Does digital radiography increase the number of intraoral radiographs? A questionnaire study of Dutch dental practices

Awareness and practice of dentomaxillofacial imaging among paediatric dentists: a questionnaire survey of members of the European Academy of Paediatric Dentistry

OBJECTIVES

Assess knowledge, attitudes and practices of paediatric dentists towards dentomaxillofacial imaging and correlate findings with practitioner and practice-specific characteristics.

METHODS

An online questionnaire was sent to all paediatric dentists who attended a scientific seminar organized by the European Academy of Paediatric Dentistry (EAPD) regarding dental radiology. Data regarding available equipment, number, type and reason for performing radiographs, frequency and reasoning for retakes were collected. Data analysis was performed according to practitioner- and practice-specific characteristics and factors directly associated with the type and frequency of radiographs taken, and reason and frequency of repeats were determined. Significant differences were tested using Chi-square and Fisher's exact test. Statistical significance was set at p < 0.05.

RESULTS

More than half of the participants (58%) reported having digital radiographic equipment and almost 1/4 (23%) conventional. A panoramic equipment was available in 39% working places and a CBCT scanner in 41%. Two thirds of the participants reported taking up to 10 intra-oral radiographs per week, mainly for trauma (75%) and caries diagnosis (47%). Extra-oral radiographs were prescribed to monitor development (75%) and for orthodontic evaluation, (63%) with a frequency of less than 5 weekly (45%). Participants reported that they repeat radiographs in a frequency of < 5 per week (70%) mainly due to patient's movement (55%).

CONCLUSIONS

The majority of paediatric dentists within Europe use digital imaging equipment for both intra- and extra-oral radiographs. Nevertheless, great variation in practices exists and, therefore, continuous education in oral imaging is crucial to maintain high quality standards for the radiographic examination of patients.

Intraoral Radiographic Processing Skills among Dentists in Saudi Arabia

AIM: The present study was designed to investigate use of intraoral radiographic techniques (conventional and digital) among general dental practitioners (GDP) in Saudi Arabia with focus on its availability in workplace, ease of the technique, and the recommended technique to be taught during undergraduate based on individual experience. METHODS: A questioner in form of a Google sheet was designed concerning demographic data, country, district, university, year of graduation, availability of radiographic technique available in workplace, which technique learned during undergraduate study, and which technique should teach during undergraduate study based on individual experience. A GDP list was developed from different dental groups on social media. The questioner was sent to the GDP list and to improve the response rate, telephone calls were made in advance to all expected participants. RESULTS: About 62.2% of participants were graduated within past 5 years, the most common dental X-ray processing technique learned during undergraduate study was the digital and conventional (both theoretical and practical) in 47.6% of participants followed by conventional (theoretical and practical) technique in 21% participants. Based on their work experience, 74.8% of participants preferred both digital and conventional techniques should be taught in dental Saudi Universities/Colleges while, the digital method was preferred by 21%. CONCLUSION: However, intraoral digital radiographic technique is widely available in most regions in Saudi Arabia; it is recommended to teach both intraoral digital and conventional radiographic techniques during undergraduate study.

Radiographic modalities for diagnosis of caries in a historical perspective: from film to machine-intelligence supported systems

Radiographic imaging for the diagnosis of caries lesions has been a supplement to clinical examination for approximately a century. Various methods, and particularly X-ray receptors, have been developed over the years, and computer systems have focused on aiding the dentist in the detection of lesions and in estimating lesion depth. The present historical review has sampled accuracy ex vivo studies and clinical studies on radiographic caries diagnosis that have compared two or more receptors for capturing the image. The epochs of film radiography, xeroradiography, digital intraoral radiography, panoramic radiography and other extraoral methods, TACT analysis, cone-beam CT and artificial intelligence systems aiding in decision-making are reviewed. The author of this review (43 years in academia) has been involved in caries research and contributed to the literature in all the mentioned epochs.

Quality and Findings of Bitewing Radiographs among Twenty-Year-Old Conscripts in Finland

Objectives

Bitewing radiographs are mainly used to confirm clinical findings in caries diagnostics. The objective here was to investigate the quality of bitewing radiographs after short brush-up training and additional findings besides caries in a low-caries population.

Methods

The material of this cross-sectional study comprised 377 pairs of bitewing radiographs of 19- to 20-year-olds taken by dentists. Radiography was considered indicated if one dentinal caries lesion was present on clinical examination. A senior oral radiologist evaluated quality and diagnosed the findings afterwards unaware of clinical status. The association between variables was analysed using cross tabulation and chi-squared testing.

Results

Almost half of the images were of compromised quality (44.1%). Dentinal caries lesions were detected in 82.3% and enamel lesions in 73.5% of the subjects. On average, the subjects had 1.7 (SD 0.52) dentinal lesions. Fillings were found in 81.8%, fractures/cracks in 11.7%, and attrition in 7.4% of the subjects. Signs of excessive bite force were recorded in 19.4%, whereas marginal bone loss was detected in 6.4%. No significant correlation was detected between fractures, attrition, and excessive bite forces.

Conclusions

Effort must be taken to ensure high quality of bitewing radiographs. In addition to caries detection, bitewing radiographs offer additional value, such as detecting excessive bite forces, tooth wear, and marginal bone loss among young adults.

Implementation of Digital Radiography during Root Canal Treatments in Saudi Endodontic and General Dental Practice

Objective:

To report usage of full-digital-radiography (FDR) during root-canal-treatments (RCTs) in Saudi dental-practice and to explore factors and measures that obstacle/contribute to better implementation.

