportive preliminary information the moment they first take a panoramic X-ray radiograph of a patient. Furthermore, as the introduced dataset is powerful enough, it can be re-labeled for different problems and used in different studies.
Keywords: artificial intelligence, computer aided diagnosis, convolutional neural networks, deep learning, dental restoration, panoramic radiographs
... In general, it has to be emphasized that there is no general justification to do a radiographic examination for the assessment of dental restorations without any clinical indication [111][112][113][114]. This approach is strictly in line with basic principles of radiation protection [115][116][117]. Nevertheless, the assessment of direct and indirection restorations is required on justified images. ...
Objectives
The FDI criteria for the evaluation of direct and indirect dental restorations were first published in 2007 and updated in 2010. Meanwhile, their scientific use increased steadily, but several questions from users justified some clarification and improvement of the living document.
Materials and methods
An expert panel (N = 10) initiated the revision and consensus process that included a kick-off workshop and multiple online meetings by using the Delphi method. During and after each round of discussion, all opinions were collected, and the aggregated summary was presented to the experts aiming to adjust the wording of the criteria as precisely as possible. Finally, the expert panel agreed on the revision.
Results
Some categories were redefined, ambiguities were cleared, and the descriptions of all scores were harmonized to cross-link different clinical situations with possible management strategies: reviewing/monitoring (score 1–4), refurbishment/reseal (score 3), repair (score 4), and replacement (score 5). Functional properties (domain F: fracture of material and retention, marginal adaptation, proximal contact, form and contour, occlusion and wear) were now placed at the beginning followed by biological (domain B: caries at restoration margin, hard tissue defects, postoperative hypersensitivity) and aesthetic characteristics (domain A: surface luster and texture, marginal staining, color match).
Conclusion
The most frequently used eleven categories of the FDI criteria set were revised for better understanding and handling.
Clinical relevance
The improved description and structuring of the criteria may help to standardize the evaluation of direct and indirect restorations and may enhance their acceptance by researchers, teachers, and dental practitioners.
... The need for computer-assisted decisions is rising to facilitate diagnosis and treatment planning for dental care providers. Dental imaging is a valuable diagnostic tool for diagnosis and treatment plans, which is not possible solely through clinical exams and patient history [33]. A dental panoramic X-ray is a comprehensive tool that screens the teeth, surrounding alveolar bone and upper and lower jaws [28]. ...
The computer-assisted radiologic informative report is currently emerging in dental practice to facilitate dental care and reduce time consumption in manual panoramic radiographic interpretation. However, the amount of dental radiographs for training is very limited, particularly from the point of view of deep learning. This study aims to utilize recent self-supervised learning methods like SimMIM and UM-MAE to increase the model efficiency and understanding of the limited number of dental radiographs. We use the Swin Transformer for teeth numbering, detection of dental restorations, and instance segmentation tasks. To the best of our knowledge, this is the first study that applied self-supervised learning methods to Swin Transformer on dental panoramic radiographs. Our results show that the SimMIM method obtained the highest performance of 90.4% and 88.9% on detecting teeth and dental restorations and instance segmentation, respectively, increasing the average precision by 13.4 and 12.8 over the random initialization baseline. Moreover, we augment and correct the existing dataset of panoramic radiographs. The code and the dataset are available at https://github.com/AmaniHAlmalki/DentalMIM.
... 32 Tiroit koruyucuların aksine, kurşun önlüklerin radyasyondan koruma üzerine etkisinin önemsiz olduğu E hızında filmlerin ve dikdörtgen kolimatörlerin rutin kullanımında kurşun önlük giyilmesinin ihmal edilebileceği ifade edilmiştir. 33 Kolimatörler, X-ışını demetinin boyutlarını sınırlandırarak hem hasta dozunun azaltılmasını hem de saçılma radyasyonun azaltılmasıyla görüntü kalitesinin artmasını sağlamaktadır. 16,34 İntraoral görüntüleme tekniklerinde, geleneksel olarak dairesel kolimatörler kullanılmaktadır. ...
Z Çocuk diş hekimliğinde teşhis, tedavi ve takip amacıyla radyografik görüntüleme yöntemlerine başvurulmak-tadır. Radyografik yöntemlerin çalışma prensibi iyonize edici radyasyona dayanmaktadır. Kullanılan radyografik yöntemlerin ihmal edilebilir düzeyde hasta dozu oluşturduğu kabul edilse de günümüzde iyonize radyasyon maruziyetinin herhangi bir eşik doz olmaksızın kanser gelişim riskine neden olabileceği bilinmektedir. Çocuk hastalarda erişkinlere kıyasla daha yüksek mitotik aktivite gösteren, daha az gelişmiş ve daha az farklılaşmış hücrelerin varlığı bunun yanı sıra çocukların fiziksel olarak küçük olmaları sebebiyle direk veya saçılmış radyas-yona daha çok organ ve dokunun maruz kalması kanser gelişme riskini arttırmaktadır. Çocuklarda radyasyona en duyarlı olan doku ve organlar tiroid, meme, kemik iliği, beyin ve cilt olarak gösterilmiş olup, dental rad-yografik muayene sırasında birincil veya saçılan X ışınlarından en çok etkilenen alanlardır. Bu nedenle, gerekli olduğu durumlarda radyografik muayeneye başvurulmalı ve radyasyon dozunu azaltan önlemler alınmalıdır. Bu derlemedeki amacımız; radyasyona daha duyarlı olan çocuk hastalarda, hangi durumlarda radyografik yöntem-lerin kullanılması gerektiğini, X ışını cihazlarındaki bazı modifikasyonlar ile çocuk hastalarda radyasyon dozunu azaltabilecek uygulamaları ve kullanılabilecek koruyucu ekipmanları yapılan pek çok çalışma yardımıyla ortaya koymaktır. Anahtar kelimeler: Deterministik etki, efektif doz, eşdeğer doz, ekstraoral radyografi, intraoral radyografi, iyo-nize radyasyon, sitokastik etki ABSTRACT Radiographic imaging methods are used in pediatric dentistry for diagnosis, treatment, and follow-up. The operation principle of radiographic methods is based on ionizing radiation. Even though the patient dose of the radiographic methods used is accepted to be at a negligible level, it is now known that ionizing radiation exposure can cause cancer without a threshold dose. The presence of less developed and less differentiated cells showing higher mitotic activity in pediatric patients compared to adults, as well as the exposure of more organs and tissues to direct or scatter radiation because children are physically small increases the risk of cancer development. It has been shown that the thyroid, breast, bone marrow, brain, and skin are the tissues and organs most sensitive to radiation in children, and they are the areas most affected by primary or scattered X-rays during dental radiographic examination. Therefore, radiographic examinations should be performed only when necessary, and steps should be taken to reduce radiation exposure. With the help of numerous studies, our aim in this study is to present in which situation the radiographic methods should be used in pediatric patients who are more sensitive to radiation, some modifications in X-ray devices, applications that can reduce the radiation dose in pediatric patients, and protective equipment that can be used on pediatric patients.
... Here, 70% of the surveyed videos showed a patient wearing a lead apron during panoramic radiography. In fact, the International Atomic Energy Agency (IAEA), European Commission, the Faculty of General Dental Practice of the United Kingdom (FGDP), the American Academy of Oral and Maxillofacial Radiology (AAOMR), and the Japanese Society of Oral and Maxillofacial Radiology (JSOMFR) all agreed that the routine use of lead aprons for dental radiography and even cone-beam computed tomography is unnecessary, as it provides minimal additional benefit to the patient and might interfere with proper exposure if improperly designed or worn [22][23][24][25][26]. ...
In this digital era, dental students often search for online resources for self-directed learning. YouTube is one of the most commonly sought online platforms for educational or instructional videos. No prior study has examined the validity of panoramic radiography videos available on YouTube. This study provides a content analysis of these YouTube videos. A search for relevant YouTube videos was conducted in April 2022. The search string was: (panoramic OR pan OR OPG) AND (dental OR dentistry OR X-ray). The first 100 videos that resulted from the search and their related videos were screened. Exclusion criteria included irrelevance (e.g., no demonstration of panoramic radiography procedures) and non-English videos. For each included video, the following parameters were recorded: image receptor type, patient age, patient type (real patient, animation, or phantom head), patient preparation procedures, machine preparation, patient positioning, and operator safety. The number of views, comments, likes, and channel subscribers were recorded, as well as the video duration and the age of the video. Forty videos were included and analyzed. Most of the videos demonstrated digital panoramic radiography with an adult patient. Procedures on the patient and machine preparations as well as patient positioning were generally explained well. However, most videos did not well-demonstrate operator safety details concerning the use of adequate personal protective equipment. View count, comment count, and channel subscriber count positively correlated with the like count. Clinicians and students should carefully critique the content of such instructional videos and refer to the contents from other sources such as user manuals and latest recommendations from local authorities.
