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Assessment of a training program on detection of TMJ osseous changes applying pre-defined 2D multiplane CBCT reconstructions
Abstract
Objectives:
Osseous changes in temporomandibular joint disorders (TMD) are common indications for cone beam computed tomography (CBCT). The number of such cases is increasing while number of qualified oral radiologists is limited. The present study investigated usefulness of a training program for general dental practitioners (GDPs) regarding temporomandibular joint (TMJ) osseous changes detection in CBCT images and evaluated the GDPs' performance in comparison to oral radiologists. A further aim was to investigate GDPs' agreement.
Methods:
We selected CBCT images of 35 TMD cases and chose 5 of them to use in training seven GDPs on detecting osseous changes in the TMJ. In evaluation directly following training, GDPs assessed the 30 remaining cases. Three qualified radiologists served as reference standard. A 2-month follow-up of training comprising evaluation of the same cases. The cases are assessed according to Ahmad et al. protocol of TMJ osseous changes in CBCT images.
Results:
Sensitivity and specificity of the CBCT protocol were high, except for some criteria that did not appear in the cases. Average observer sensitivity was 65% while specificity was 87%. Average correct individual response rate was 84%. Mean agreement among the GDPs was 73%. Observer performance had improved at the 2-month follow-up.
Conclusion:
The present educational program could be a helpful material on recognizing possible osseous changes of TMJ and it can be used as a part of training program for GDP and for specialist candidates. This article is protected by copyright. All rights reserved.
... Various CBCT online training programmes are available to support dental education in radiology, and they are useful and show high efficacy in delivering knowledge. [15][16][17][18] Our research team recently published a training programme on the detection of TMJ osseous changes using predefined 2D multiplane CBCT reconstructions. 18 Thus, the purpose of this study was to develop and evaluate the usefulness of a web-based educational programme for TMJ assessment using CBCT. ...
... [15][16][17][18] Our research team recently published a training programme on the detection of TMJ osseous changes using predefined 2D multiplane CBCT reconstructions. 18 Thus, the purpose of this study was to develop and evaluate the usefulness of a web-based educational programme for TMJ assessment using CBCT. ...
... The changes in overall percentage of correct diagnosis responses between the two assessments for all participants in the previous programme reported the programme to be helpful training material. 18 Its limitation, however, was the use of predefined Mitov et al 13 recommended the online dental learning approach as a valuable tool for self-learning. The Clark 12 study suggested that incorporating the web-based learning approach into dental education would be beneficial. ...
Cone-beam computed tomography (CBCT) examination of the tem-poromandibular joint (TMJ) has become a recognised tool in case of suspicion for the presence of osseous changes, after a thorough history and clinical examination of the patient. CBCT images provide high spatial resolution in three-dimensional (3D) images, which is desirable in diagnostics and treatment of temporomandibular disorder (TMD). Often, its diagnostic accuracy and reliability are better than that of two-dimensional (2D) images. 1 CBCT provides comparable diagnostic accuracy with a relatively lower radiation dose and cost compared with medical computed tomography (CT) 2-4 and, at present , is considered the technique of choice for evaluating osseous changes of the TMJ. 5 Abstract Objectives: To develop and evaluate an educational web-based programme for tem-poromandibular joint (TMJ) assessment using cone-beam computed tomography (CBCT). Methods: A web-based educational programme was designed for TMJ assessment using CBCT images. Fifteen CBCT cases of the TMJ (three-dimensional reconstructed volumes) and an assessment module based on image analysis criteria in the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were added to the programme. Thirty-six undergraduate dental students were invited to test the programme by assessing all cases twice: before and after 2 months of training. Participants submitted written subjective evaluations of the programme. Results: The web-based programme can be accessed on Malmö University webpage (www.cbct-tmj.mau.se). Despite limited CBCT learning in their undergraduate training and not using the programme in the 2-month interval, the students were able to correctly diagnose 80% of the cases at the second assessment. Their diagnoses, however, did not differ significantly from the first assessment. Overall, the students were satisfied with the programme and considered it user-friendly. Conclusion: The web-based educational programme that was developed in the present study and tested by dental students could be a useful educational tool for TMJ assessment using CBCT. K E Y W O R D S cone-beam CT, education, temporomandibular joint, training programme
... Various CBCT online training programmes are available to support dental education in radiology, and they are useful and show high efficacy in delivering knowledge. [15][16][17][18] Our research team recently published a training programme on the detection of TMJ osseous changes using predefined 2D multiplane CBCT reconstructions. 18 Thus, the purpose of this study was to develop and evaluate the usefulness of a web-based educational programme for TMJ assessment using CBCT. ...