Methods:

Following a pilot study, questions on demography, types of radiographic systems used during RCTs, advantages and disadvantages of FDR, reasons of not using it and measures that increase its implementation were included. The sample size was calculated considering the total number of general dentists (GDs) in Saudi Arabia and a 50-60% expected response rate. The questionnaire was emailed to 550 GDs and all endodontists in Saudi Arabia (185). A solo a reminder was emailed two months later. Data were analyzed by the Chi-square test at P=0.05.

Results:

Most participants (64.9%) used FDR for RCTs (P<0.001); with all endodontists (100%) and 52% of GDs (P<0.001). While all who were working in governmental-academia (100%) used FDR, 69.2% in private-academia did so (P<0.001); with no difference between private and governmental-clinics (60.6 and 69.2%). As the weekly-performed RCTs increased and participants’ experience decreased, FDR usage increased (P<0.05). While high-cost was the main FDR disadvantage, faster-workflow, better image-quality and less-radiation were the main advantages (P<0.001). The majority (76.1%) of FDR none-users were doing so because of unavailability. Participants reported lower-cost and better undergraduate-education as most effective measures that increase FDR implementation in dental-practice.

Conclusion:

FDR was adopted to good extent in Saudi dental-practice. Financial aspects were the main concern that should be addressed to increase FDR implementation in private practice. Endodontists showed better perception towards FDR and suggested more attention to educational aspects.

Outcomes of different radioprotective precautions in children undergoing dental radiography: a systematic review

PURPOSE

To evaluate the effectiveness of all radioprotective measures in underage patients who undergo a dental radiodiagnostic examination.

METHODS

A systematic review was performed including randomised controlled trials (RCTs), or cluster trials, cohort studies, cross-sectional studies, case-control studies and comparative in vitro research. These studies examined the healthy underage human population (below 18 years) undergoing a dental radiodiagnostic examination. All radioprotective measures were included except for justification as an intervention. The primary outcomes were in vivo mortality and morbidity. Some surrogate or indirect outcomes such as in vitro effective dose and organ absorbed doses were also accepted. Secondary outcomes with regards to image quality and therapeutic value were also analysed.

RESULTS

Eighteen papers were eligible for implementation. Fifteen studies underwent narrative synthesis. Regression analysis was performed on three studies.

CONCLUSION

The following radioprotective measures can reduce the exposure dose. For lateral cephalometry: collimation, filtration, the fastest receptor type and circumstantial thyroid shielding. For oblique lateral radiographs: the shortest exposure time, a smaller horizontal angulation, a longer focus to skin distance. For intraoral radiography: rectangular collimation, the fastest image receptor speed and thyroid shielding when the thyroid gland is in line of or very close to the primary beam. For panoramic radiographs: collimation, the fastest receptor type and the use of automatic exposure control (AEC) or manual adjustment of intensity. For cone-beam computed tomography: collimation, the largest voxels size in relation to the treatment need, change in image settings such as ultra-low dose settings, shorter exposure time, a lower amount of projections, lower beam intensity, reduction of the potential, use of a thyroid shield except in two situations and the use of AEC. All of the changes in exposure parameters should be performed while maintaining a sufficient therapeutic value on an individual and indication-based level.

Effect of different exposure times on caries detection and pixel value in a wireless digital system

Objectives

: The aim of this study was to assess, using the CDR Wireless®, the effect of different exposure times on caries detection and pixel intensity values.

Materials and Methods

Forty teeth were x-rayed using a Schick CDR Wireless sensor at eight different exposure times - 0.06, 0.10, 0.13, 0.16, 0.20, 0.25, 0.30, and 0.32 s. Four observers evaluated the images for presence of carious lesions scoring proximal surfaces of each tooth on a 5-point scale. Scores were compared to histological sections of the teeth. Accuracy was evaluated by means of ROC curve analysis. Radiographs of an aluminum step wedge were obtained using the same eight exposure times. Pixel intensity measurements were obtained, and mean pixel values were statistically analyzed using linear regression.

Results

The Az for each exposure time varied from 0.53 to 0.62. Two-way analysis of variance and Tukey test demonstrated that the exposure time of 0.25 s presented the best result and was significantly higher than 0.30 s and 0.35 s. In regard to mean pixel values, two different behaviors were observed, and the exposure time of 0.20 s presented mean pixel values in both phases.

Conclusion

The performance of the exposure times from 0.06 s to 0.25 s was satisfactory for proximal caries detection, and 0.25 s is the best as indicated for this finality.

Clinical Relevance

Considering that a reduction of exposure time represents a reduction of patient exposure dose, and this reduction cannot neglect image quality, the behavior of any digital system must be carefully evaluated.

Comparison of Efficiency and Image Quality of Photostimulable Phosphor Plate and Charge-Coupled Device Receptors in Dental Radiography

The photostimulable phosphor (PSP) plate and charge-coupled device (CCD) are receptors commonly used for intraoral radiography in U.S. dental schools. However, it is unclear which receptor is more beneficial for radiology education and patient care in an academic setting. The aim of this study was to compare the time efficiency, image quality, and operator performance for student-operated PSP plate and CCD receptors. At one U.S. dental school in 2018, 20 dental hygiene and dental students (n=10 each) were recruited as operators. They each exposed anterior and posterior periapical and bitewing radiographs on dental radiograph teaching and training replica using the PSP plate and CCD as receptors. The time taken to expose the radiographs was recorded. Image sharpness/definition, brightness/contrast, and technical errors, including placement, angulation, and cone cut errors, were evaluated on a three-point scale with 0=non-diagnostic, 1=diagnostic acceptable with minor errors, and 2=perfect diagnostic quality. The results showed that it was generally faster for the students to expose intraoral radiographs with CCDs than with PSP plates, although the difference was not significant (p>0.05). Image quality and technical accuracy, especially angulation, were significantly superior for PSP relative to CCD (p<0.05). This study found that PSP imaging was of higher quality and accuracy than CCD, whereas CCD was more efficient. Dental and dental hygiene students would benefit from being trained on both receptors to be able to adapt to a diversified workplace.