... TahaEmreKose et al. [8] has done study in 743 edentulous asymptomatic patients requiring removable or implant prosthesis to rule out impacted teeth, retained root fragments, foreign bodies, and severe atrophy of the posterior maxillary alveolar bone, mucous retention cysts, and soft tissue calcifications. However, drawbacks are lower image resolution, high distortion and presence of phantom images [9]. ...
Aim: To evaluate various dental radiographic examination techniques carried out among insured population. Material and method: This was a retrospective study performed among patients reported to Department of Dentistry, ESIC Medical College, Hyderabad during a two year period from January 2017 to December 2018. Records of 11,535 patients who required radiographic investigations like intraoral periapical radiograph (IOPAR), Orthopantamogram (OPG), Computerized Tomogram (CT) and Cone beam computerized tomogram (CBCT) for diagnosis and treatment planning were analyzed. Results: Among the 11,535 patients, a total of 9,193 IOPAR, 1936 OPG, 348 CT, and 58 CBCT were taken. Among IOPAR, 6164 (67.05%) were advised to diagnose dental caries, 1514 (16.47%) for periodontal disease, and 636 (6.92%) for dental trauma. Regarding OPG, 485(25.05%) were advised to diagnose maxillofacial trauma, 338(17.46%) for periodontal disease, and 224 (11.57%).With regards to CT, 308(88.51%) were advised to diagnose maxillofacial trauma and 40(11.5%) were advised for Cysts and Tumours. In 58 instances where CBCT was advised 47(81.04%) were advised to diagnose Cysts and Tumours and 11(18.96%) were advised for maxillofacial trauma. Conclusion: About 17.07% (11,535 out of 67,551) of the Out-patients required radiological investigations. Among them IOPAR was most commonly advised while the least was CBCT. IOPAR was gold standard for Dental caries and its sequel, and for periodontitis. OPG was ideal for multiple teeth lesions; however had the drawback of ghost images. CT gives a good 3D view but has high radiation exposure and is expensive. CBCT is advanced and gave realistic anatomical picture with comparatively less radiation. However, its availability and standing posture are the drawbacks.
... Yet, placement of oral implants in the mandible is associated with numerous complications, including hemorrhage and neurosensory disturbances. [1][2][3] Enumerating precise information concerning the vital structures of the mandible, thus, becomes all the more important before the placement of implants. [4] A precise knowledge of the anatomy and their disparities is important to execute suitable surgical procedures and to secure the vital structures of the patient. ...
Context and Aim: Dental implants are widely used for the rehabilitation of edentulous arches. Yet, placement of oral implants in the mandible is associated with numerous complications, including hemorrhage and neurosensory disturbances. Enumerating precise information concerning the vital structures of the mandible, thus, becomes all the more important before the placement of implants. The aim of the present study was to determine the efficiency and accuracy of digital orthopantomography (OPG) and cone-beam computed tomography (CBCT) in determining the location of mandibular canal in preoperative assessment of the mandibles for implant placement. Materials and Methods: Ten dry edentulous mandibles of adult humans were selected for this study which comprised two phases, namely a radiographic phase and an in vitro phase. The radiographic phase was based on the obtaining digital orthopantomographs and cone-beam computed tomograms. During the in vitro phase, all the mandibles were sectioned at an angle of 90° to the inferior border of the mandible, and in vitro measurements were obtained. Statistical Analysis Used: Statistical analysis was done using IBM SPSS statistics 20 (Chicago, IL, USA). Paired and unpaired t-tests were used to do a comparative analysis of the two modalities used. P < 0.05 was considered to be statistically significant. Results: The results of the present study revealed that the measurements of both the vertical (D1 and D2) and the buccolingual distances of the mandible (D3 and D4) obtained by CBCT were in accordance with the ones obtained with the help of in vitro measurements, and there was no statistically significant difference in the studied variables (D1, D2, D3, and D4) between the two measurements. On the contrary, there was a significant statistical difference between the values obtained from digital OPG (D1 and D2) when compared to the values obtained by in vitro measurements. Conclusion: The findings of the present study implied that CBCT is the most efficient and accurate diagnostic tool available to locate the course of mandibular canal in the selection of potential
... With respect to the low mean effective doses of these procedures their contribution to the collective effective dose is, however, estimated to be 2-4% of the total collective effective dose for plain radiography (European Commission 2015). Even so, efforts should be undertaken to minimize the amount of dental radiographs and to keep exposure as low as diagnostically achievable (Le Heron 1999; Minister of Public Works and Government Services 1999; White et al. 2001;EC 2004;NRPB 2001;Valentin 2007;EC 2015) especially in children and adolescents. Modern X-ray-free imaging techniques which may replace radiography should be used whenever possible. ...
... Radiographic examination is an important part of dental practice as it serves as a prime source of investigation and helps us to arrive at a proper diagnosis [1]. ...
... This situation is not observed in some other countries considered as developed. 9,25 One of the most notable aspects of our study is the absence of rectangular collimator. In other countries such as Canada, 8% of dental practitioners 23 have been reported as using such a device, while in the United States this percentage is 5% to 47% 9,26 and in Sweden 29% to 36%. ...
Objectives. To assess the influence of new European Union (EU) legislation on dental radiology practices and the reduction in patient radiation exposure. Study design. A total of 7176 official reports from Spanish dental offices or clinics covering the period 1996 to 2001 were analyzed. Results. Of the dental radiological installations inspected in 2001, 72.79% used the kilovoltage recommended by the EU (70 kVp) and 98.85% used at least 1.5 mm Al filtration. At least 90.11% of the installations had a focal film distance of 20 cm although there were no cases with a rectangular collimator as adapted to the size of film. Thirty percent of the installations showed a mechanical fault every year. In 17.62% of cases the radiological film was stored in the exposure room. Few clinics (10.24%) used high-speed films and only 11.95% of clinics employed digital systems. The mean dose received by patients fell during the 5 years studied by 18.75%. Radiological equipment fulfilling the EU specifications emitted significantly lower doses than other nonapproved equipment.
... PA : Le recours à l'imagerie (IRM, scanner de l'ATM) est limité. Selon White, et al. 169 AM : L'imagerie de l'articulation temporomandibulaire (ATM) a continuellement évolué en même temps que les technologies d'imagerie. L'utilisation de l'ima-gerie par résonance magnétique (IRM) a augmenté en raison de sa grande résolution de contraste, de sa capacité à mettre en évidence les structures des tissus mous et les signes d'inflammation, et de sa capacité à acquérir une imagerie dynamique pour observer le fonctionnement de l'articulation. ...
... PA : Le recours à l'imagerie (IRM, scanner de l'ATM) est limité. Selon White, et al. 169 AM : L'imagerie de l'articulation temporomandibulaire (ATM) a continuellement évolué en même temps que les technologies d'imagerie. L'utilisation de l'ima-gerie par résonance magnétique (IRM) a augmenté en raison de sa grande résolution de contraste, de sa capacité à mettre en évidence les structures des tissus mous et les signes d'inflammation, et de sa capacité à acquérir une imagerie dynamique pour observer le fonctionnement de l'articulation. ...
... It is of fundamental importance that, even knowing that health workers are not at risk during the radiographic examination, as this is considered a non-invasive procedure, this should not be a reason for neglect regarding the protection rules for infection control and protection of the environment, since it is possible to infect patients by infections transmitted directly or indirectly and the materials and substances used during radiographic processing if disposed of inappropriately (White 2012) One item that should be observed in clinics is the need for patient protection, and having knowledge about the calibration of the device, milliamperage, filtration and the use of open cylinders in order to improve the functioning of the x-ray equipment is part of this protection ( Praveem 2013). The use of lead coat for thyroid and other sensitive organs, the use of quick films that where the image can be visualized with a lower dose of radiation and having an office properly prepared to have x-ray equipment is also essential for patient safety (Hart 2013;Singh et al. 2018) The potential that ionizing radiation has to cause somatic and / or genetic changes to humans has led to the appearance of essential preventive means to prevent professionals, patients and staff from being at risk (White 2001, Roman torres 2017). It is emphasized that many laws and Ordinances were created, in order to minimize the doses resulting from exposures in diagnostic radiology (Rout 2012). ...
