Clinical Trial of the Canary System for Proximal Caries Detection: A Comparative Study

Background: Detecting initial caries on the proximal surfaces of teeth in an intact dentition is a problem in dental practice since radiograph has been shown to have poor sensitivity with this stage of caries lesions. Hence there is need for an alternative technology. Objectives: The aim of this study was to investigate the efficacy of the Canary System (CS) to detect proximal caries in a clinical setting, comparing it with bitewing radiography (BWR). Methodology: 33 subjects, age 18 years and above, were recruited from a mixed population of low, moderate, and high caries risk patients. BWR and the CS were used to detect proximal caries lesions in these subjects. Teeth were separated by 48 hours insertion of rubber rings, and the proximal surfaces were examined by direct visual examination using the International Caries Detection and Assessment System II (ICDAS-II) scoring system. The Sensitivity (se), specificity (sp), positive (ppv) and negative predictive (npv) values of the CS and BWR in detecting caries on proximal surfaces were calculated by evaluating each method alone against ICDAS-II system (used as bronze standard). The two methods were compared statistically using their Area Under the Receiver Operating Curve (AUC). The sensitivities and specificities were compared using a test of proportions and AUC values were compared using DeLong’s method of nonparametric testing of AUC values. Results: The se, sp, ppv and npv for the CS are 0.92, 0.78, 0.89, 0.84 respectively, and for BWR are 0.67, 0.54, 0.78, and 0.40 respectively. The AUC of the Canary System (0.77) was statistically significantly higher than the AUC of the radiography (0.53, P < .001). Conclusions: This study demonstrated the efficacy of the Canary System in detecting proximal caries lesions to be greater than that of bitewing radiography. Clinical Significance: The Canary System can be a valuable clinical device for detecting and monitoring proximal caries lesions in clinical practice.

Detecting of Proximal Caries in Primary Molars using Pen-type QLF Device

The purpose of this in vivo study was to assess the clinical screening performance of a quantitative light-induced fluorescence (QLF) device in detecting proximal caries in primary molars. Fluorescence loss, red autofluorescence and a simplified QLF score for proximal caries (QS-proximal) were evaluated for their validity in detecting proximal caries in primary molars compared to bitewing radiography. Three hundred and forty-four primary molar surfaces were included in the study. Carious lesions were scored according to lesion severity assessed by visual-tactile and radiographic examinations. The QLF images were analyzed for two quantitative parameters, fluorescence loss and red autofluorescence, as well as for QS-proximal. For both quantitative parameters and QS-proximal, the sensitivity, specificity and area under receiver operating curve (AUROC) were calculated as a function of the radiographic scoring index at enamel and dentin caries levels. Both quantitative parameters showed fair AUROC values for detecting dentine level caries (△F = 0.794, △R = 0.750). QS-proximal showed higher AUROC values (0.757 - 0.769) than that of visual-tactile scores (0.653) in detecting dentine level caries. The QLF device showed fair screening performance in detecting proximal caries in primary molars compared to bitewing radiography.

Comparison of Laser Fluorescence and Digital Radiograph with International Caries Detection and Assessment System in Primary Teeth (In-vivo study)

Background: There has been an increased incidence of dental caries in children due to recent changes in lifestyle. More sensitive and reproducible diagnostic tools for precise caries detection in children are needed because of the complex occlusal anatomy. Aim: To compare the clinical performance and accuracy of international caries detection and assessment system-II (ICDAS II) versus DIAGNOdent pen and digital bitewing radiograph in the detection of occlusal caries in the primary teeth. Materials and Methods: Fifty children aged 6-11 years were assessed of both gender (29 girls and 21 boys) and 377 occlusal surface of primary teeth were examined by visual ICDAS II, DIAGNOdent pen and digital bitewing radiographic examination at D0 (non caries lesions), D1 (lesions limited to enamel) and D2 (lesions limited to dentin) thresholds. Results: Sensitivity at D0 for ICADS II was 14.23% and 95.95% for DIAGNOdent pen and 87.85% for digital bitewing, radiographs while specificity for both ICADS II and bitewing radiographs were 99.23% but 73.85% for DIAGNOdent pen. At D1, threshold sensitivity of ICADS II and digital bitewing radiographs were higher than DIAGNOdent pen but specificity for bitewing radiographs and DIAGNOdent pen 90.69% - 87.99%. were highly significant than ICADS II At D2, threshold specificity for all diagnostic methods was almost similar with better sensitivity for ICADS II and digital bitewing radiographs. Conclusion: This study showed that ICDAS II, Diagnodent pen, and bitewing radiography are effective for the detection of occlusal caries for primary molars. Digital bitewing radiography correlated stronger with ICDASII than Diagnodent pen and proved to be the best method to detect occlusal lesions within the dentin in primary molars while Diagnodent pen and bitewing radiography are better for detecting enamel caries lesion. In addition, the clinical performance of three diagnostic methods was insufficient to detect occlusal caries lesions separately. Consequently, it is advisable to use a combination of diagnostic methods, especially in unclear cases, as well as in cases of initial lesions and their monitoring.