Dentists' use of digital radiographic techniques: Part I - intraoral X-ray: a questionnaire study of Swedish dentists

OBJECTIVE

The present study aims to gain knowledge about the dentist's use and choice of digital intraoral imaging methods.

MATERIALS AND METHODS

A questionnaire sent to 2481 dentists within the Swedish Dental Society contained questions about the type of X-ray technique used, problems experienced with digital radiography, and reasons for choosing digital technology, and about indications, clinic size and type of service. Response rate was 53%.

RESULTS

Ninety-eight percent of the dentists had made the transition to digital radiography; only 2% used film technique, and solid-state detector (SSD) was the most used digital technique. More years in service decreases the likelihood of applying individual indications for performing a full mouth examination. More retakes were done with SSDs compared to storage phosphor plates. Reasons for choosing digital techniques were that work was easier and communication with the patients improved. However, dentists also experienced problems with digital techniques, such as exposure and projection errors and inadequate image quality. The Swedish Radiation Safety Authority states that all radiological examinations should be justified, something not always followed.

CONCLUSIONS

This study showed that 98% of the respondents, Swedish dentists within the Swedish Dental Society, used digital techniques, and the most used was the solid-state technique.

Digital Intraoral Imaging Re-Exposure Rates of Dental Students

A guiding principle of radiation safety is ensuring that radiation dosage is as low as possible while yielding the necessary diagnostic information. Intraoral images taken with conventional dental film have a higher re-exposure rate when taken by dental students compared to experienced staff. The aim of this study was to examine the prevalence of and reasons for re-exposure of digital intraoral images taken by third- and fourth-year dental students in a dental school clinic. At one dental school in Canada, the total number of intraoral images taken by third- and fourth-year dental students, re-exposures, and error descriptions were extracted from patient clinical records for an eight-month period (September 2015 to April 2016). The data were categorized to distinguish between digital images taken with solid-state sensors or photostimulable phosphor plates (PSP). The results showed that 9,397 intraoral images were made, and 1,064 required re-exposure. The most common error requiring re-exposure for bitewing images was an error in placement of the receptor too far mesially or distally (29% for sensors and 18% for PSP). The most common error requiring re-exposure for periapical images was inadequate capture of the periapical area (37% for sensors and 6% for PSP). A retake rate of 11% was calculated, and the common technique errors causing image deficiencies were identified. Educational intervention can now be specifically designed to reduce the retake rate and radiation dose for future patients.

Repeat analysis of intraoral digital imaging performed by undergraduate students using a complementary metal oxide semiconductor sensor: An institutional case study

PURPOSE

This study was performed to quantify the repeat rate of imaging acquisitions based on different clinical examinations, and to assess the prevalence of error types in intraoral bitewing and periapical imaging using a digital complementary metal-oxide-semiconductor (CMOS) intraoral sensor.

MATERIALS AND METHODS

A total of 8,030 intraoral images were retrospectively collected from 3 groups of undergraduate clinical dental students. The type of examination, stage of the procedure, and reasons for repetition were analysed and recorded. The repeat rate was calculated as the total number of repeated images divided by the total number of examinations. The weighted Cohen's kappa for inter- and intra-observer agreement was used after calibration and prior to image analysis.

RESULTS

The overall repeat rate on intraoral periapical images was 34.4%. A total of 1,978 repeated periapical images were from endodontic assessment, which included working length estimation (WLE), trial gutta-percha (tGP), obturation, and removal of gutta-percha (rGP). In the endodontic imaging, the highest repeat rate was from WLE (51.9%) followed by tGP (48.5%), obturation (42.2%), and rGP (35.6%). In bitewing images, the repeat rate was 15.1% and poor angulation was identified as the most common cause of error. A substantial level of intra- and interobserver agreement was achieved.

CONCLUSION

The repeat rates in this study were relatively high, especially for certain clinical procedures, warranting training in optimization techniques and radiation protection. Repeat analysis should be performed from time to time to enhance quality assurance and hence deliver high-quality health services to patients.

Radiation shielding in dentistry: an update

The purpose of this article was to review the literature and provide guidelines on the use of radiation protection for patients in the dental setting. There are limited published data on the effects of low radiation doses such as those used in dental radiology. Most of the evidence is subject to bias, with risk models extrapolated from higher dose models such as studies of the Hiroshima bomb survivors. However, the lack of evidence does not denote the absence of risk, as there is no established 'safe' level of radiation exposure. All imaging utilizing ionizing radiation carries a risk for the patient. Hence the patient benefits of imaging must outweigh the potential risk. All diagnostic imaging should adhere to three basic principles, these being justification, optimization and application of dose limits. This article discusses dose reduction techniques and shielding of sensitive organs, particularly the thyroid, during procedures such as intraoral imaging, orthopantomograms and imaging of the pregnant patient.

DOSE REFERENCE LEVELS IN SPANISH INTRAORAL DENTAL RADIOLOGY: STABILISATION OF THE INCORPORATION OF DIGITAL SYSTEMS IN DENTAL CLINICAL PRACTICES

A total of 34 044 official quality assurance reports in dental radiodiagnostic surgery from 16 regions of Spain, compiled from 2002 to 2014, were studied in order to determine the progress of diagnostic reference levels (DRLs) for obtaining diagnostic images under normal conditions for clinical practice in Spanish dental clinics. A DRL of 2.8 mGy was set in 2014, which represents a 41.7 % decrease compared with that of 2002 (4.8 mGy). Over the same time period, the mean dose fell by 55.2 %. However, over the last 3 y, the stabilisation of the mean dose administered to patients has been observed with only a 6.7 % reduction in DRLs, which corresponds to the stabilisation of dental radiodiagnostic surgery on replacing the use of radiographic film with digital imaging systems.

