Is the digital radiographic detection of approximal caries lesions influenced by viewing conditions?

The Detection of Dental Pathologies on Periapical Radiographs—Results from a Reliability Study

(1) Background: Caries, periapical lesions, periodontal bone loss (PBL), and endo-perio lesions are common dental findings that require an accurate diagnostic assessment to allow appropriate disease management. The purpose of this reliability study was to compare the inter- and intra-rater reliability for the detection of the above-mentioned pathologies on periapical radiographs. (2) Methods: Fourteen dentists (three with more than two years and eleven with less than two years of work experience) participated in a training workshop prior to data acquisition. A total of 150 radiographs were assessed by all raters in two rounds. Cohen’s Kappa (CK) values and a binary logistic regression were calculated. (3) Results: The reliability was found in a moderate and substantial range of agreement: caries (mean inter-rater CK value/first round 0.704/mean inter-rater CK value/second round 0.659/mean intra-rater CK value 0.778), periapical lesions (0.643/0.611/0.768), PBL (0.454/0.482/0.739) and endo-perio lesion (0.702/0.689/0.840). The regression model revealed a significant influence of the clinical experience, and furthermore, periapical pathologies and PBL were identified less reliably in comparison to caries and endo-perio lesions. (4) Conclusions: The dentist’s ability to detect the chosen pathologies was linked with significant differences. Periapical lesions and PBL were identified less reliably than caries and endo-perio lesions.

Influence of different viewing conditions on the detection of fractured endodontic instruments using periapical radiographs at 3 projection angles

OBJECTIVES

The objective of this study was to assess the influence of ambient lighting levels and horizontal viewing angle (HVA) on the radiographic detection of fractured endodontic instruments in root canals in extracted human mandibular molars.

STUDY DESIGN

Thirty-two root canals were selected. Endodontic instrument fracture was induced in 24 canals, and all canals were endodontially treated. Periapical radiographs were obtained at orthoradial, mesioradial, and distoradial projection angles. Five oral radiologists examined the radiographs for detection of fractured endodontic instruments under 3 ambient lighting levels (high, 450 lux; medium, 28 lux; and low, 2.5 lux) and 3 HVAs (90°, 67.5°, and 45°). Area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, and specificity were calculated and compared by 2-way analysis of variance using Tukey post hoc tests (α = .05).

RESULTS

AUROC data indicated that ambient lighting (P = .739) and HVA (P = .238) did not significantly influence the detection of fractured endodontic instruments. Overall mean diagnostic values were 0.745, 0.57, 0.46, and 0.90 for AUROC, accuracy, sensitivity, and specificity, respectively.

CONCLUSIONS

The viewing conditions assessed in this study did not influence the radiographic detection of fractured endodontic instruments in root canals.

Influence of the image file format of digital periapical radiographs on the diagnosis of external and internal root resorptions

OBJECTIVES

To evaluate the influence of different image file formats of digital radiographic images on the diagnosis of external (ERR) and internal root resorption (IRR).

MATERIALS AND METHODS

Thirty-four human teeth were selected. For ERR, 20 teeth were used (10 control and 10 with simulated ERR), and for IRR, 14 teeth were used (before and after IRR simulation). Digital periapical radiographs were acquired using the Digora Toto system and exported in four different image file formats: TIFF, BMP, PNG, and JPEG, totaling 192 radiographs. Five examiners evaluated the images using the JPEGView software and scored the detection of ERR or IRR on a 5-point scale. Sensitivity, specificity, accuracy, and the area under the ROC curve were obtained for the diagnosis of ERR and IRR in the different image file formats. Two-way ANOVA compared the diagnostic values between the file formats and the Kappa test assessed intra- and inter-examiner agreement. The significance level was set at 5% (α = 0.05).

RESULTS

The mean values of intra-examiner agreement were substantial (0.740) for ERR and almost perfect (0.836) for IRR and, inter-examiner was fair (0.263) and moderate (0.421), respectively. No statistically significant differences were found among the different file formats for the diagnostic values of ERR and IRR.

CONCLUSION

The file format of digital radiographs does not influence the diagnosis of ERR and IRR.

CLINICAL RELEVANCE

Digital radiographic images may be susceptible to computational factors; however, they can be stored in multiple file formats without affecting the diagnosis of dental root resorptions.

Effect of image acquisition parameters on the radiopacity of bulk-fill and nanocomposite resins

OBJECTIVE

This study evaluated the radiopacity of 2 bulk-fill resins (SonicFill and Filtek Bulk Fill) and a nanocomposite (Filtek Z350 XT) resin compared with enamel, dentin, and aluminum as measured with different exposure parameters.

STUDY DESIGN

Resin disks were radiographed together with a 1-mm human tooth section and an aluminum stepwedge, at exposure times of 0.2 and 0.32 s, and source-image (S-I) distances of 30 and 40 cm, using complementary metal oxide semiconductor (CMOS) and photostimulable phosphor systems. Grayscale values were measured using ImageJ software. Paired Student t tests were used to compare the effect of the receptor on grayscale values for each material. Analysis of variance was used to evaluate the effects of receptor, exposure parameters, and the resins on radiopacity.

RESULTS

All resins exhibited greater radiopacity scores than enamel and were significantly different from each other. Filtek Z350 produced the lowest radiopacity values, whereas SonicFill produced the highest. The radiopacity values were higher on images acquired with CMOS receptors. Receptor type, exposure time, S-I distance, and material, as well as many interactions of these parameters, affected the radiopacity of the resins.

CONCLUSION

The tested resins complied with ISO 4049. Exposure parameters and digital receptors affected their radiopacity.