Concern about the risks of radiation and the quality of the
radiographic image has led many researchers and public agencies to carry
out studies on the subject, which have found the existence of a series of
problems in the practice of dental radiology. Based on the above, the
objective of this study was to evaluate the knowledge and attitudes of
dental surgeons regarding biosafety and the use of devices and materials
used throughout the radiographic process in dental offices. 200 Dentists
were interviewed with offices in some cities in the Baixada Santista region
in the State of São Paulo, Brazil, variables such as age, gender, time since
graduation, professional specialty, were only identified at the time of the
interview. During the visit, the researcher assessed, by means of a
questionnaire, components related to the radiological practice in the
offices and about the attitudes during the radiological practice and,
consequently, about the radiological protection rules adopted, either for
the patients or professionals involved. When the questionnaire was
applied, a statistically significant difference was observed in relation to the
concept of biosafety 98% of the interviewees answered yes, that they know
what biosafety is. If there are notices in the office warning about the x-ray
equipment, 89% responded that they do not. The viewing of radiographs
taken previously by the patients was indicated by 97.5% of the interviewed
dentists, and 95% use breast and thyroid protection with a lead apron.
More than half of the dentists, 52%, discard the substances used in the
revelation process in the office sink. The results observed in our study are
not encouraging, either due to the ignorance of the current legislation, the
use of the devices inappropriately and the processing carried out with real
chances of contamination of the environment, we believe that an increase
in teaching and control of biosafety in dental radiology is necessary
... 8 They also found that experienced dental radiologists diagnose these findings, especially the nondental findings, more often compared with general dentists. Although international guidelines suggest that findings on panoramic radiographs should be entered into the patient's clinical record, 9 there is currently no universal practice of generating a specific radiographic report. AI technology may facilitate the production of such a report, further improving patient management and communication. ...
Objectives
This study aimed to develop a computer vision algorithm based on artificial intelligence, designed to automatically detect and classify various dental restorations in panoramic radiographs.
Methods
A total of 738 dental restorations in 83 anonymized panoramic images were analyzed. Images were automatically cropped to obtain the region of interest containing maxillary and mandibular alveolar ridges. Subsequently, restorations were segmented using a local adaptive threshold. The segmented restorations were classified into 11 categories, and the algorithm was trained to classify them. Numerical features based on the shape and distribution of gray level values extracted by the algorithm were used for classifying the restorations into different categories. Finally, a Cubic Support Vector Machine (SVM) algorithm with Error-Correcting Output Code (ECOC) was used with a cross-validation approach for the multi-class classification of the restorations according to these features.
Results
The algorithm detected 94.6% of the restorations. Classification eliminated all false marks and ultimately 90.5% of the restorations were marked on the image. The overall accuracy of the classification stage in discriminating between the true restoration categories was 93.6%.
Conclusions
This machine-learning algorithm demonstrated excellent performance in detecting and classifying dental restorations in panoramic images.
... With respect to the low mean effective doses of these procedures their contribution to the collective effective dose is, however, estimated to be 2-4% of the total collective effective dose for plain radiography (European Commission 2015). Even so, efforts should be undertaken to minimize the amount of dental radiographs and to keep exposure as low as diagnostically achievable (Le Heron 1999;Minister of Public Works and Government Services 1999;White et al. 2001;EC 2004;NRPB 2001;Valentin 2007;EC 2015) especially in children and adolescents. Modern X-ray-free imaging techniques which may replace radiography should be used whenever possible. ...
Background
The European Academy of Paediatric Dentistry (EAPD) proposes this best clinical practice guidance to help practitioners decide when and how to prescribe dental radiographs in children and adolescents.
Methods
Four expert working groups conducted each a systematic review of the literature. The main subjects were radiation protection, intraoral dental radiography (bitewing and periapical radiographs), panoramic radiography (PR) and cone-beam computed tomography (CBCT). In addition, three workshops were held during the corresponding EAPD Interim Seminar in Chania (Crete, Greece) in 2019. On the basis of the identified evidence, all invited experts presented their findings and during the workshops aspects of clinical relevance were discussed.
Results
Several clinical-based recommendations and statements were agreed upon.
Conclusion
There is no or low-grade evidence about the efficacy of dental radiographic examinations in young populations. The given recommendations and rationales should be understood as best clinical practice guidance. It is essential to respect the radiological principles of an individualized and patient-specific justification. When a dental radiograph is required, its application needs to be optimized, aiming at limiting the patient’s exposure to ionising radiation according to the ALADAIP principle (As Low As Diagnostically Achievable being Indication-oriented and Patient-specific).
... The limited benefit of using CBCT to detect implant width and the high levels of correct prediction at both initial 64.7% and final planning 100% stages must be viewed with some latitude, especially because cases with poor bone dimensions in which a CBCT exam would be essential were previously excluded from the study sample. In contrast, implant width was more frequently underestimated in final planning, compared to the actual width at implant placement (22). ...
... Por ser um exame radiográfico deve ser indicado somente após realizado o exame clínico do paciente, considerando os achados anamnésicos e a necessidade individual de cada paciente (WHITE et al., 2001). ...
Este estudo pretende realizar uma revisão de literatura a respeito da utilização da técnica radiográfica panorâmica em odontopediatria, abordando suas indicações, vantagens e limitações. Foi realizada uma revisão de literatura abordando a utilização da radiografia panorâmica dentro da clínica infantil. Por ser uma técnica extrabucal é melhor aceita pela criança e sua utilização deve estar associada à necessidade de se obter um número maior de informações da região maxilo-mandibular, para auxílio ao diagnóstico e avaliações do crescimento e do desenvolvimento dentário, falhas na erupção, condições patológicas extensas, dentre outras. Além de requerer um tempo mais curto para sua obtenção, é de baixo custo para o paciente e utiliza menor dose de radiação quando comparada ao levantamento radiográfico completo. Entretanto, deve ser complementada quando houver necessidade de maior detalhe e nitidez.
... Many patients are apprehensive about dental treatments: their confidence in the dentist's diagnosis is low, and as a result they avoid preventive treatment in the early stage of the dental disease when damage is still minimal (Vassend, 1993). Dental imaging provides valuable information for diagnosis and treatment planning, which is not available through clinical examination or patient history (White et al., 2001). Information that can be extracted immediately by computer processing of the panoramic images and then conveyed directly to the patient would increase the patient's confidence in the doctor's diagnosis. ...
Background: A panoramic radiograph is an external dental radiograph of the oro-maxillofacial region, obtained with minimal discomfort and significantly lower radiation dose compared to full mouth intra-oral radiographs or cone-beam computed tomography (CBCT) imaging. Currently, however, a radiologic informative report is not regularly designed for a panoramic radiograph, and the referring doctor needs to interpret the panoramic radiograph manually, according to his own judgment.
Methodology: An algorithm, based on techniques of computer vision and machine learning, was developed to automatically detect and classify dental restorations in a panoramic radiograph, such as fillings, crowns, root canal treatments and implants. An experienced dentist evaluated 63 panoramic anonymized images and marked on them, manually, 316 various restorations. The images were automatically cropped to obtain a region of interest (ROI) containing only the upper and lower alveolar ridges. The algorithm automatically segmented the restorations using a local adaptive threshold. In order to improve detection of the dental restorations, morphological operations such as opening, closing and hole-filling were employed. Since each restoration is characterized by a unique shape and unique gray level distribution, 20 numerical features describing the contour and the texture were extracted in order to classify the restorations. Twenty-two different machine learning models were evaluated, using a cross-validation approach, to automatically classify the dental restorations into 9 categories.
Contribution: The computer tool will provide automatic detection and classification of dental restorations, as an initial step toward automatic detection of oral pathologies in a panoramic radiograph. The use of this algorithm will aid in generating a radiologic report which includes all the information required to improve patient management and treatment outcome.
Findings: The automatic cropping of the ROI in the panoramic radiographs, in order to include only the alveolar ridges, was successful in 97% of the cases. The developed algorithm for detection and classification of the dental restorations correctly detected 95% of the restorations. ‘Weighted k-NN’ was the machine-learning model that yielded the best classification rate of the dental restorations - 92%.
Impact on Society: Information that will be extracted automatically from the panoramic image will provide a reliable, reproducible radiographic report, currently unavailable, which will assist the clinician as well as improve patients’ reliance on the diagnosis.