... [15][16][17][18] Our research team recently published a training programme on the detection of TMJ osseous changes using predefined 2D multiplane CBCT reconstructions. 18 Thus, the purpose of this study was to develop and evaluate the usefulness of a web-based educational programme for TMJ assessment using CBCT. ...
... The changes in overall percentage of correct diagnosis responses between the two assessments for all participants in the previous programme reported the programme to be helpful training material. 18 Its limitation, however, was the use of predefined Mitov et al 13 recommended the online dental learning approach as a valuable tool for self-learning. The Clark 12 study suggested that incorporating the web-based learning approach into dental education would be beneficial. ...
Objectives
To develop and evaluate an educational web‐based program for temporomandibular joint (TMJ) assessment using cone‐beam computed tomography (CBCT).
Methods
A web‐based educational program was designed for TMJ assessment using CBCT images. Fifteen CBCT cases of the TMJ (three‐dimensional reconstructed volumes) and an assessment module based on image analysis criteria in the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were added to the program. Thirty‐six undergraduate dental students were invited to test the program by assessing all cases twice: before and after 2 months of training. Participants submitted written subjective evaluations of the program.
Results
The web‐based program can be accessed on Malmö University webpage (www.cbct-tmj.mau.se). Despite limited CBCT learning in their undergraduate training and not using the program in the 2‐month interval, the students were able to correctly diagnose 80% of the cases at the second assessment. Their diagnoses, however, did not differ significantly from the first assessment. Overall, the students were satisfied with the program and considered it user friendly.
Conclusion
The web‐based educational program that was developed in the present study and tested by dental students could be a useful educational tool for TMJ assessment using CBCT.
... To minimise the false positive rate, the training programme fo- Similar to our results, other studies of short training programmes on specific types of diagnostic imaging have reported improvements in diagnostic accuracy for GDPs, 24 physicians 26 and complete nov- ices. 27 The GDPs in the present study also presented high skill re- tention at the 1-year follow-up. ...
Purpose
To study General Dental Practitioners (GDPs) ability to detect Calcified Carotid Artery Atheromas (CCAAs) in Panoramic Radiographs (PRs) and if their diagnostic accuracy in long‐term is improved after a short training program.
Methods
Fourteen GDPs had their diagnostic accuracy regarding CCAA in PR assessed at baseline, two weeks and one year after training. Comparison were made with a reference standard based on consensus results from two experienced oral and maxillofacial radiologists. At each session 100 radiographs were assessed individually by the GDPs. After the baseline assessment, the GDPs participated in a two‐hour training program comprising a lecture and diagnostic training by calibration. The GDPs results before and after training were compared, as well as between follow‐up sessions.
Results
A significant improvement in diagnostic accuracy was observed with increased sensitivity (from 41.8% to 55.7%, p = 0.02) without a significant decrease in specificity (from 87.2% to 86.7%, p = 0.87). The Kappa‐values also increased (from 0.66 to 0.71, p = 0.04). At one‐year follow‐up the improvement compared to baseline remained significant. There were no significant changes between the two‐weeks and one‐year follow‐up assessment
Conclusion
A short training program can significantly and sustainable improve GDPs diagnostic accuracy regarding CCAA.
This article is protected by copyright. All rights reserved.