Silicone loop alternative for posterior bitewing radiography

Background: Bitewing radiography is a technique that depicts the crown of the maxillary and mandibular teeth and the crest of the alveolar bone in the same receptor. The use of film holders and paper loops in bitewing techniques is very helpful in standardising radiographs, but it has some disadvantages, including the lack of efficiency and discomfort. Therefore, silicone has been widely used in the medical field as a replacement for paper loops. Purpose: This study was conducted to describe the compatibility of the silicone material as an alternative for bitewing radiography. Methods: This research is experimental and a one-shot case study. It used the Mann–Whitney (P < 0.05) test for statistical analysis to compare the results of the radiographs using silicone loops and paper loops and to analyse the quality of each radiograph: object coverage, density, contrast, sharpness, geometry, and overlapping. Results: The images where silicone loops were used show adequate results in six radiograph quality assessments. There was no significant difference between the radiographs that were obtained using the silicon loop and the paper loop (p > 0.05). Conclusion: Silicone loops can be an alternative tool for bitewing radiography because they result in optimal image quality.

Development and validation of two new image receptor-holding devices for overlapping reduction of proximal surfaces in bitewing radiography: a preclinical study

Objective: To create and validate two new Image Receptor-Holding devices (IRHDs) to reduce proximal surfaces overlapping in bitewing radiography in comparison to a regular well-established and commercially available IRHD. Methods: Two IRHDs for bitewing radiographs with a wedge on the biting surface were designed and 3D-printed. These IRHDs, with a large wedge (Pr-Lw) and small wedge (Pr-Sw), were compared with a regular commercially available IRHD (Rinn XCP®) during image acquisition of bitewing radiographs of four posterior regions (one upper region and three lower regions) in two dry skulls and mandibles. A total of 156 interproximal regions on bitewing radiographs were radiographed by 13 oral radiology graduate students and independently assessed by two oral radiologists (10 years of experience). IRHDs were compared by Cochran’s Q test regarding the number of overlapped proximal surfaces in the acquired radiographs with a significance level of 5%. Results: The observers were in perfect agreement (κ = 1.0) to classify the proximal surfaces overlapping. The Pr-Lw IRHD presented the lowest number of surfaces overlapping (19.2%) followed by the Pr-Sw IRHD (48.1%) and the XCP®IRHD with the highest surfaces overlapping (71.2%). The Pr-Lw IRHD surfaces overlapping was statistically different from the XCP IRHD (p < 0.001), and the Pr-Sw IRHD (p = 0.014). Conclusions: The Pr-Lw IRHD demonstrated the most efficient performance in overlapping surfaces reduction, compared with the Pr-Sw IRHD and the XCP® IRHD in adult dry skulls and mandibles.

The role of stationary intraoral tomosynthesis in reducing proximal overlap in bitewing radiography