Future Research: The algorithm for automatic detection and classification of dental restorations in panoramic imaging must be trained on a larger dataset to improve the results. This algorithm will then be used as a preliminary stage for automatically detecting incidental oral pathologies exhibited in the panoramic images.
... 8,9 The most accurate radiographic projection of the alveolar bone level is achieved when the film is placed parallel to tooth and the X-ray central beam impinges at a right angle to tooth and film. 10 The interproximal technique is the one that best fulfills these requirements. 11 When used properly, the positioners assist the acquisition of images that enable the detection of reduced bone loss, less than 1 mm. ...
دراسة سريرية وشعاعية حول استخدام المكثفات العظمية الآلية في رفع قاع الجيب الفكي بالمدخل السنخي
Purpose: The aim of this study is to evaluate the knowledge levels and attitudes of pediatric dentists regarding the use of dental radiography through an online survey. Materials and Methods: A data collection form consisting of a total of 17 questions and 2 basic parts, which was prepared in accordance with the current guidelines of the European Academy of Pediatric Dentistry regarding the use of radiography in 2020, was used. The first part of the form was prepared to evaluate the sociodemographic characteristics of the participants and the second part of the form was for the evaluation of the participants' level of knowledge about the use of radiography in pediatric dentistry. In the analysis of the data, descriptive statistics, mean values, frequencies and proportions were calculated. The chi-square test was used to determine the association between categorical variables. Results: 131 pediatric dentists participated in the study. In accordance with the Guideline recommendation, 40.5% of dentists stated that they preferred bite-wing radiographs as the first choice for the detection and diagnosis of dental caries and 77% stated that they preferred periapical radiographs as the first choice for dental trauma. Conclusion: Even though pediatric dentists in Turkey usually choose the most appropriate radiographic technique for most clinical situations; knowledge levels need to be increased for more precise diagnosis and treatment planning and radiation protection.
Objectives
: This study compared the clinical usefulness of structured reports (SRs) and free-text reports (FTRs) of lesions depicted on cone beam computed tomography (CBCT) images from the perspectives of report providers and receivers.
Study Design
: In total, 36 CBCT images of jaw lesions obtained between February 2020 and August 2020 were evaluated. A working group of 3 oral and maxillofacial radiologists (OMRs) established a reporting system and prepared reports. Evaluation group I (2 OMRs) wrote SRs and FTRs for each case and assessed the reporting process for the criteria of convenience and organization. Evaluation group II (3 general practitioners [GPs] and 3 oral and maxillofacial surgeons [OMSs]) assessed the reports for the criteria of productivity, consistency, and organization. A five-point Likert scale was used to assess the usefulness of each report. Scores were statistically compared according to report type with the paired Wilcoxon signed-rank test.
Results
: SRs scored significantly higher for all criteria as assessed by Evaluation group I and the GPs of group II (P<.001). FTRs scored significantly higher for productivity and organization as assessed by the OMSs of group II (P=.005).
Conclusions
: The clinical usefulness of reports may differ according to roles of the report recipients in diagnosis and treatment.
Background:
The success of dental implants depend on implant design, surgical technique, bone density, implant morphology and postoperative care. Initial stability is utmost importance and is of concern in low density bone. The osseo-densification strategy enhance primary stability by raising density of the osteotomy site walls by non-subtractive drilling, unlike conventional technique.
Objective:
The aim of this in vivo study was to assess and compare the osseo-densification implant drilling technique with conventional implant drilling in terms of primary implant stability along with other factors, plaque index, bleeding on probe, pocket depth and radiographic assessment of bone density, marginal bone loss using CBCT.
Method:
A total of 20 patients aged between 40 and 59 years were included in this research. A split-mouth configuration of 40 implants was used. In the osseo-densification group, specialized (Densah) bur kit was used to insert 20 implants on one side. In the conventional group, standard bur kit was used to insert 20 implants on the opposite side of the jaw. For each patient, clinical and radiographic assessment was performed at regular intervals at the beginning (immediately after surgery), seven months, and a year following surgery.
Results:
With the exception of bone density, which was statistically significant in favour of the osseo-densification group immediately after surgery, primary and secondary stability, plaque index, bleeding on probe, pocket depth and even marginal bone loss were not significantly different between the two groups in this investigation.
Conclusion:
Osseo-densification technique provided a better primary stability in the low density bone cases thus, can be consider as a trustworthy treatment for speeding up the healing process while also maintaining marginal bone integrity following loading. Use of specialized bur while drilling procedure improves the density around the implants.
The frequency and structure of purulent-inflammatory diseases of maxillofacial region are analyzed. Medical documentation of patients with purulent-inflammatory diseases of maxillofacial region was studied. According to the Department of Oral and Maxillofacial Surgery, multidisciplinary clinic of Tashkent medical academy (TMA) from period 2017–2018yy. specialized medical care for purulent-inflammatory diseases was provided to 593 patients. Some causes of the development of purulent-inflammatory diseases are determined taking into account the spectrum of identified microorganisms. Factors affecting of timing and quality of treatment of purulent inflammatory diseases have been established.
This study was aimed at the estimation of the effective doses and radiation risks from dental X-ray examinations based on the data collection in St. Petersburg and the Leningrad Region. The range of mean values of effective doses for intraoral examinations on the X-ray units with film detectors was from 3.5 to 8.2 μSv and for the units with digital detectors—from 1.2 to 2.5 μSv. The mean effective doses for panoramic examinations were 22.9 μSv and for cone-beam computed tomography (CBCT)—530.6 μSv, respectively. The highest detriment-adjusted lifetime risk values were estimated for the 20–24-year-old age group: 40.8 × 10−6 in females and 32.7 × 10−6 in males for CBCT. Effective doses in St. Petersburg and Leningrad region were comparable or higher compared with the published data.
Surgical guides are aides that help improve clinical outcomes in implant dentistry. Whereas standard 2D radiographs (Panoramic radiographs and peri-apical radiographs) only allow view of the bone in two dimensions, Cone Beam Computed Tomography (CBCT) allows the clinician to see the complete bony architecture in all three dimensions. Modern surgical planning software merges the CBCT three-dimensional (3D) radiograph with a stone cast or intraoral scan of the teeth and soft tissue, enabling a precise restorative-driven implant plan. Thereafter, a surgical guide can be printed to guide the osteotomy.
Guided implant surgery promotes faster and more accurate surgery, reduces post-operative swelling and safer surgery by avoiding all critical structures. It also provides for greater precision in implant planning and placement, more precise implant restoration with improved esthetics and less stress on the patient through the reduced surgical time, diminished pain and greater safety.
The doses of patients for the most common intraoral and panoramic radiographic dental studies were evaluated and compared with the published data. The range of median values of effective doses for intraoral examinations on the units with films detectors was from 3.5 to 8.2 µSv and for the units with digital detectors the corresponding range was from 1.2 to 2.5 µSv. For panoramic examinations median value of the effective dose was 22.9 µSv. The ranges without emissions for the examination of premolars of the upper jaw, molars of both jaws and occlusion have the substantial width. Results compared with published data indicated that the effective doses in St. Petersburg and the regional institutions are lower than the values obtained using standard round collimator and medium and high sensitivity films (class D and F, respectively), as well as lower dose levels in the European Commission Guidelines. However, the effective doses in St. Petersburg and the Leningrad Region are higher than those obtained using a square collimator and high-sensitivity films. The present study suggests the possibility of further optimization. Obtained dose values can be used as reference for local regulations concerning patient dose in dental radiography and preliminary value prior to the establishment of national diagnostic reference level
Background/Aim. Radiology is a crucial part of dentists? everyday practice. It plays a vital role in diagnosis, treatment planning and the follow-up care of patients. The aim of this study was to evaluate the knowledge of dentists in Serbia concerning the use of radiology in pediatric dentistry. Methods. In total, 252 dentists from across Serbia participated in the study. A questionnaire was created in order to examine dentists? knowledge about the use of radiology in pediatric dentistry. The questionnaire consisted of 39 questions. All questions were analyzed in SPSS 24 statistical software. Results. According to the results, 42.1% of dentists worked in private practice, 17.8% at University clinics and 40.1% in National Health Services. Out of total 252 respondents, only 82 (32.5%) had an x-ray unit. A total of 199 (79%) dentists replied they would diagnose early caries lesions only by inspection, but 30 (11.9%) dentists said they would make a diagnosis by doing both the inspection and taking a radiograph. The results show that 187 (74.2%) respondents said that they did not make an OPG for every patient. When asked about the disposal of radiological waste, 84.3% of dentists did not answer the question. Conclusion. Attempts should be made in order to upgrade and update Serbian dentists overall knowledge about the use of radiology in pediatric dentistry.