Oral Radiology Safety Standards Adopted by the General Dentists Practicing in National Capital Region (NCR)

INTRODUCTION

With advancement in diagnostic techniques, the utilization of radiologic examination has risen to many folds in the last two decades. Ionizing radiations from the radiographic examination carry the potential for harm by inducing carcino-genesis in addition to the diagnostic information extracted. Radiation doses utilized in the course of dental treatment might be low for individual examinations but patients are exposed to repeated examinations very often and many people are exposed during the course of dental care. Therefore, principles of radiation protection and safety are necessary for the dentists to follow to ensure minimum and inevitable exposure.

AIM

The aim of this study was to investigate the knowledge and behaviour of general dentists practicing in the National Capital Region (NCR) regarding radiation safety during oral radiographic procedures.

MATERIALS AND METHODS

The study was a questionnaire based cross-sectional study. A total of 500 general dentists were contacted to participate in the study. The target population entailed of general dentists practicing in the National Capital Region. Data was computed and tabulated in Microsoft excel sheet and statistical analysis was performed with the help of SPSS version 21.0.

RESULTS

The total response rate recovered was 70.6% and the respondents comprised of 59% and 41% males & females respectively. Only 64.8% of the general dentists contemplated thyroid to be the most important organ for radiation protection. Only 28.8% of the general dentists followed the position & distance rule appropriately.

CONCLUSION

The results showed that the knowledge and behaviour of the general dentists and the practices adopted by them regarding radiation safety is not satisfactory. To ensure the following of basic and necessary guidelines for radiation safety and protection, strict rules with penalties should be implemented by the state councils and new and interesting methods of education for this spectrum of the field should be introduced.

Comparison of Swedish and Norwegian Use of Cone-Beam Computed Tomography: a Questionnaire Study

Objectives

Cone-beam computed tomography in dentistry can be used in some countries by other dentists than specialists in radiology. The frequency of buying cone-beam computed tomography to examine patients is rapidly growing, thus knowledge of how to use it is very important. The aim was to compare the outcome of an investigation on the use of cone-beam computed tomography in Sweden with a previous Norwegian study, regarding specifically technical aspects.

Material and Methods

The questionnaire contained 45 questions, including 35 comparable questions to Norwegian clinics one year previous. Results were based on inter-comparison of the outcome from each of the two questionnaire studies.

Results

Responses rate was 71% in Sweden. There, most of cone-beam computed tomography (CBCT) examinations performed by dental nurses, while in Norway by specialists. More than two-thirds of the CBCT units had a scout image function, regularly used in both Sweden (79%) and Norway (75%). In Sweden 4% and in Norway 41% of the respondents did not wait for the report from the radiographic specialist before initiating treatment.

Conclusions

The bilateral comparison showed an overall similarity between the two countries. The survey gave explicit and important knowledge of the need for education and training of the whole team, since radiation dose to the patient could vary a lot for the same kind of radiographic examination. It is essential to establish quality assurance protocols with defined responsibilities in the team in order to maintain high diagnostic accuracy for all examinations when using cone-beam computed tomography for patient examinations.

The quality of radiographs accompanying endodontic referrals to a health authority clinic

AIM

To assess the quality of radiographs accompanying endodontic referrals, from general dental practitioners, to a health authority clinic.

METHODS

A total of 200 conventional film and digital radiographs accompanying referrals were assessed and rated as 'excellent', 'diagnostically acceptable' or 'unacceptable' according to the National Radiographic Protection Board (NRPB) guidelines. Statistical analyses of the results included inter- and intra-observer agreement to achieve a kappa score and the chi-squared test.

RESULTS

Out of the 200 radiographs assessed, 38 (19%) were conventional film and 162 (81%) were digital. Of the conventional film radiographs, 55% were rated 'excellent' and 37% were 'diagnostically acceptable', whilst 27% of digital radiographs were rated 'excellent' and 40% were 'diagnostically acceptable'. In the 'unacceptable' category, 33% were digital and 8% were conventional film radiographs (p <0.001).

CONCLUSIONS

The quality of digital radiographs was significantly lower compared with conventional film radiographs. The percentage of 'unacceptable' digital radiographs was above the target according to the NRPB guidelines. Hence, there is a need for improvement in quality to avoid repeat radiographs and unnecessary ionising radiation exposure. Instead of hard, printed copies, digital radiographs accompanying referrals should, within the parameters of information governance, be supplied electronically so that they may be optimised, if necessary, for better diagnostic value.

How do dentists use CBCT in dental clinics? A Norwegian nationwide survey

OBJECTIVES

Cone beam computed tomography (CBCT) was introduced to Norwegian dental clinics in 2007. The aim of the study was to investigate how dental clinics use this imaging modality, including factors related to workflow and image quality, and to evaluate dentists' opinions on and experiences of using it.

MATERIALS AND METHODS

A web-based 59-item questionnaire regarding the clinical use of CBCT was sent to all 39 CBCT clinics in Norway.

RESULTS

Twenty-nine clinics (74%) responded. Most respondents (93%) were from clinics with more than one dentist and 83% had at least one specialist. All clinics had digital intraoral x-ray receptors and all but one had panoramic imaging. The most common indications for CBCT were implant treatment planning (34% of all clinics) and localization of impacted teeth (43% of specialist clinics). Seventy-two per cent of clinics reported an average of four or fewer CBCT examinations each week and 83% of respondents were subjectively satisfied with the image quality. The most commonly used enhancement functions were contrast (97%), brightness (90%) and zoom (86%).