AIMS: The original Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Axis I diagnostic algorithms have been demonstrated to be reliable. However, the Validation Project determined that the RDC/TMD Axis I validity was below the target sensitivity of ≥ 0.70 and specificity of ≥ 0.95. Consequently, these empirical results supported the development of revised RDC/TMD Axis I diagnostic algorithms that were subsequently demonstrated to be valid for the most common pain-related TMD and for one temporomandibular joint (TMJ) intra-articular disorder. The original RDC/TMD Axis II instruments were shown to be both reliable and valid. Working from these findings and revisions, two international consensus workshops were convened, from which recommendations were obtained for the finalization of new Axis I diagnostic algorithms and new Axis II instruments.
METHODS: Through a series of workshops and symposia, a panel of clinical and basic science pain experts modified the revised RDC/TMD Axis I algorithms by using comprehensive searches of published TMD diagnostic literature followed by review and consensus via a formal structured process. The panel's recommendations for further revision of the Axis I diagnostic algorithms were assessed for validity by using the Validation Project's data set, and for reliability by using newly collected data from the ongoing TMJ Impact Project-the follow-up study to the Validation Project. New Axis II instruments were identified through a comprehensive search of the literature providing valid instruments that, relative to the RDC/TMD, are shorter in length, are available in the public domain, and currently are being used in medical settings.
RESULTS: The newly recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for detecting any pain-related TMD as well as valid diagnostic criteria for differentiating the most common pain-related TMD (sensitivity ≥ 0.86, specificity ≥ 0.98) and for one intra-articular disorder (sensitivity of 0.80 and specificity of 0.97). Diagnostic criteria for other common intra-articular disorders lack adequate validity for clinical diagnoses but can be used for screening purposes. Inter-examiner reliability for the clinical assessment associated with the validated DC/TMD criteria for pain-related TMD is excellent (kappa ≥ 0.85). Finally, a comprehensive classification system that includes both the common and less common TMD is also presented. The Axis II protocol retains selected original RDC/TMD screening instruments augmented with new instruments to assess jaw function as well as behavioral and additional psychosocial factors. The Axis II protocol is divided into screening and comprehensive self report instrument sets. The screening instruments' 41 questions assess pain intensity, pain-related disability, psychological distress, jaw functional limitations, and parafunctional behaviors, and a pain drawing is used to assess locations of pain. The comprehensive instruments, composed of 81 questions, assess in further detail jaw functional limitations and psychological distress as well as additional constructs of anxiety and presence of comorbid pain conditions.
CONCLUSION: The recommended evidence-based new DC/TMD protocol is appropriate for use in both clinical and research settings. More comprehensive instruments augment short and simple screening instruments for Axis I and Axis II. These validated instruments allow for identification of patients with a range of simple to complex TMD presentations.
Cone beam CT (CBCT) is a relatively new imaging modality, which is now widely available to dentists for examining hard tissues in the dental and maxillofacial regions. CBCT gives a three-dimensional depiction of anatomy and pathology, which is similar to medical CT and uses doses generally higher than those used in conventional dental imaging. The European Academy of DentoMaxilloFacial Radiology recognizes that dentists receive training in two-dimensional dental imaging as undergraduates, but most of them have received little or no training in the application and interpretation of cross-sectional three-dimensional imaging. This document identifies the roles of dentists involved in the use of CBCT, examines the training requirements for the justification, acquisition and interpretation of CBCT imaging and makes recommendations for further training of dentists in Europe who intend to be involved in any aspect of CBCT imaging. Two levels of training are recognized. Level 1 is intended to train dentists who prescribe CBCT imaging, such that they may request appropriately and understand the resultant reported images. Level 2 is intended to train to a more advanced level and covers the understanding and skills needed to justify, carry out and interpret a CBCT examination. These recommendations are not intended to create specialists in CBCT imaging but to offer guidance on the training of all dentists to enable the safe use of CBCT in the dentoalveolar region.
The aim of this study was to assess the accuracy and reliability of cone beam CT (CBCT) images compared with multidetector CT (MDCT) images for the detection of surface osseous changes in temporomandibular joints (TMJs).