The purpose of the study is to evaluate the effective doses of patients for the most common radiographic dental studies, comparing the obtained data with the literature and reference values given in the guidelines “Filling in the forms of the federal state statistical observation No. 3-DOZ” and are still often used for form filling instead of measured values. In the framework of this work in 2016-2018, 44 X-ray units were examined at 37 dental medical facilities in St. Petersburg and the Leningrad Region. Seven radiographic studies were included: radiographs of three groups of teeth (incisors, premolars, and molars) for the upper and lower jaw and bite radiography. Physical-technical and geometrical parameters were collected for selected types of the standard patient studies: X-ray tube voltages, total filtration, radiation output, combination of the time and the current of exposure or the exposure, area of the study, size of the irradiation field; the focal length. Further, the input (surface) dose was calculated from the radiation output of the device. Then, based on the initial information about the parameters of the procedures and the input dose, the absorbed doses and the effective dose were calculated using the PCXMC program. For most devices, the dose values are in the range of 0.5 to 10.7 µSv, which is significantly lower than the values used to fill in the 3-DOS form. The results of evaluating the effective dose for these devices are fairly homogeneous, but on one device, there were doses exceeding not only the values of doses on other devices, but also the values from the recommendations for 3-DOS for devices with digital receivers, as well as those approaching similar values for film devices. An almost linear dependence of the effective dose on the exposure time was established, while a similar dependence on the voltage on the X-ray tube was not found. The median value of the effective dose for the units with films detectors was 3.2 µSv for the maxillary incisors, 3.8 µSv for the maxillary premolars, 6.8 µSv for the maxillary molars, and for the mandibular incisors, premolars and molars – 3.2, 3.4 and 5.8 µSv, and for bitewing – 6.7 µSv. For the unit with digital detectors, effective doses were 1 µSv, 1,2 µSv, 2,2 µSv for maxilla, 1 µSv, 1,3 µSv, 2 µSv for mandibula and 2,8 µSv for bitewing. Attention is drawn to the substantial width of the ranges without emissions for the examination of premolars of the upper jaw, molars of both jaws and occlusion, which is the reason for the possible enhancement of optimization measures in these studies. When comparing with published data, it was found that the effective doses in St. Petersburg and the regional institutions are lower than the values obtained using standard round collimator and medium and high sensitivity films (class D and F, respectively), as well as lower dose levels in the European Commission Guidelines. In addition, the dose values deduced in this study are significantly lower than the values given in the guidelines “Filling in the forms of federal state statistical observation No. 3-DOZ” and which are still often used to fill in the form instead of the measured values. This indicates an overestimation of estimates of patient doses when using reference values from the 3-DOZ manual and the need to use individual patient doses, obtained on the basis of measurements. However, the effective doses in St. Petersburg and the Leningrad Region are higher than those obtained using a square collimator and high-sensitivity films. The above results suggest that it is necessary and possible to carry out optimization in X-ray dental studies in St. Petersburg and the Leningrad Region. Analysis of similar studies on other X-ray diagnostic techniques allows to extrapolate this statement to other regions of Russia.
La première partie porte sur l'épidémiologie, l'étiologie, l'éruption normale et le trajet normal d'éruption, l'anatomopathologie ainsi que le rôle et l'importance des canines incluses maxillaires.L'étude clinique des inclusions canines maxillaires garde une place de choix dansle diagnostic, notamment en présence ou pas de complications. La deuxième partie est consacrée au diagnostic radiologique où nous détaillons les différentes techniques et leur importance. La radioprotection, une discussion et une conclusion clôturent ce travail.Nous pouvons au terme de cette revue de littérature, dire que la radiographie panoramique reste la méthode de choix pour la détection des canines incluses maxillaires.Son accessibilité, son coût (financier et dosimétrique) et de sa rapidité d'exécution ainsi que de la vision d'ensemble de la sphère dento-maxillaire sont ses atouts.Les radiographies intra-buccales conservent leurs utilités dans le rôle d'examen complémentaire. La radiographie en coupe est le moyen le plus sûr pour un diagnostic clair et sans ambiguïté. Mais elle s'avère moins accessible, plus coûteuse (financière, dosimétrique), requière des connaissances et un savoir faire dans la lecture des clichés. Actuellement le seul examen de cone-beam peut suffire là où une telle machine est disponible.Il se pose le problème de la vulgarisation de cette nouvelle technique ainsi que sa prise en charge par la sécurité sociale. Le scanner devient ainsi une technique utile mais non indispensable dans le diagnostic radiologique des canines incluses maxillaires.
Dental age estimation for pediatric patients who will receive dental treatment is of upmost importance because this allows the evaluation of biologic maturation. AIM: To validate the dental radiogram chart used for dental age estimation of pediatric patients used by the Specialty in Pediatric Dentistry Program U.C.V. from 2014 to 2016. MATERIALS AND METHODS: The study group was selected and stratified by age and gender, including 71 high quality panoramic radiographs from healthy children ages 4 to 11 years old. Dental age was estimated using the Nolla, Demirjian and Willems´ methods. Each radiograph was randomly assigned and evaluated by at least one observer. RESULTS: Highest correlation between chronologic and dental was found for the Demirjian y Willems method. The difference between dental and chronologic age was significant for Nolla (-0.30 p=0.001) and Demirjian (0.272 p<0.001), and not significant for Willems (0.02 p=0.74). Only 4 patients (5.63%) presented significant difference (p<0.001) for all three methods. All methods presented differences in dental age estimation, being Nolla more sensible to the effect of the observer. CONCLUSION: The dental radiogram proposed allows dental age estimation in a practical manner, obtaining validity for this recollection instrument and allowing its standardized use for optimization of dental diagnosis in pediatric patients.
58 Medina AC, del Pozo R asociación entre agenesia dental y maloclusión en pacientes pediátricos associação entre a agenesia de dentes permanentes e a presença de má oclusão em pacientes pediátricos Resumen Introducción: La agenesia dental es la anomalía del desarrollo más frecuente en el ser humano, asociándose a maloclusiones y alteraciones fun-cionales. Objetivo: El objetivo de la presente in-vestigación es determinar la asociación entre la agenesia de dientes permanentes y la presencia de maloclusiones en pacientes pediátricos en el área Metropolitana de Caracas, Venezuela. Material y métodos: Fueron evaluados 1.188 radio-grafías panorámicas y 648 registros ortodóncicos de pacientes sanos con edades entre 5 y 18 años, registrando agenesia de dientes permanentes, exceptuando terceros molares. La maloclusión se diagnosticó según Angle. Fueron calculados es-tadísticos descriptivos, diferencias entre prome-dios y correlaciones entre variables (t de Student, rho de Pearson, p=0,05, odds ratio). Resultados: La prevalencia de agenesia fue 5,6%, siendo la media 1,64 y afectando mayormente al sexo fe-menino (1,44:1). Los dientes más afectados fue-ron segundos premolares inferiores (35,19%), e incisivos laterales superiores (30,55%). La preva-lencia de maloclusión fue mayor en el grupo con agenesia dental (Clase I 52%, Clase II 31%, Clase III 17%) al comparar con el grupo control (Clase I 77%, Clase II 14%, Clase III 9%); habiendo co-rrelación estadísticamente significativa entre el número de dientes ausentes y Clase III. Conclu-sión: La prevalencia y distribución de agenesia dental variaron entre géneros, siendo el feme-nino el más afectado. Hubo correlación positiva estadísticamente significativa entre el número de dientes afectados y la maloclusión Clase III. Palabras clave: Agenesia dental, población pe-diátrica, prevalencia, maloclusión.
Aim:
The aim of the present study was to compare the accuracy of radiographic measurements for dental implants planning using cone-beam computed tomography (CBCT) and helical computed tomography (HCT).
Methods:
Six pig ribs were wrapped by putty impression material, with radiographic markers placed. Two CBCT and an HCT were taken following the standard protocols. Twenty-five locations were selected, with vertical and horizontal dimensions measured using the default software, as well as on the processed HCT films by a digital caliper. The actual dimensions of the ribs measured by the digital caliper served as the control. Differences between radiographic dimensions and the actual dimensions were tested by two-way analysis of variance.