Objectives: This study examined the utility of stationary intraoral tomosynthesis (s-IOT) in opening proximal contacts in bitewing radiography. Methods: 11 DENTSPLY Rinn Dental X-ray Teaching and Training Replica mannequins (Model #546002, Elgin, Ill) were imaged with a prototype s-IOT device (Surround Medical Systems, Morrisville, NC) and standard bitewing (SBW) technique. Premolar and molar bitewings were acquired with each system. Image receptor holders were used to position receptors and aid in the alignment of the position indicating devices. An expert operator (having more than 5 years of experience in intraoral radiography) acquired the images with the s-IOT prototype and standard intraoral X-ray devices. Images were assessed to analyze percentage overlap of the proximal surfaces using the tools available in ImageJ (NIH, Bethesda Maryland). Results: 253-paired surfaces were included in the analysis. The difference in overlap was statistically significant with standard bitewing (SBW) images resulting in a median overlap of 13%, a minimum of 0%, a maximum of 100% and an interquartile range of 40%. s-IOT resulted in a median overlap of 1%, a minimum of 0%, a maximum of 37% and an interquartile range of 0%. The s-IOT prototype substantially reduced proximal surface overlap compared to conventional bitewing radiography. Conclusions: The use of s-IOT reduced proximal contact overlap compared to standard bitewing radiography for an experienced radiographer. Stationary intraoral tomosynthesis may be a potential alternative to SBW radiography, reducing the number of retakes due to closed contacts.

In Vitro Comparison of Several Methods for Initial Proximal Caries Detection

Introduction: Initial proximal caries is both diagnostic and therapeutic challenge. The disadvantages of the conventional methods for caries detection and the development of technologies led to the creation of contemporary optical devices for early caries detection. Aim: In vitro comparison of the diagnostic accuracy of several methods for early proximal caries detection &ndash; visual-tactile, bitewing radiography and laser fluorescence device (DIAGNOdent pen). Materials and methods: Fifty-eight proximal surfaces of extracted human permanent premolars and molars were examined by two examiners using visual inspection, bitewing radiography, DIAGNOdent with proximal contact, and DIAGNOdent directly in the lesion. Results were compared with the histological gold standard. Statistical analysis with ROC curve, sensitivity, specificity and diagnostic accuracy of each detection method was performed. Analysis was conducted in 3 diagnostic thresholds &ndash; initial, developed and advanced demineralization. Results: Sensitivity of visual inspection was 16%&ndash;33%, specificity 93.3%&ndash;100%, sensitivity of bitewing radiography 54%&ndash;67%, speci&shy;ficity 93%&ndash;94%, sensitivity of DIAGNOdent with proximal surfaces in contact 88%&ndash;91%, specificity 79%&ndash;89%, sensitivity of DIAG&shy;NOdent directly 89%&ndash;92.5%, specificity 81.29%&ndash;93%. The highest diagnostic accuracy, increasing with the rise of the level of demin&shy;eralization, was shown by DIAGNOdent directly, followed by DIAGNOdent with proximal contact, bitewing radiography, and visual inspection with the lowest accuracy. Conclusion: The use of contemporary diagnostic devices significantly increases the possibility for early detection of proximal lesions. DIAGNOdent can be used as an adjunct to and increasing the diagnostic accuracy of the conventional caries detection methods.

Evaluation of General Dentistsʼ View Point of Relative Factors in Appropriate Prescription of Dental Radiographs in Yazd in 2018

Introduction: Due to preventing unnecessary exposure to x-ray, the dentists must acquire adequate information about radiography. Methods: This descriptive cross-sectional study was conducted on general dentists working in Yazd City, selected by convenience sampling method. The data were collected using a three-part questionnaire, the first part included demographic information of the dentists (age, gender, work experience, education level), and the second part contained the effective clinical findings in radiography (patient age, sex, history, radiographic costs, patient preferences, clinical observations, type of radiographic imaging system). Results: 120 dentists with an average age of 37.38 ± 9.88 were in this study. The greatest impact factors on decision making by dentists in prescribing radiography were: surgical treatment plan (87.5%), toothache (75%), poor oral hygiene and heavily restored dentition (73.3%) and those who afraid of X-ray exposure were the least effective factors. The top radiographic choice of most of the dentists for diagnosis of occlusal caries was periapical radiograph, with 55%, even though according to the existing researches bitewing radiography would be the effective method. The top choice for the diagnosis of interdental caries was bitewing radiography with 88.3%, which matched the existing researches. Conclusion: Based on the results of this study, it can be said that the dental community has little knowledge in the field of radiography for the diagnosis of occlusal carieshowever most of the dentists were right about diagnosing interdental caries. Therefore, it is important to hold retraining courses in order to maintain and improve the level of awareness of dentists and their familiarity with the latest radiographic techniques.