CONCLUSIONS

The Norwegian CBCT clinics surveyed were fully digitized and had multiple dentists. Periodontists and oral and maxillofacial surgeons were the most frequent specialties represented in the clinics. Clinics with only dental specialists performed more CBCT examinations/week than clinics with general practitioners or both general practitioners and specialists. The most common indications for CBCT examinations were related to treatment planning. This study found some challenges related to image quality and communication within the radiological team.

Digital radiography in the dental practice: an update

The implementation of digital imaging in dental practice should be considered. The vast number of advantages of digital imaging include time saving and image manipulation. Dose reduction is a big attraction but in practical terms this might not be fully taken advantage of, as a number of studies suggest. Challenges of images storage, back-up and exchange should be taken into account. Careful planning and integration with practice software should lead to a smooth transition. Remember, computer systems sometimes fail and contingency plans should be in place to avoid disruption to the workflow of the practice.

Evolution of diagnostic reference levels in Spanish intraoral radiology

A total of 16 175 official reports of quality assurance on dental radiodiagnostic surgeries from 16 Spanish autonomous regions compiled during 2002-09 were studied to determine the evolution of diagnostic reference levels (DRLs) for obtaining a diagnostic image in the normal conditions of clinical practice in Spanish dental clinics. A DRL of 3.1 mGy was set in 2009, which represents a 35.4 % decrease compared with the dose determined in 2002 (4.8 mGy). During the same period, the mean dose fell by only 17.2 %. The DRL recommended by the European Union in 2004 for intraoral radiology is 4 mGy, and this study shows that 83.4 % of the installations used a dose below this. Of the installations using indirect or direct digital systems 1.1 and 1.2 %, respectively, used doses higher than those recommended, while 14.2 % of those using radiographic film exceeded this limit.

Questionnaire surveys of dentists on radiology

OBJECTIVES

Survey by questionnaire is a widely used research method in dental radiology. A major concern in reviews of questionnaires is non-response. The objectives of this study were to review questionnaire studies in dental radiology with regard to potential survey errors and to develop recommendations to assist future researchers.

METHODS

A literature search with the software search package PubMed was used to obtain internet-based access to Medline through the website www.ncbi.nlm.nih.gov/pubmed. A search of the English language peer-reviewed literature was conducted of all published studies, with no restriction on date. The search strategy found articles with dates from 1983 to 2010. The medical subject heading terms used were "questionnaire", "dental radiology" and "dental radiography". The reference sections of articles retrieved by this method were hand-searched in order to identify further relevant papers. Reviews, commentaries and relevant studies from the wider literature were also included.

RESULTS

53 questionnaire studies were identified in the dental literature that concerned dental radiography and included a report of response rate. These were all published between 1983 and 2010. In total, 87 articles are referred to in this review, including the 53 dental radiology studies. Other cited articles include reviews, commentaries and examples of studies outside dental radiology where they are germane to the arguments presented.

CONCLUSIONS

Non-response is only one of four broad areas of error to which questionnaire surveys are subject. This review considers coverage, sampling and measurement, as well as non-response. Recommendations are made to assist future research that uses questionnaire surveys.

The usage of digital radiography and cone beam computed tomography among Turkish dentists

OBJECTIVES

The aim of this study was to determine the prevalence of the use of digital radiography and report how it was used by Turkish dentists.

METHODS

The survey was based on 383 dentists who were present at the sixteenth International Congress organized by the Turkish Dental Association. A questionnaire which consisted of 19 questions was given to the dentists who participated in the study. Data were assessed according to frequency distribution and the χ(2) test was used to determine the significance of differences between two independent groups.

RESULTS

376 questionnaires were analysed. The mean age of the dentists who participated in the study was 37.14 ± 9.6 years (range: 20-63 years). The distribution of the dentists according to the 7 regions of Turkey were: Marmara 58%, Aegean 13% and Mediterranean 10%, Central Anatolia 8%, Black Sea 7%, Southeastern Anatolia 3%, Eastern Anatolia 1%. 124 dentists (33%) said they did not work with digital radiography. 95 dentists indicated that they did not use digital radiography owing to cost (60%). 252 dentists (67%) said they used digital radiography. 40% of the participants noted that the repetition of periapical radiographs was due to digital radiography. 166 dentists (55.9%) and 79.1% academicians had knowledge about cone beam CT (CBCT).

CONCLUSION

Digital radiography users are increasing in Turkey and levels of knowledge of CBCT and awareness of radiation safety has also increased.

An Investigation into Dental Digital Radiography in Dental Practices in West Kent following the Introduction of the 2006 NHS General Dental Services Contract

Aims

The primary aims of the study were to investigate the use of digital radiography within primary dental care practices in the West Kent Primary Care Trust (PCT) area and general dental practitioners’ (GDPs) self-reported change in radiographic prescribing patterns following the introduction of the nGDS contract in 2006.

Methods

Data were gathered via a piloted, self-completed questionnaire, and circulated to all GDPs listed on the National Health Service (NHS) Choices website as practising in the West Kent PCT area. There were three mailings and follow-up telephone calls. The resulting data were entered into a statistical software database and, where relevant, statistically tested, using the chi-square test and Pearson correlation coefficient.