Results:
No differences were found between measurements made by CBCT and HCT images using the default software (P > 0.05). However, both measurements were statistically-significantly lower than the control (P < 0.001), and the mean difference was 0.3 mm. Measurements made on HCT films were statistically-significantly greater than the control (P < 0.001), and the mean difference was 0.5 mm.
Conclusion:
The accuracy of CBCT and HCT are similar, and both are reliable tools for implant planning. It is preferable to perform the planning using default software, rather than making direct measurements on films.
Oral fluids are potential contaminants of radiographic processors. This investigation measured bacterial contamination in a radiographic processing room during times of high and low clinical activity and processing effects on five types of microorganisms. Cultures in the clinical setting, during high and low activity, were taken by brain-heart infusion agar plates placed near automatic processors. Site samples were taken of entrance, developer, fixer, water, and exit surfaces. Measurements of processing effects were accomplished by intentional contamination of films run in series through an automatic processor. Site samples were again taken of the processor. In the clinical setting colony-forming units increased with activity. Radiographic processing after intentional contamination decreased colony-forming units on films, but they increased for all processing solutions. Bacteria on radiographic film survived processing. Although processing procedures significantly reduce the number of bacteria on films, the potential for contamination and cross-contamination remains.
Four mandibular specimens were radiographically examined bilaterally to locate the mandibular canal. The following radiographic techniques were used: periapical and panoramic radiography, hypocycloidal tomography, and computed tomography (CT). The distance from the crest of the alveolar process to the superior border of the mandibular canal was measured in millimeters on all radiographs. The specimens were then sectioned, and the location of the mandibular canal (as measured on contact radiographs of the sections) was compared with measurements made on the other radiographs. The results showed that CT gave the most accurate position of the mandibular canal and is therefore probably the best method for preoperative planning of the implant surgery involving the area close to the mandibular canal.
The diagnosis of periodontitis is generally made on the basis of a clinical examination supported by radiographic evidence of bone loss. Recent guidelines promulgated by the US Food and Drug Administration recommend that periapical radiographs be ordered on the basis of clinical signs and symptoms indicating the probable presence of disease. This study evaluated the effectiveness of the FDA Guidelines for ordering radiographs for new adult dental patients as related to assessment of the periodontal condition of the patient. We examined 490 patients and determined the periapicals needed to supplement the posterior bitewings based upon the patient's clinical findings. We measured the reduction in the number of radiographs ordered as well as the extent of missed alveolar and furcation bone loss resulting from the use of the selected set of radiographs compared with a complete set. Four hundred thirty-three subjects had at least one clinical sign of periodontitis present in their mouths, and 264 demonstrated radiographic evidence of alveolar bone loss. Of the 460 subjects on whom periodontal probing was conducted, two-thirds demonstrated periodontal probing depths in excess of 3 mm; almost half showed evidence of bleeding upon probing. Individuals with clinical signs of periodontitis had, on average, 10 periapicals ordered--more than twice the number as those with no sign of periodontitis. Of the 2,415 teeth with radiographic findings of proximal or furcal bone loss, 152 sites of bone loss (6%) were missed when the selected set of films plus the posterior bitewings was used.
The purpose of the present study was to compare the radiographic measurements of periodontal osseous destruction with the surgical measurements, which represent the true value of osseous destruction, and to select the most successful method of conventional radiography in detecting and accurately assessing periodontal osseous destruction. A total of 5072 proximal surfaces in 2536 teeth of 100 patients with periodontitis were evaluated surgically during periodontal flap surgery and radiographically by using periapical and panoramic radiography. Comparative evaluation of the measurements obtained by these 3 different methods of osseous destruction assessment revealed the following. (1) The radiographic detection ability of small osseous destruction (1-4 mm) was very low for both methods of assessment and became even lower for the initial osseous destruction (1 or 2 mm). (2) Periapical radiography was more successful than panoramic in the detection of osseous destruction, especially of the small destruction (4.7x). (3) Panoramic radiography underestimated the osseous destruction, whereas periapical radiography was relatively accurate in the osseous destruction assessment. (4) Periapical radiography was more accurate in the osseous destruction assessment than panoramic, regardless of the location of the dental surfaces (jaw, tooth group, mesial or distal) and the degree of osseous destruction. (5) The deviation of the radiographic measurements of osseous destruction from the surgical measurements, as well as the difference between the two radiographic methods, depended on the jaw location, the tooth group and the degree of osseous destruction. (6) The radiographic assessment of osseous destruction underestimated the osseous destruction in initial periodontitis, it was relatively accurate in moderate periodontitis, but overestimated it in severe periodontitis. The radiographic measurements of osseous destruction deviated least from the surgical measurements in the group of moderate periodontitis and most in that of severe osseous destruction. (7) The 2 radiographic methods agreed most in the assessment of osseous destruction in the severe periodontitis group and least in the initial periodontitis group. (8) The indirect Schei method was less successful in detecting the small osseous destruction and less accurate in assessing the osseous destruction than the direct millimetric method of radiographic evaluation. (9) The osseous destruction as assessed from periapical radiographs by the Schei method was not significantly different from that assessed by the radiopaque Fixot-Everett grid. The results of the present study suggest that periapical radiography is more successful in detecting periodontal osseous destruction and more accurate in assessing it than panoramic radiography.
A technique that employs new computer-assisted tomography (CT) computer software generates oblique and panoramic CT images of the mandible. These images facilitate preoperative planning and permit precise positioning of endosseous implants.
This updated self-assessment exercise for the dental team by the Radiology Practice Committee of the American Academy of Oral and Maxillofacial Radiology is intended to produce the highest quality diagnostic radiographs while keeping patient exposure as low as is reasonably achievable. To continue to provide the best radiographic services to patients, those involved in dental radiography need to be aware of the latest changes and advances in dental radiography and need to use them in their practice. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:369-74)
Extra t.p. with thesis statement inserted. Thesis (doctoral)--Karolinska Institutet, Stockholm, 1982. Includes bibliographical references.
Preoperative planning is an essential aspect of endosteal implant placement. Three-dimensional imaging allows the surgeon and restorative dentist to accurately visualize potential implant receptor sites relative to adjacent vital structures. This information is correlated with the planned occlusion, and transferred to the patient by means of a surgical prosthetic guide, which is developed on the diagnostic cast. The steps involved in planning and placing implants in an atrophic mandible in the first case illustrates the value of three-dimensional scanning in treating patients with limited bone volume. The second case presented with a mandibular bilateral distal extension partial denture, which was ultimately replaced with two implant-supported fixed prostheses. The use of three-dimensional imaging showed the location of the inferior alveolar neurovascular bundle which allowed utilization of all of the bone above it without encroaching on the nerve. The third case illustrates an edentulous maxilla where visualization of the osseous contour allowed for implant placement at an optimal angulation to provide support for the planned prosthesis.
At surgery, the results of preoperative radiographic evaluation are used in conjunction with surgical stents to determine the ideal site and angulation of implants. However, it would be desirable to be able to plan the optimal implant location before the actual surgical appointment. This paper presents a technique in which barium-coated stents or dentures are used in conjunction with computer-assisted tomography to locate important anatomic landmarks, such as the inferior alveolar nerve, and anomalies of the underlying bone, such as deficiencies in ridge height, preoperatively. This allows more accurate determination of optimal implant placement.
This paper reviews infection control procedures with the related regulations and recommendations. Procedures for processing contaminated instruments include presoaking, cleaning, packaging, sterilization, spore-testing and hand-piece asepsis. Surface asepsis techniques include surface covering, surface precleaning and surface disinfection.
When implants are to be inserted in the mandible posterior to the mental foramen, tomography is required to determine the exact location of the mandibular canal and assess the dimensions of the body and alveolar process. Previous studies have shown discrepancies between the true distance between the alveolar crest and the upper border of the mandibular canal and that measured from computed tomograms. This study evaluates the reliability of such measurements made from hypocycloidal tomograms. Six examiners, three radiologists and three oral surgeons, independently measured the distance from the alveolar crest to the upper border of the mandibular canal in transverse hypocycloidal tomograms of the mandible. Analysis of variance showed an average standard deviation between observers of 1.33 mm. This variation, which is the total of inter- and intra-observer variation conditional upon patient and radiograph, was mainly due to the latter which amounted to a mean of 1.04 mm. Calculation of lower confidence limits showed that these could be decreased by the use of several observers. Various confidence levels, equal to the probabilities of obtaining lower confidence limits which are below the true values, can be used to choose acceptable levels of risk in overestimating the true distance.