Naked-eye inspection of 110 sites in 10 TMJs from 5 dry human skulls provided the gold standard. Two radiologists interpreted the images. Sensitivity, specificity and kappa statistics were used for analysis.
The sensitivities of both modalities were low and comparable whereas the specificities were high and comparable. Intraobserver reliabilities for CBCT (p=0.0005) and for MDCT (p=0.0001) showed significant agreement. Interobserver reliability was higher for CBCT than for MDCT.
CBCT and MDCT accuracy was comparable in detecting surface osseous changes with comparable intraobserver reliabilities. However, since CBCT requires less radiation exposure, it should be encouraged for imaging TMJ with suspected surface osseous changes.
There are many limitations to image acquisition, using conventional radiography, of the temporomandibular joint (TMJ) region. The Computed Tomography (CT) scan is a better option, due to its higher accuracy, for purposes of diagnosis, surgical planning and treatment of bone injuries. The aim of the present study was to analyze two protocols of cone beam computed tomography for the evaluation of simulated mandibular condyle bone lesions. Spherical lesions were simulated in 30 dry mandibular condyles, using dentist drills and drill bits sizes 1, 3 and 6. Each of the mandibular condyles was submitted to cone beam computed tomography (CBCT) using two protocols: 1) axial, coronal and sagittal multiplanar reconstruction (MPR); and 2) sagittal plus coronal slices throughout the longitudinal axis of the mandibular condyles. For these protocols, 2 observers analyzed the CBCT images independently, regarding the presence or not of injuries. Only one of the observers, however, performed on 2 different occasions. The results were compared to the gold standard, evaluating the percentage of agreement, degree of accuracy of CBCT protocols and observers' examination. The z test was used for the statistical analysis. The results showed there were no statistically significant differences between the 2 protocols. There was greater difficulty in the assessment of small-size simulated lesions (drill # 1). From the results of this study, it can be concluded that CBCT is an accurate tool for analyzing mandibular condyle bone lesions, with the MPR protocol showing slightly better results than the sagittal plus coronal slices throughout the longitudinal axis.
The diagnostic outcome and observer performance of sagittal tomography in detecting degenerative lesions of the temporomandibular joint was studied. Thirty tomograms depicting findings such as cyst, erosion, osteophyte and sclerosis and 30 with a normal appearance were selected. The joint status was verified histologically. Four observers evaluated the tomograms with the aid of reference tomograms, independent of the microscopic examination. The diagnostic accuracy was high (80-87%). The sensitivity was between 67% and 90% and the specificity between 73% and 93%. An osteophyte was, with few exceptions, a true finding whereas sclerosis most frequently was false. About two-thirds of the reports of cyst and erosion were found to be true. The interobserver overall agreement rates for any two observers varied between 68% and 90%, for three observers between 65% and 82%, and for all four observers was 63%. The Kappa value for any two observers was 0.40-0.80, indicating fair to substantial agreement. The intra-observer agreement was only somewhat higher than the interobserver. This study shows that, with the aid of reference tomograms, high diagnostic accuracy and observer agreement can be achieved in sagittal tomography.
Radiographic examination is essential for the diagnosis and management of temporomandibular joint (TMJ) disorders. The goals of TMJ radiography are to evaluate cortical and trabecular architecture of the bony structures and confirm their integrity, to assess the extent and monitor progression of osseous changes, and to evaluate the response to treatment. Accurate evaluation of the TMJ by conventional radiography is limited by structure superimposition. Cone beam computed tomography (CBCT) provides high-resolution multiplanar images and delivers substantially lower radiation dose, compared with multislice CT. CBCT allows examination of TMJ anatomy without superimposition and distortion to facilitate analysis of bone morphology, joint space and dynamic function in all three dimensions. This article will describe the role of CBCT imaging for the assessment of the TMJ osseous structures and present typical appearances of common pathological conditions of the TMJ.
The purpose of this study was to determine whether bony changes in temporomandibular joint (TMJ) osteoarthritis (OA) is correlated with pain and other clinical signs and symptoms.