Results

Of 223 GDPs, 168 (75%) responded. There were 163 usable questionnaires. The respondents represented 85% of the general dental practices in West Kent. Eighty (49%) respondents were using digital intra-oral radiography. Of those who used digital radiography, 44 (55%) reported that they used phosphor plate systems and 36 (45%) that they used direct digital sensors. Eighty-three (51%) had a panoramic machine in their practice, 46 of whom (55%) were using digital systems; of these, 32 (67%) were using a direct digital system. Seventy-one GDPs reported that they worked exclusively or mainly in private practice. Forty (56%) of these ‘mainly private’ GDPs reported that they used digital radiographic systems, whereas only 40 (44%) of the 89 ‘mainly NHS’ GDPs reported using digital radiographic systems. On average, mainly private GDPs made the transition to a digital radiographic system six months before mainly NHS GDPs. Of those who provided NHS dentistry before and after April 2006, only 18 (14%) reported taking fewer radiographs and seven (6%) taking more.

Conclusions

In February 2010, of the West Kent GDPs who responded to the questionnaire, just under 50% used digital radiography. Mainly private GDPs were more likely to use digital radiography than their mainly NHS counterparts. A link between digital radiography and increased prescription of radiographs was not specifically apparent from this study. There was no evidence that West Kent GDPs were taking fewer radiographs than they did prior to the introduction of the new GDS contract in April 2006. Research is needed to investigate whether the uptake of digital radiography by GDPs in the rest of the country is similar to that in West Kent.

The status of Spain's dental practice following the European Union directive concerning radiological installations: 11 years on (1996-2007)

OBJECTIVES

The aim of this study was to assess the influence of European Union legislation on dental radiology practice in Spain and the reduction in doses administered in dental radiological installations 11 years after its introduction.

METHODS

A total of 19 079 official reports on dental surgeries from 16 Spanish autonomous regions published between 1996 and 2007 were studied. We analysed the physical characteristics of the X-ray units, anomalies, film processing, exposure times and mean radiation doses administered in clinical situations.

RESULTS

The dose applied to obtain a radiograph of an upper second molar had decreased by 37% up until 2007, the mean dose being 2.7 mGy, with 81.1% of installations using a dose of less than 4 mGy, with a reference dose for the 3(rd) quartile of 3.6 mGy. Of note was the incorporation of digital systems (50.1%), which are gradually replacing manual processing systems (45.3%). There were significant differences between the systems: direct digital radiology < indirect digital radiology = Insight = Ektaspeed = Ultraspeed (P < 0.001). In installations with digital systems, 6.3% used more than 4 mGy (20.5% with direct radiology and 3.2% with indirect radiology) and 7.4% a dose of less than 0.5 mGy, with a mean dose of 1.8 mGy and a reference dose for the 3(rd) quartile of 2.3 mGy.

CONCLUSION

There has been a gradual improvement in dental radiology practices; however, the incorporation of digital systems has not resulted in all the benefits hoped for, and mistakes are frequent. Besides the physical parameters that have been established, anatomical and clinical image quality criteria should be established to convince dentists of the real benefits of incorporating quality guarantee procedures in their practices.

Patient discomfort and retakes in periapical examination of mandibular third molars using digital receptors and film

OBJECTIVE

The aim was to compare patient discomfort and evaluate the frequency of retakes using intraoral digital receptors and conventional film for radiographic examination of mandibular third molars.

STUDY DESIGN

Both mandibular third molar regions were examined in 110 patients with 2 of 5 digital intraoral receptors. Discomfort was scored on a visual analog scale (VAS) for each receptor and for film as a reference. If the whole tooth was not imaged on the digital image, a retake was performed using film. t Tests evaluated differences in VAS score, chi-squared tests evaluated differences in frequency of remakes, and logistic regression analyses evaluated factors predisposing for retake.

RESULTS

No significant difference existed in VAS scores between right and left sides for film (P = .24). The digital receptors were more uncomfortable than film (P < .001), and CDR-APS was more uncomfortable than Digora (P = .049) and Vista (P = .002). The frequency of retakes was higher for solid-state sensors than photostimulable phosphor plates (PSPs) (P < .018). Gender (P = .022), type of receptor (P < .021), and VAS score (P = .001) were predisposing factors for a retake.

CONCLUSION

Patients accepted film better than digital intraoral receptors, and retake frequency was lower for PSPs compared with solid-state sensors.

Better imaging: the advantages of digital radiography

BACKGROUND

Digital radiography has been available in dentistry for more than 25 years, but it has not replaced conventional film-based radiography completely. This could be because of the costs involved in replacing conventional radiographic equipment with a digital imaging system, or because implementing new technology in the dental practice requires a bit of courage. When the practitioner is fully aware of the new possibilities offered by digital radiography, he or she can make a more informed decision about adopting it. This article offers information about digital radiography, not just as a replacement of conventional radiography, but also as a concept offering benefits beyond those of conventional radiography.

OVERVIEW

Digital radiographs are composed of a set of numbers arranged as a grid of rows and columns. The dentist can perform mathematical operations on these numbers to create a new image in which certain characteristics are enhanced, thus making interpretation of the image easier. The dentist also can correct, to some extent, overexposed or underexposed images and can optimize contrast and brightness for specific diagnostic procedures, such as caries detection and bone level assessment. More advanced procedures are available as well, such as digital subtraction radiography and computer-aided recognition of image features.

CONCLUSIONS AND CLINICAL IMPLICATIONS

The author presents a selection of the advantages of digital radiography that are not achievable with conventional film-based radiography. Implementing digital radiography in the dental office requires additional training. However, once members of the dental team have gone through this initial phase, they have the benefits of several new diagnostic possibilities. With a digital system, information from radiographic images is collected more easily and in a more objective way, which will improve the performance of the diagnostic process.