The purpose of this study was to determine whether erroneous kVp meter readings, induced by plastic wrap, affected the actual kVp (output) of a dental X-ray machine. To evaluate the effect of plastic wrap on dental X-ray machine kVp meters, a radiation output device was used to measure output in mR/ma.s. An intraoral dental X-ray unit (S.S. White Model #90W) was used to make the exposures. First, the kVp meter was not covered with plastic wrap and output readings were recorded at various kVp settings with the milliamperage and time held constant. Secondly, the same kVp settings were selected before the plastic wrap was placed. Milliamperage and time were again held to the same constant. The X-ray console was then covered with plastic wrap prior to measuring the output for each kVp. The wrap possessed a static charge. This charge induced erroneous kVp meter readings. Out-put readings at the various induced kVp settings were then recorded. A kVp of 50 with no wrap present resulted in the same output as a kVp of 50 induced to read 40 or 60 kVp by the presence of wrap. Similar results were obtained at other kVp settings. This indicates that the plastic wrap influences only the kVp meter needle and not the actual kilovoltage of the X-ray machine. Dental X-ray machine operators should select kVp meter readings prior to placing plastic wrap and should not adjust initial settings if the meter is deflected later by the presence of wrap. The use of such a procedure will result in proper exposures, fewer retakes, and less patient radiation. If plastic wrap leads to consistent exposure errors, clinicians may wish to use a 0.5% sodium hypochlorite disinfectant as an alternative to the barrier technique.
The accuracy of panoramic radiography and computed tomography (CT) in the evaluation of depth of the mandible at recipient implant sites was compared by measuring the distance between the edentulous bony crest and the superior border of the inferior alveolar canal in a group of ten patients. Distortion was calculated using the metal ball technique for the panoramic radiographs and the computer scale for the CT scans. The precise distance between the bony crest and inferior alveolar canal was determined from postoperative radiographs from the known length of the implants. It was found that although CT scans are more precise, panoramic radiography is sufficiently accurate for routine clinical purposes. CT scans have, however, an additional advantage in presurgical planning, since they reveal the horizontal dimension and shape of the mandible, and the topography and buccolingual location of the inferior alveolar canal.
Routine disinfection of materials that have contacted human blood products and body fluids during patient care is recommended by the American Dental Association and the Centers for Disease Control. The purpose of this study was to determine whether surface disinfection with sodium hypochlorite would be an effective means for disinfection of radiographic film packets used in chairside developers. Disinfection of exposed radiographic film packets for 30 seconds in 5.25% sodium hypochlorite has been found to be a simple procedure suitable for routine use. A suggested disinfection protocol for the use of chairside developing boxes is described. This procedure should be considered for adoption as an infection control guideline.
An accurate tomographic technique is described for acquisition of optimal cross-sectional images of implant sites before implant surgery. The described technique is applicable to tomographic systems equipped with a cephalometric head positioner. This cross-sectional tomographic technique was performed on a series of patients and the images of the first 20 patients subsequently evaluated. The cross-sectional images allowed for the characterization of the alveolar crest and visualization of anatomic structures in a buccolingual dimension while providing an accurate estimation of available vertical space from the crest.
In severely atrophic or osteoporotic mandibles, the location of the inferior alveolar nerve may vary considerably, both superoinferiorly and mediolaterally. A clinician's ability to reliably locate this nerve within the mandible would permit the surgical planning of implant placement in the posterior edentulous mandible. Eight edentulous cadaver mandibles were studied. A technique that precisely locates the inferior alveolar nerve within the mandible is described. The technique will aid the surgeon in planning a surgical approach to the posterior mandible with reduced risk of injury to the inferior alveolar nerve.
Orthopantomography is often used in implantology to determine the position of implants in the bone. Implants, which in fact are parallel, can be projected in a non-parallel position. Considerations inherent to the technique of orthopantomography are responsible for this phenomenon. In this study some experiments were carried out to demonstrate this. It can be concluded that orthopantomography cannot be used to determine whether implants are placed parallel or not.
A radiographic technique was developed to accurately assess bone available for the placement of intraosseous implants. Hypocycloidal tomographs were made at right angles to the long axis of the mandibular and/or maxillary alveolus while the patient was wearing a specially designed splint. Alveolar height and width measurements were obtained from the resulting films. Sensitivity results for this technique showed that the mean difference between the actual bone height and width and that measured in the radiographs was 0.49 mm and 0.35 mm, respectively. A paired difference test revealed a range of 0.25 mm to 0.73 mm in the expected error in the height and 0.20 mm to 0.50 mm in width measurements with a 95 confidence interval.
A clinical tomographic method of defining and demonstrating the hard and soft tissue morphology of those parts of the maxilla which are intended for osseointegrated implants is described. This preoperative examination is an useful aid in the choice and planning of the treatment as such, and in the decision concerning the calibre and position of the implants. Hence, it facilitates the surgical procedure.
A method was described that includes a stent provided by the restorative dentist indicating optimum implant location. The stent, with imbedded metal bearings, is worn by the patient during tomographic radiographic survey. The tomogram provides a more accurate image of the quantity and quality of the osseous structures. The same template may be used as a surgical stent to aid the surgeon in initial bur placement. Through careful planning and systematic control, the predictable placement of osseointegrated implants can be achieved. With cooperative efforts of restorative dentists and surgeons, more than 400 implants have been successfully placed at University of California, Los Angeles, School of Dentistry.
This study was undertaken to determine whether adequate diagnostic information could be obtained from a thorough clinical examination supplemented with a limited number of intraoral radiographs, the exact number of films determined in each case by applying a set of historical and/or clinical selection criteria. The 100 patients in this study required an average of 8.2 periapical radiographs (range, 0 to 18), in addition to posterior bitewing films to complete the diagnostic process. Later evaluation of complete-mouth surveys on these patients revealed that no cases of periodontitis, no periapical lesions, and no impacted teeth were overlooked when selection criteria were used. Forty-two unsuspected abnormalities were found, but only three of these required treatment-a root tip close to the surface and enlarged follicular spaces distal to two clinically erupted third molars.
A computed tomography technique for frontal, lateral, oblique, and panoramic images of the maxilla is described. The images aid in preparing for the surgical placement of endosseous implants.
Films, exposed with rotational panoramic radiography, are generally considered inferior regarding the accuracy of measurements. Theoretic mathematical calculations, confirmed by an experimental test, have been performed in order to evaluate the reliability of measurements of distances that appear vertical in the image. It is demonstrated that, within certain limits, the panoramic film may be used for vertical measurements in clinical practice provided the patient has been properly positioned in the equipment during the exposure.
This study compared the FDA guidelines for ordering dental radiographs to a conventional full-mouth examination for the detection of intraosseous disease and conditions affecting teeth other than caries.
We examined 490 patients and selected posterior bite-wing and periapical views as indicated by the patient's signs or symptoms. We compared the radiographic findings with the use of this selected set of radiographs to those from a full-mouth set of radiographs to determine the rates of missed disease when the FDA guidelines were used.
The most commonly missed intraosseous findings were osteosclerosis, unerupted teeth, periapical radiolucencies, and primary root tips. Periapical radiolucencies that were most probably periapical cemental dysplasia were missed in six patients. The most commonly missed dental findings were resorbed roots and pulp stones. Three instances of dens in dente were missed.
When we used the FDA guidelines, the number of missed intraosseous and dental conditions was small and most likely inconsequential given the range of variability in dental diagnosis and treatment.
In 1988, the U.S. Food and Drug Administration issued guidelines to help dentists reduce the amount of X-ray exposure to patients without reducing the quality of care. This study assesses the efficacy of those guidelines. The authors examined 490 patients and ordered radiographs as indicated by the FDA guidelines. Using the guidelines, they ordered a mean of 9.7 radiographs out of a 17-film series, a reduction of 43 percent compared with a full-mouth series. The authors conclude that dentists can reduce a patient's exposure to X-rays by using these guidelines with a low level of missed radiographic findings, most of which would have no effect on the patient's treatment.
There are no data relating complex film tomography with effective dose that may be used to estimate the relative risk associated with dental implant diagnostics. The purpose of this study was to calculate the effective dose and estimate risk from the use of the Scanora multimodal imaging system. With the use of a tissue equivalent human phantom and thermoluminescent dosimetry, panoramic radiography was found to result in an effective dose of 26 microSv, while complex film tomography resulted in an effective dose of < 1 microSv to 30 microSv depending on the anatomical location of the imaging plane and the collimation option. An effective dose of this magnitude for panoramic radiography was estimated to represent a probability for stochastic effects on the order of 1.9 x 10(-6). Similarly, the effective dose associated with film tomography may be estimated to be equal to a probability for stochastic effects in the range of < 1 x 10(-6) to 2.2 x 10(-6).