Clinical data and cone beam CT (CBCT) images of 30 patients with TMJ OA were analysed. The criteria of Koyama et al (Koyama J, Nishiyama H, Hayashi T. Follow-up study of condylar bony changes using helical computed tomography in patients with temporomandibular disorder. Dentomaxillofac Radiol 2007; 36: 472-477.) and Ahmad et al [Ahmad M, Hollender L, Anderson Q, Kartha K, Ohrbach R, Truelove EL, et al. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: 844-860.] were used to classify the condyles observed on the CBCT. Clinical measures included self-reported pain, mandibular range of motion, TMJ sound, pain on palpation of the TMJ and masticatory muscles, and pain on jaw function. Generalized linear modelling was used to correlate the clinical and radiographic findings and Spearman's rho was used to correlate the two classification systems.
There was poor correlation between the maximum condyle change and pain rating (Koyama: r² = 0.1443, p = 0.3995; Ahmad: r² = 0.0273, p = 0.9490), maximum mouth opening (Koyama: r² = 0.2910, p = 0.0629; Ahmad: r² = 0.2626, p = 0.0951), protrusion (Koyama: r² = 0.0875, p = 0.7001; Ahmad: r² = 0.1658, p = 0.3612), right lateral motion (Koyama: r² = 0.0394, p = 0.9093; Ahmad: r² = 0.0866, p = 0.6877) and left lateral motion (Koyama: r² = 0.0943, p = 0.6494; Ahmad: r² = 0.1704, p = 0.3236). Strong correlation was observed between Koyama et al's and Ahmad et al's classifications for average (r = 0.9216, p < 0.001) and maximum (r = 0.7694; p < 0.0001) bony change.
There was poor correlation between condylar changes (as observed on CBCT images), pain and other clinical signs and symptoms in TMJ OA.
As part of the Multisite Research Diagnostic Criteria For Temporomandibular Disorders (RDC/TMD) Validation Project, comprehensive temporomandibular joint diagnostic criteria were developed for image analysis using panoramic radiography, magnetic resonance imaging (MRI), and computerized tomography (CT).
Interexaminer reliability was estimated using the kappa (kappa) statistic, and agreement between rater pairs was characterized by overall, positive, and negative percent agreement. Computerized tomography was the reference standard for assessing validity of other imaging modalities for detecting osteoarthritis (OA).
For the radiologic diagnosis of OA, reliability of the 3 examiners was poor for panoramic radiography (kappa = 0.16), fair for MRI (kappa = 0.46), and close to the threshold for excellent for CT (kappa = 0.71). Using MRI, reliability was excellent for diagnosing disc displacements (DD) with reduction (kappa = 0.78) and for DD without reduction (kappa = 0.94) and good for effusion (kappa = 0.64). Overall percent agreement for pairwise ratings was >or=82% for all conditions. Positive percent agreement for diagnosing OA was 19% for panoramic radiography, 59% for MRI, and 84% for CT. Using MRI, positive percent agreement for diagnoses of any DD was 95% and of effusion was 81%. Negative percent agreement was >or=88% for all conditions. Compared with CT, panoramic radiography and MRI had poor and marginal sensitivity, respectively, but excellent specificity in detecting OA.
Comprehensive image analysis criteria for the RDC/TMD Validation Project were developed, which can reliably be used for assessing OA using CT and for disc position and effusion using MRI.
To develop "basic principles" on the use of dental cone beam CT by consensus of the membership of the European Academy of Dental and Maxillofacial Radiology.
A guideline development panel was formed to develop a set of draft statements using existing European directives and guidelines on radiation protection. These statements were revised after an open debate of attendees at a European Academy of Dental and Maxillofacial Radiology (EADMFR) Congress in June 2008. A modified Delphi procedure was used to present the revised statements to the EADMFR membership, utilising an online survey in October/November 2008.
Of the 339 EADMFR members, 282 had valid e-mail addresses and could be alerted to the online survey. A response rate of 71.3% of those contacted by e-mail was achieved. Consensus of EADMFR members, indicated by high level of agreement for all statements, was achieved without a need for further rounds of the Delphi process.