European survey of dental X-ray equipment

The implementation of an X-ray Quality Assurance (QA) program is a legal requirement in Europe as stipulated in the EU Council Directive 97/43/EURATOM (MED). A review of the literature has identified that European countries are performing some level of QA testing of their dental X-ray equipment, although the type and level to which testing is performed can differ. The European SENTINEL co-ordination action proposed to collate a survey of equipment data for both conventional and digital dental X-ray installations among the SENTINEL partners. The European QA results confirm that systems can be operated below tolerance, and in some cases significantly so, while still in clinical use. This can occur despite servicing of equipment. The results have emphasised the fact that there is a requirement for the medical physics/engineering professions to become more closely involved in the management of dental radiology equipment. This also includes their involvement in the development and delivery of appropriate training courses for dentists and suppliers of dental radiology equipment.

Spanish dental hygienist attitudes to dental radiological protection: assessment of a 1-day pilot course

OBJECTIVES

To determine hygienists' knowledge of and attitudes to X-ray equipment and film processing, and to assess both after a 1-day course.

STUDY POPULATION

One-hundred and four dental hygienists from the south-east of Spain attending a 1-day course in oral radiology.

METHODOLOGY

A questionnaire comprising different sections related with socio-demographic items, X-ray equipment and the processing of dental films was answered before and after a 1-day pilot course on radiation protection.

RESULTS

The response rate was 89.42% (n = 93). Of the participants 94.6% were women, with a mean age of 29.52 (SD 6.861) and 7.20 years of professional experience (SD 5.089). The level of knowledge before the course was 48.28%, which increased to 85.62% after the course (P < 0.001).

CONCLUSIONS

The prescribed standard was reached by <23.65% of those attending the course at the beginning. Although attending the course led to a considerable improvement, it did not always result in a high level of knowledge of basic radiation equipment and processing.

The influence of the X-ray spectrum at compact bone-titanium interfaces in digital dental radiography

OBJECTIVES

To determine the optimum X-ray spectrum in digital dental radiography once the dose around an implant and the diagnostic usefulness of the image are taken into account.

MATERIALS AND METHODS

A Monte Carlo code (MCNP4B) was employed for computing the dose distribution across the bone-titanium interface. The X-ray spectra used were those met in digital dental radiography; 50-70 kVp, 2 mm Al total filtration, 5 kVp increment.

RESULTS

The variation of the ratio of dose with as opposed to without implant against depth reaches maximum values at the bone-implant interface that vary between 2.9 and 3.2. For the same number of photon histories followed, the higher the tube potential setting, the greater the dose both in contact and inside the implant.

CONCLUSION

In digital dental radiography, a 60-65 kVp spectrum accompanied by the known 30% reduction in mAs leads to lower dose to the patient for a diagnostically useful image.

Digital radiography in dentistry: a survey of Indiana dentists

OBJECTIVES

The purpose of this study was to assess the number of Indiana dental practices that utilize digital radiography and to identify the reasons for using or not using digital radiography.

METHODS

A questionnaire was sent to a random sample of 300 licensed dentists in the State of Indiana. Demographic, clinical and digital technology responses were obtained. The data were analysed using SPSS 12.0 (Statistical Package Social Sciences) software; t-tests and Pearson's chi(2) test were performed on several variables with significance levels set at P< 0.05.

RESULTS

One hundred and fifty-two dental practices (51%) responded to the survey. Thirty dental practices (19.7%) used digital radiography in their office. Twenty-two (73%) of the dentists using digital radiography were general practitioners. The number of dentists in a practice was a significant factor in predicting the use of digital radiography (t=2.57, P=0.011).

CONCLUSIONS

The results of this study indicate that digital radiography is more commonly used by general dentists in group practices.

A review of dentists' use of digital radiography and caries diagnosis with digital systems

OBJECTIVES

To investigate the evidence for (1) dentists' use of digital radiography and (2) the outcome of caries diagnosis with digital systems.

METHODS

A literature search with the software search package PubMed was used to get internet-based access to Medline through the website www.ncbi.nlm.nih.gov/pubmed. The search was limited to the years 1999-2005 since most papers dealing with the diagnostic value of digital radiography systems published before 1999 will hold little interest for today's users due to changes in the systems. The search strategies resulted in 123 articles (Table 1, #4 and #5). Original research articles (not reviews) were selected by the following inclusion criteria: (1) questionnaire studies on the use of direct digital intraoral radiography systems (not digitized film), (2) studies which used human teeth and natural caries lesions, and further in laboratory studies, the sectioned tooth was the gold standard for validating the presence or depth of a lesion.

RESULTS

The search resulted in 42 articles fulfilling the above criteria, which could be grouped into three types of studies: (a) questionnaire studies, (b) clinical (in vivo) studies, and (c) laboratory (in vitro) studies. Nine questionnaire studies, five clinical studies and 28 laboratory studies were found. These studies and their results are summarized in Tables 2-5.

CONCLUSIONS

The number of studies was limited, and some of the digital systems were evaluated in only one or two studies. A conclusive judgment may therefore not be possible for the majority of the digital systems selected for this review. There is a continuous need for the evaluation of new digital intraoral radiography systems that appear on the market, first and foremost for their image quality and diagnostic accuracy, but certainly also for their performance in the clinic, a clear deficiency observed after the literature search for the present review.

End-user survey for digital sensor characteristics: a pilot questionnaire study

OBJECTIVE

To survey end-user opinions on dental digital sensor characteristics for the design of a new X-ray imaging sensor.

MATERIALS AND METHODS

100 questionnaires were sent out to dentists and dental radiologists. The questionnaire consisted of six parts related to dental sensors. A: Details about the respondent; B: Prioritization of most important aspects of digital sensors; C: Rating advantages and D: disadvantages of digital sensors; F: Dental features that need to be enhanced by digital sensors; G: End-user comments.

