Assessment of enamel-dentin caries lesions detection using bitewing PSP digital images

Comparison of diagnostic ability of conventional film and storage phosphor plate in detecting proximal caries with direct measurements by stereomicroscope: A diagnostic test evaluation

Background:

Radiography plays an important role in detection of interproximal caries. The aim of study is to compare diagnostic ability of conventional film and photostimulable phosphor (PSP) with direct measurement using stereomicroscope in detecting proximal caries.

Methodology:

In this descriptive study – diagnostic test evaluation, 200 proximal surfaces of 100 extracted human posterior teeth were radiographed with dental X-ray unit. Evaluation of conventional and digital radiographs was performed twice by three observers. Carious lesions were classified based on a four-point scale (R0–R3) suggested by Abesi et al. Weighted kappa coefficients were calculated to assess intra- and interobserver agreement for each image set. Indices of diagnostic ability calculation were based on the first readings of the three observers. The scores were compared with the histological gold standard using receiver operating characteristic (ROC) analysis to evaluate diagnostic ability.

Results:

Intraobserver kappa coefficients calculated for each observer for each method of detecting caries ranged from 0.914 to 0.956. Interobserver kappa coefficients for each image set ranged from 0.8788 to 0.9583. The sensitivity and specificity of film for the first observer were 77.5% and 78.3% and for PSP were 77.5% and 80%, respectively. ROC analysis revealed that there were no statistically significant results (P > 0.05) between Az values for the two detection methods.

Conclusion:

PSP plate should be preferred over conventional films in detecting cavitated proximal caries. Further studies with more noncavitated proximal surfaces are required to conclusively establish the diagnostic ability of PSP over conventional film.

Diagnostic efficacy of and indications for intraoral radiographs in pediatric dentistry: a systematic review

PURPOSE

To systematically evaluate the diagnostic efficacy of intraoral radiographs and evidence supporting the indications for taking of intraoral radiographs in children in the following five clinical categories: caries, pathological conditions (including acute odontogenic infections and periodontal disease), dental/developmental anomalies, dental trauma, and enhancement of comfort/technique for taking radiographs in children. This was carried out to facilitate the updating of existing European Academy of Paediatric Dentistry (EAPD) guidelines on dental radiography in pediatric dentistry.

METHODS

A systematic electronic literature search was conducted on Cochrane Library (1992-24 July 2018), MEDLINE (PubMed, 1946-24 July 2018), EMBASE (Embase.com, 1974-24 July 2018) and Scopus (pre-1970-24 July 2018). Hand search of handbooks and grey literature search was also performed. Study screening and study inclusions were agreed upon by three authors. Data extraction, and methodological quality and risk of bias assessment were carried out in duplicate for each of the included studies.

RESULTS

A total of 9581 papers were identified. Following the primary and secondary assessment process, 36 papers were included in the final analysis. The included studies were further categorized into five main clinical categories for analysis: caries, pathological conditions, dental/developmental anomalies, dental trauma and comfort/technique-related studies. Only one paper was found to be of good quality and at low risk of bias; while, 9 papers were found of be at moderate risk of bias and 26 papers were at high risk of bias. Meta-analysis was not possible for any of the aforementioned clinical situations, and only a narrative synthesis was done.

CONCLUSION

There is insufficient high-quality evidence for the use of intraoral radiographs in pediatric dentistry and current guidelines are based largely on expert opinion. There is a clear need for well-conducted and standardized studies regarding the use of intraoral radiography in pediatric dentistry.

Biomimetic transformation of polyphosphate microparticles during restoration of damaged teeth

OBJECTIVE

In the present study, we investigated the fusion process between amorphous microparticles of the calcium salt of the physiological polymer comprising orthophosphate units, of inorganic polyphosphate (polyP), and enamel.

METHODS

This polymer was incorporated as an ingredient into toothpaste and the fusion process was studied by electron microscopy and by synchrotron-based X-ray tomography microscopy (SRXTM) techniques.

RESULTS

The data showed that toothpaste, supplemented with the amorphous Ca-polyP microparticles (aCa-polyP-MP), not only reseals tooth defects on enamel, like carious lesions, and dentin, including exposed dentinal tubules, but also has the potential to induce re-mineralization in the enamel and dentin regions. The formation of a regeneration mineralic zone on the tooth surface induced by aCa-polyP-MP was enhanced upon exposure to artificial saliva, as demonstrated by SRXTM. Energy dispersive X-ray analysis revealed an increase in the calcium/phosphorus atomic ratio of the enamel deposits to values characteristic for the particles during the treatment with polyP applied in the toothpaste, indicating a fusion of the particles with the tooth mineral.

SIGNIFICANCE

Our results suggest that toothpaste enriched with aCa-polyP-MP is a promising biomimetic material for accelerating enamel and dentin restoration.

An ex vivo comparative study of occlusal and proximal caries using terahertz and X-ray imaging

OBJECTIVES:

To examine the effectiveness of terahertz (THz) pulsed imaging (TPI) in comparison to intraoral photostimulable phosphor late (PSP) and cone beam CT (CBCT) for the detection of dental caries ex vivo.