A set of 20 basic principles on the use of dental cone beam CT has been devised. They will act as core standards for EADMFR and, it is hoped, will be of value in national standard-setting within Europe.
This study examined the influence of lateral and frontal temporomandibular joint tomograms on the initial diagnosis and treatment plan of patients having facial or preauricular pain or temporomandibular joint disorders.
Five or six general dentists, all with experience in treating patients with disorders of the temporOmandibular joint, examined records of 105 patients from a university-based orofacial pain clinic. The examiners proposed a diagnosis and treatment plan for each patient without the benefit of tomograms. They then repeated this procedure after study of the radiographs. The impact of the radiographs was measured as the change in pre- versus postradiographic diagnosis and treatment plan.
The availability of temporomandibular joint tomograms changed or modified diagnosis in 65% of the judgments and influenced treatment recommendations in 40%. These changes were substantive for 21% of the diagnoses and 22% of the treatment plans. The strongest correlation to changes in both diagnosis and treatment plan was with radiographic detection of osseous changes. New information about condyle position had less effect on clinical decisions.
These findings indicate that temporomandibular joint tomograms play a valuable role in influencing clinician's diagnosis and treatment plan of patients with disorders of the temporomandibular joint.
We sought to compare a new limited cone beam computed tomography (CT) machine for dental use (3DX) with the multidetector CT machine for image quality and skin doses.
Images of the right maxillary central incisor and the left mandibular first molar of an anthropomorphic phantom were taken by both the 3DX and the multidetector CT. A 5-point method was used to evaluate the depiction of cortical and cancellous bone, enamel, dentin, pulp cavity, periodontal ligament space, lamina dura, and overall impressions. Furthermore, the skin doses for both modalities were compared.
The image quality of the 3DX was better than the multidetector CT for all items (P < .01). Moreover, the mean skin doses with the multidetector CT were 458 mSv per examination, whereas the doses with the 3DX were 1.19 mSv per examination.
These results clearly indicate the superiority of the 3DX in the display of hard tissues in the dental area while substantially decreasing the dose to the patient.
We sought to determine the prevalence of joint diseases in patients with either of 2 forms of myofascial pain (with and without limited mouth opening) and to verify the accuracy of temporomandibular joint-related clinical diagnoses through the use of magnetic resonance imaging (MRI).
On the basis of the results of a clinical examination carried out according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), 61 patients were divided into 2 subgroups. The first group consisted of 36 patients who had myofascial pain with limited mouth opening (MPLO), whereas the other 25 patients were diagnosed with myofascial pain without limited mouth opening. MRI was carried out on all patients. The clinical joint-related diagnoses from RDC/TMD were compared with MRI results.
Patients with MPLO often had joint diseases that were not detected by means of a clinical examination alone. The kappa statistic was used to compare MRI and clinical diagnoses, confirming poor agreement in patients with MPLO (kappa=0.13) and acceptable agreement in patients with myofascial pain without limited mouth opening (kappa=0.72).
Restricted mandibular mobility is frequently associated with temporomandibular joint diseases that were not identified during a clinical examination. Therefore, an adaptation of the classification scheme used for the RDC/TMDs may result in the improvement of the sensitivity of clinical joint-related diagnoses, especially in patients with MPLO.
Cone beam CT (CBCT) is a new technique for maxillofacial imaging. We describe a reconstruction technique for radiographic examination of the temporomandibular joint (TMJ) using CBCT, and we further present four cases where the technique was employed. The technique provides a complete radiographic investigation of the bony components of the TMJ. The reconstructed images are of high diagnostic quality. The examination time is shorter and the patient dose is lower than that with conventional CT. It may therefore be considered as the imaging technique of choice when investigation of bony changes of the TMJ is the task at hand.
We compared the diagnostic reliability of cone beam computed tomography (3DX) and helical computed tomography (helical CT) for the detection of osseous abnormalities of the mandibular condyle, using macroscopic observations as the gold standard.