RESULTS

Fifty-six questionnaires were returned. Contrast resolution and imaging time were assessed as the most and the least important aspects, respectively. Aspects considered as advantages by approximately 80% of respondents were: optimal contrast resolution, increased specificity, increased discrimination between diseased and healthy tissue, increased sensitivity, lower dose to the patient by more than 20%; as a disadvantage, increased patient dose was given. Dental features considered important by over 80% of the respondents were for intraoral radiographs: the visibility of caries, periapical, periodontal, and bone lesions; for panoramic radiographs: reduction of ghost images, image sharpness and bone. Bone and soft tissues on cephalograms and bone on temporomandibular joint (TMJ) tomograms were mentioned by over 70%.

CONCLUSION

The most desired characteristic for a new sensor is contrast resolution. Dose saving is not considered as important unless it is more than 20%. Examination time is not a major issue. Caries, periapical and periodontal, and bone lesions for intraoral radiographs, reduction of ghost images, image sharpness and bone for panoramic radiographs were the most frequently mentioned dental features that should be enhanced by digital sensors.

Evaluation of the linear measurements by conventional radiographs and indirect digital images in the endodontic treatment

INTRODUCTION

A successful endodontic therapy depends on the linear measurements obtained by means of radiographs taken during odontometry and also on the application of the established working length up to the final obturation.

OBJECTIVE

The aim of this study was to compare the precision of the linear measurement obtained by means of conventional radiographs and indirect digital images evaluated by the Digora 1.5 software during the different stages of endodontic treatment, as well as to evaluate the tools available on this software.

METHODS

A total of 160 radiographs of single-rooted teeth were obtained from files, which were analysed and divided in 4 groups comprising odontometry, cone fit, condensation and the final obturation. Analyses of the conventional radiographs and digitized images were performed by five previuosly calibrated examiners.

RESULTS

A high level of inter and intra-examiner agreement was observed through application of the Kendall coefficient and the correlation index, respectively. In relation to the results of linear measurement, the two-way variance analyses and the Tukey test revealed that, concerning the method, a statistically significant decrease was observed on the measurement obtained through the digital method when compared to the conventional radiograph (p<0,05). Moreover, the measurement presented a statistically significant difference among the different stages of endodontic treatment. Regarding interpretation of the digitized image, there was a statistically significant preference towards the Brightness and Contrast tool of the Digora 1.5 software, as evaluated through the Friedman test.

CONCLUSION

The present study demonstrated that image processing by the digital method aids the radiographic interpretation and consequently the determination of reference points for the achievement of the small linear measurements of endodontic treatment. The digital image provided statistically significant smaller linear measurements than those obtained by the conventional method.

An investigation into the use of bitewing radiography in children in Greater Glasgow

AIM

In recent years there have been a number of reviews and guidelines published with respect to the diagnosis and management of caries in children. Bitewing radiography remains the recommended method of choice for caries diagnosis in most circumstances. The aims of the study were to investigate the usage of bitewing radiography by general dental practitioners (GDPs) in Greater Glasgow, for the diagnosis of caries in children and to assess the usefulness of the technique as perceived by these dental practitioners.

DESIGN

A questionnaire for self completion was sent to all GDPs with an NHS list number in the Greater Glasgow area.

RESULTS

An 80% response rate was obtained with 303 GDPs responding. Less than half the dentists (44%) indicated that they always carried out caries risk assessments for all children, but 71% reported doing this for 6 and 7-year-old children. Approximately 60% of dentists stated they had read the recent radiation and caries management guidelines. Only 72% stated that they used radiography as a caries diagnostic tool in children, with 12 GDPs (4%) indicating they would never consider using bitewing radiography in children. Only 17% would consider taking bitewing radiographs in children under 6 years, and the majority of dentists (61%) reported that they would first consider taking radiographs in the 6-11-year-old age group. However, only a low proportion of children in this age band had dental x-rays taken. Bitewing radiography was considered to be more important for 12-year-olds than for 6-year-olds. Recommended methods for decreasing radiation exposure such as rectangular collimation and film holders were not being used universally, with 41% and 58% respectively using these devices.

CONCLUSIONS

A significant proportion of dentists in Greater Glasgow are not complying with recent guidelines and recommendations and it would appear that the value of bitewing radiography as a diagnostic tool in children is not being fully exploited.

The dynamic range of digital radiographic systems: dose reduction or risk of overexposure?

OBJECTIVES

To investigate the range of diagnostically acceptable digital radiographs and film as a function of exposure time, as well as the relationship to dose reduction and consequences for dental practice.

METHODS

Five systems for intraoral radiography were used to take a series of radiographs, with increasing exposure times, of five different dry bone specimens. Seven observers evaluated the 25 series of radiographs. The observers had to determine which radiographs of each series were acceptable for dental diagnostics and which radiograph of each series they preferred.

RESULTS

For Ektaspeed Plus film, the exposure time for the preferred radiograph was 0.52 s, with a range of diagnostically acceptable radiographs from 0.23-1.02 s. The preferred radiograph of the solid-state systems required less radiation than film (Sirona, 0.13 s; MPDx 0.35 s). The exposure range of these systems is narrow. In contrast, the exposure range of the phosphor plate systems is very wide. The preferred radiograph of the phosphor plate systems required high exposure (Digora, 1.21 s; Gendex DenOptix, 1.16 s).

CONCLUSIONS

All digital systems require less exposure than film for diagnostically acceptable radiographs, but this is less obvious for preferred radiographs. Solid-state systems alert the dentist when a too long exposure time is used by a lack of image quality; phosphor plate systems, however, produce good quality radiographs even at high exposure times, which may result in an unnecessarily high dose.