METHODS:

Newly extracted 32 human permanent teeth surfaces (16 with caries and 16 without caries) were serially sectioned mesiodistally and imaged by using four image sets as follows: (1) CBCT; (2) PSP; (3) THz movie video; and (4) THz static images. All images were evaluated twice separately by two calibrated observers for the presence/absence of caries using a 5-grade rating/confidence scale. Weighted κ coefficients were calculated. Different image sets were compared with the histological gold-standard using the receiver operating characteristic and area under curves for each image set were compared using χ² tests, with a significance level of α = 0.05.

RESULTS:

Intra- and interobserverκ-values for all image sets were almost excellent ranging between 0.777 and 0.988. Mean Az values of observers and readings were 0.898 for CBCT, 0.888 for PSP images, 0.853 for THz static images and 0.781 for THz video movie. No statistically significant differences (p > 0.05) were found between Az values for the different image sets. When observer scores were evaluated according to caries location again no statistically significant differences (p > 0.05) were found between Az values for the occlusal and proximal caries for the four image sets.

CONCLUSIONS:

Terahertz pulsed imaging was found to be successful for the detection of dental caries ex vivo.

Detecting demineralization of enamel and cementum after gamma irradiation using radiographic densitometry

The purpose of this study was to evaluate the ability of radiographic densitometry in detecting the early demineralization of human enamel and cementum in irradiated and non-irradiated teeth. Sixty extracted teeth were divided into two groups: irradiated group and non-irradiated group. After irradiation, the groups were subjected to demineralization-remineralization (PH) cycling. Radiographic densitometric measurements (gray values) of a selected area of interest in the enamel and in the cementum of each tooth were performed at baseline and after PH cycling. After PH cycling, there was a significant reduction in gray values for both groups. The difference between "baseline" and "after PH cycling" values represents the reduction in the mineral content of the hard tissue, i.e., the demineralization. Results show that the demineralization of irradiated tooth enamel and cementum was significantly higher compared to that of non-irradiated tissues as determined by gray-level values. It is concluded that densitometric measurements by means of digital radiographs allow for the detection of demineralization of enamel and cementum, and can be used successfully for diagnosis of the early carious lesions in patients who received head and neck radiotherapy. This will allow implementation of remineralizing therapy and avoid the risk of progression of radiation caries. Furthermore, it is concluded that gamma irradiation with typical therapeutic doses for head and neck carcinoma is a direct cause of demineralization of tooth enamel and cementum.

Clinical performance of the near-infrared imaging system VistaCam iX Proxi for detection of approximal enamel lesions

OBJECTIVES/AIMS

Apart from the visual detection of caries, X-rays can be taken for detection of approximal lesions. The Proxi head of VistaCam iX intraoral camera system uses near-infrared light (NIR) to enable caries detection in approximal surfaces. The aim of this study was to evaluate the performance of the NIR for the detection of approximal enamel lesions by comparison with radiographic findings.

MATERIALS AND METHODS

One hundred ninety-three approximal surfaces from 18 patients were examined visually and using digital radiographs for presence or absence of enamel lesions. Then digital images of each surface were produced using the near-infrared light. Correlation between methods was assessed using Spearman's rank correlation coefficient (rs). Agreement between radiographic and NIR findings was calculated using the kappa coefficient. McNemar's test was used to analyse differences between the radiographic and NIR findings (α=0.05).

RESULTS

Moderate correlation was found between all detection methods (rs=0.33-0.50, P<0.0001). Agreement between the radiographic and NIR findings was moderate (κ=0.50, 95% CI=0.37-0.62) for the distinction between sound surfaces and enamel caries. No significant differences were found between the findings (P=0.07).

CONCLUSION

Radiographs and NIR were found to be comparable for the detection of enamel lesions in permanent teeth.

Diagnostic accuracy of digital and conventional radiography in the detection of non-cavitated approximal dental caries

Background

Radiography plays an important role in the detection of interproximal caries.

Objectives

The aim of the present study was to determine diagnostic accuracy of chargecoupled devices (CCD), Photo Stimulable Phosphor (PSP) and film radiography in detecting non-cavitated caries.

Patients and Methods

Seventy-two non-cavitated approximal surfaces of extracted human posterior teeth were radiographed under standardized conditions using three intraoral modalities: CCD Dixi3 (Planmeca, Finland), PSP Digora PCT (Soredex, Finland),and E-speed film (Kodak, USA). Radiographs were interpreted by four observers and caries lesions were classified as sound (R0), restricted to enamel (R1), reaching the dentinoenamel junction (DEJ) and the outer half of the dentin (R2) and the inner half of the dentin (R3). The teeth were subsequently sectioned for histological analysis which served as the gold standard for radiographic examination.

Results

Microscopic examinations showed that the distribution of caries were 63.9% sound, 18.1% enamel, 9.7% DEJ and outer half of the dentin and 8.3% into the inner half of the dentin.

The sensitivity and specificity of film, CCD and PSP for the detection of enamel caries were 38% and 98%; 15% and 96 %; and 23% and 98%, respectively.

The sensitivity and specificity of film, CCD and PSP for the detection of both dentin and enamel caries were 55% and 100%; 45% and 100% ; and 55% and 100%, respectively.

Conclusions

The results demonstrated that the diagnostic accuracy of digital images is similar to that of conventional film radiography in the detection of non-cavitated approximal caries.