Twenty-one temporomandibular joint autopsy specimens underwent imaging with 3DX and helical CT. The specimens were macroscopically evaluated for cortical erosion or osteophytosis and sclerosis. The images were independently assessed for the same osseous abnormalities. Observations with the two imaging modalities were compared with the macroscopic observations using the McNemar test.
According to the macroscopic observations, 10 of the 21 mandibular condyles and one fossa showed osseous abnormalities. 3DX detected abnormalities in eight of these condyles and helical CT identified abnormalities in seven, giving a sensitivity of 0.80 for 3DX and 0.70 for helical CT. The specificity of the condyle assessment was 1.0 for both 3DX and helical CT and hence, the accuracy was 0.90 and 0.86, respectively. No significant differences were detected between the 3DX and helical CT for assessment of osseous abnormalities of the mandibular condyle (P=0.286).
The cone beam CT equipment 3DX is a dose-effective and a cost-effective alternative to helical CT for the diagnostic evaluation of osseous abnormalities of the mandibular condyle.
To evaluate and compare the image validity of a cone beam CT machine for dental use (3DX) and the latest medical CT system, multidetector row helical CT (MDCT).
A dried right maxilla of an Asian adult was used as a phantom. It was cut from the zygomatic process towards the midline, parallel to the midline plane, into eight slices of 2 mm thickness. This phantom was imaged with the 3DX and MDCT machines. Images were evaluated by comparing them with one selected bone slice from the phantom. In this comparison, two types of MDCT images were used: one with the window level (WL) and window width (WW) suitable for observing teeth (MDCT tooth image), and the other appropriate for observing bone (MDCT bone image). Three dentists and one radiographer then used our reported subjective five-level scale to evaluate and compare images generated by the two systems in terms of validity. Cancellous bone as well as enamel, dentin, pulp cavity, periodontal ligament space, lamina dura and overall impression were evaluated.
Statistically significant differences (P<0.05) were found for almost all observation items. Our subjective evaluation clarified that 3DX was superior to MDCT in terms of image validity. Few significant intra- or interevaluator errors were found.
Our subjective evaluation of image validity clarified 3DX as being superior to MDCT. Taken together with the low skin dose we previously reported for 3DX, the results demonstrate 3DX to be beneficial for imaging diagnosis of hard tissues in the maxillofacial region.
To evaluate the effectiveness of a web-based instruction in the interpretation of anatomy in images acquired with maxillofacial cone beam CT (CBCT).
An interactive web-based education course for the interpretation of craniofacial CBCT images was recently developed at our institution. Self-evaluation modules on correlative anatomical features were also included to support the learning process. Three e-learner groups were selected to evaluate the effectiveness of the educational modules. The three groups were (1) oral health specialists (OHSs) (comprising periodontologists, prosthodontists, orthodontists and maxillofacial surgeons); (2) third grade (DS3) and (3) first grade (DS1) undergraduate dental students. The assessment modules that were part of the interactive web-course content were administered after delivery of the course material. In addition, each group received a computer affinity questionnaire to quantify the extent of knowledge about computers and a perception questionnaire to assess their attitudes toward the web-course.
The OHS group yielded significantly better scoring results in the post-course test than the pre-course test. However, no statistically significant differences in test scores were found for both undergraduate student groups (DS1 and DS3). All groups presented a highly positive attitude towards the web-course, as was demonstrated by the post-course perception questionnaire.
The present CBCT educational course is an effective didactic method for teaching OHSs the anatomical interpretation of CBCT multiplanar reformatted images and, for undergraduate students, it was found to be as effective as conventional educational methods in dentistry. The efficacy of a web-based educational course requires further evaluation.
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How to cite this article: Iskanderani D, Alstergren P,
Hellén-Halme K. Assessment of a training programme on
detection of temporomandibular joint osseous changes
applying pre-defined 2D multiplane cone beam computed
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Temporomandibular joint pathosis in patients with myofascial pain: a comparative analysis of magnetic resonance imaging and a clinical examination based on a specific set of criteria
- Schmitter