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.

Bisphophonate alterations of the jaw bones in individuals with multiple myeloma

Objectives: To verify quantitative differences of the mandibular cortical and trabecular bone between patients with multiple myeloma (MM) under bisphosphonate (BP) therapy and a control group never exposed to BP. Methods: Clinical and demographic characteristics were collected through medical records and interviews. Mandibular cortical thickness (MCT) and fractal dimension (FD) were measured on cone beam computed tomography (CBCT) images, on the molar region, in both groups. Additionally, FD was measured on periapical digital intraoral radiography and results were compared to CBCT measurements. Results: There were 33 patients with MM under BP therapy and 28 controls, with no significant differences in gender and age between groups. Pamidronate was used by all MM patients, either associated or not to other types of BP. The median MCT was higher in MM group exposed to BP (5.20 mm) than in controls (3.50 mm, p < 0.001). There were no significant differences in the median FD between patients in the MM group and controls, on CBCT (0.95 vs 0.90, p = 0.814) and periapical digital intraoral radiography (0.98 vs 0.96, p = 0.963), respectively, even when more than one type of BP was used. Conclusions: The MCT represents an useful tool in the detection of bone dimensional changes caused by BP, in patients with MM. Additional studies are necessary to improve the knowledge on the quantitative evaluation of trabecular jaw bone, in individuals with MM, under BP therapy.

Comparison of Micro-Computed Tomography and Digital Intraoral Radiography to Determine the Accuracy of Digital Radiographic Measurements of Mandibular Molar Teeth in Dogs

Introduction: The purpose of this study was to compare root and root canal width measurements between digital intraoral radiography (IOR) and micro-computed tomography (μCT). The accuracy of IOR measurements of canine mandibular molars was scrutinized to assess feasibility of developing a model to estimate animal age based on dentinal thickness. Materials and Methods: Thirty-nine canine mandibular first molars were imaged using μCT and IOR. For each tooth, the root and root canal width of the mesial and distal roots were measured by a single observer at 3 marked sites on μCT and IOR. Two different software programs were used to measure the radiographs. The radiograph measurements were compared to each other and to the μCT measurements. The μCT images were considered the anatomic reference standard for structural representation. Results: The data collected demonstrated IOR bias and variability throughout all measurement sites, with some sites being more affected than others. Neither IOR system produced unbiased measurements that closely reflected the μCT measurements consistently. The overall lack of agreement between measurements demonstrated the difficulties in developing a standardized protocol for measuring root and root canal width for the first molar teeth in dogs. Conclusion: Developing a protocol to accurately measure and compare μCT and IOR measurements is challenging. Designing a measurement system that would allow for universal application to age dogs would require continued research utilizing a standardized approach to overcome the limitations identified in this article.

Comparison of Cone-Beam Computed Tomography and Intraoral Radiography in Detection of Recurrent Caries under Composite Restorations

Secondary caries is the most common cause of dental restoration failures. This study aimed to compare the diagnostic accuracy of conventional and digital intraoral radiography and cone beam computed tomography (CBCT) for detection of recurrent caries around composite restorations. mesio-occluso-distal (MOD) cavities were prepared using bur on 45 extracted sound human molar teeth. The teeth were divided into 3 groups. In the control group, cavities were restored with composite resin after etching and bonding (n=15). In Group 2, 500-μm thick wax was placed over the buccal, lingual and gingival walls and the cavities were restored with composite resin. Group 3 specimens were subjected to pH cycling and artificial caries were created on the buccal, lingual and gingival walls. The cavities were restored with composite. Conventional and digital photo-stimulable phosphor (PSP; Optime) radiographs and two CBCTs images (NewTom 3G and Cranex 3D) were obtained from them. Presence or absence of caries in the cavity walls was assessed on these images. Data were analyzed using Kappa statistic. The diagnostic accuracy of CBCT was significantly higher than that of digital and conventional intraoral radiography (p<0.05). The accuracy was 0.83, 0.78, 0.55 and 0.49 for CBCT Cranex 3D, CBCT NewTom 3G, conventional and digital intraoral radiography, respectively. CBCT has a higher diagnostic accuracy than digital and conventional intraoral radiography for detection of secondary caries around composite restorations.

Identification of the Procedural Accidents During Root Canal Preparation Using Digital Intraoral Radiography and Cone Beam Computed Tomography

Crown or root perforation, ledge formation, fractured instruments and perforation of the roots are the most important accidents which appear during endodontic therapy. Our objective was to evaluate the value of digital intraoral periapical radiographs compared to cone beam computed tomography images (CBCT) used to diagnose some procedural accidents. Material and methods: Eleven extracted molars were used in this study. A total of 18 perforations and 13 ledges were created artifically and 10 instruments were fractured in the root canals. Digital intraoral periapical radiographs from two angles and CBCT scans were made with the teeth fixed in position. The images were evaluated and the number of detected accidents were stated in percentages. Statistical analysis was performed using the chi square-test. Results: On digital periapical radiographs the evaluators identified 12 (66.66%) perforations, 10 (100 %) separated instruments and 10 (76.9%) created ledges. The CBCT scans made possible the recognition of 17 (94.66 %) perforations, 9 (90 %) separated instruments and 13 (100%) ledges. The totally recognized accidental procedures showed significant differences between the two groups. (p<0.05) Conclusion: Digital periapical radiographs are the most common imaging modalities used during endodontic treatments. Though, the CBCT allows a better identification of the procedural accidents.