This study evaluated the effect on caries diagnosis of using the Food and Drug Administration (FDA) guidelines for ordering radiographs on a sample of new adult patients seeking general dental care at a dental school clinic. These guidelines recommend posterior bitewing views accompanied by supplemental periapical views as indicated by the patient's clinical signs or symptoms. We compared the findings from the use of this protocol to those from a full-mouth set of radiographs made on the same new patient. We examined 490 patients and ordered periapical radiographs in accordance with the FDA guidelines, namely, when there was some clinical sign or symptom suggesting the need for radiographs. A full-mouth set of radiographs was obtained, and both the full and selected sets were evaluated separately. We found that 95% of our patients had one or more carious lesions, with an average of 5.7 carious teeth per patient. Of the 2808 carious teeth detected in the study, 1949 (69%) were found radiographically and 1564 (56%) were found clinically. Indeed, 1244 (44%) of the carious teeth were detected only by radiographic examination. Use of the FDA guidelines resulted in a 43% reduction in the number of radiographs ordered. Reduction in the number of images made on patients resulted in failure to detect 93 lesions (3.3%) located on 88 teeth in 11.4% of the study patients. Most of the missed lesions (2.9%) were radiographically confined to the enamel of anterior maxillary teeth. Only 36 of the missed lesions (1.6% of all radiographic lesions) extended into the dentin. We believe that this number is very small and most likely inconsequential compared with the considerable diversity among dentists regarding radiographic detection of caries, as well as the diversity of opinion regarding the indications for restorative treatment.
There has been considerable controversy about the incidence of periodontal disease in adolescents. It is noteworthy that there is disagreement between workers as to be radiological features that should be used to detect the earliest signs of periodontitis, and variation in the choice of criteria may have influenced the results of previous studies. The present project represents a 3-year longitudinal assessment into the periodontal condition, assessed clinically and radiologically, of a group of adolescents. The radiographic investigations were carried out using vertical bitewing radiographs and, to reduce potential error caused by variation in film placement and tube alignment, individual impressions were used so that the film could be positioned accurately at repeat assessments. It was found that several of the radiographic features, such as the width of the periodontal ligament space and the angle of the interproximal bone crest relative to the tooth, similar to those previously attributed to the commencement of destructive periodontal changes, were found to be correlated with the maturation changes associated with the eruption of the adjoining permanent teeth. In spite of the use of impressions, some of the series of radiographs showed variation in tube alignment, and several of the above radiological features were also found to correlate with errors in radiographic technique. It was concluded that the various eruptive and maturation changes taking place during this stage in the adolescent dentition must be allowed for when looking for the earliest signs of periodontal destruction.
A variety of imaging modalities are available for the preoperative evaluation of potential implant sites. The pantomograph provides initial screening information. Cephalometric films are most useful in analyzing the incisor regions. Tomography can provide cross-sectional views of segments at a relatively low patient radiation dose. Computed tomography is a superior method when the analysis of complete arches is required. Experimental designs of postoperative radiologic evaluation of small changes in bone height require reproducible image geometry and the evaluation of intraobserver error.
This study investigated microbiologic contamination of an automatic dental radiograph processor and daylight loader during a week of simulated clinical use. Pure cultures of Candida albicans, Streptococcus pneumoniae, Staphylococcus aureus, or Klebsiella pneumoniae were used to contaminate 320 vinyl intraoral radiograph packets. Each end of the films was deliberately contaminated during opening. These films and 24 uncontaminated control films were processed. Daylight loader ports, inlet and outlet rollers, fixer and developer samples, and 12 processed films were cultured daily. To simulate a weekend, the processor sites were cultured during 72 hours of inactivity after the contaminated runs. The results showed that contamination of the processor and daylight loader occurred and remained even after 48 hours of inactivity. Films remained contaminated after processing. In addition, cross-contamination of films occurred in the processor.
It has been recommended that the prescription of dental radiographic examinations be based on a series of selection criteria. This study evaluated the usefulness of the presence of a large or deep restoration as an indicator for the need for a radiographic examination. Patients in need of routine examinations were questioned regarding pain in restored teeth. The radiographs of 2269 restored teeth in 209 patients were evaluated for depth of restoration and presence or absence of periapical pathosis. Another 1306 nonrestored teeth in 100 patients were evaluated similarly. There was an association between pain and periapical pathosis and between depth of restoration and periapical pathosis (p < 0.001 in each case). Radiographic yield for positive apical findings was low in restored teeth, especially when the restoration was shallow. The radiographic yield may be increased if other factors such as pain or integrity of the restoration are used to help make the decision regarding the need for radiographs.
The effective dose from computed tomography of the maxillofacial complex has been estimated and used for an assessment of risk. For each scan sequence 64 TLDs were placed in 27 selected sites in the upper portion of a tissue-equivalent human phantom to record the equivalent dose in radiosensitive organs/tissues. Equivalent doses ranged from 0.11 mSv (bone marrow, maxillary scan) to 20 mSv (salivary glands, mandibular scan). By the use of a calculation that included the salivary glands as part of the remainder, two contiguous 1 cm axial slices of the maxilla were found to result in an effective dose of 0.1 mSv, and four contiguous 1 cm axial slices of the mandible in an effective dose of 0.76 mSv. Effective doses of this magnitude represent a probability of stochastic effects of the order of 8 X 10(-6) and 56 X 10(-6) respectively.
Thermoluminescent dosimeters were used to measure radiation doses at craniofacial sites in a tissue-equivalent phantom during film-based multidirectional tomography with the Tomax Ultrascan (Incubation Industries, Ivyland, Pa.) and during computed tomography with the Elscint Excel 2400 (Elscint Corp., Tel Aviv, Israel). Mean absorbed doses for presurgical mandibular and maxillary canine and molar implant assessments were converted to equivalent doses, which were then multiplied by published weighting factors and summed to give effective doses. The computed tomography device consistently delivered higher doses than the Tomax Ultrascan to all anatomic locations; the differences were most pronounced when only one or two implant sites were evaluated. The reasons for the dose disparities are considered both anatomically and procedurally. A survey of examination cost revealed film-based multidirectional tomography to be less expensive than computed tomography.
Various imaging techniques for the temporomandibular joint are discussed with respect to uses, strengths, and limitations. An imaging protocol is outlined for evaluating patients with a wide variety of temporomandibular joint related signs and symptoms.
To examine the use of tomography for dental implant planning.
A questionnaire was sent to oral radiology clinics in Sweden and to implantology clinics in different parts of the world with questions on selection criteria and techniques for, and frequency of, pre-implant tomography. Differences between mean values were assessed by t-test. A new method developed by the Swedish Radiation Protection Institute was used to assess radiation absorbed dose from CT.
Tomography was used by 93.4% of the clinics, but there was marked variation both between and within different clinical situations. It was performed in all cases by 21% and the majority used it for the evaluation of the maxilla, the posterior mandible and in single implant cases. Small clinics (< 100 patients per year) used tomography frequently and clinics in Sweden significantly more often than those in other countries. The majority had changed their policy recently, using tomography more often. CT was used by 73% of respondents, mainly the small clinics. The majority of the large clinics (> 500 patients per year) used conventional tomography. The mean absorbed dose for CT scanning protocols was 65 mGy. The variation within and between different makes of CT was considerable.
There are large variations in frequency of use of both conventional and computed tomography for dental implant planning by different clinics who also vary in the indications for their choice. A substantial factor influencing the technique chosen was its availability rather than clinical need.
Although exposure to blood is rare in oral and maxillofacial radiology, contact with saliva occurs. Thus the spread of infectious diseases is possible through cross-contamination, and specific infection control protocols and unit dosing of items are needed. This article outlines rationale for implementing state-of-the-art infection control procedures; and explains federal standards and guidelines with an impact on infection control and occupational safety in dental radiology procedures.
This updated self-assessment exercise for the dental team by the Radiology Practice Committee of the American Academy of Oral and Maxillofacial Radiology is intended to produce the highest quality diagnostic radiographs while keeping patient exposure as low as is reasonably achievable. To continue to provide the best radiographic services to patients, those involved in dental radiography need to be aware of the latest changes and advances in dental radiography and need to use them in their practice.
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