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Background: Changes in healthy and inflamed pulp on periapical radiographs are traditionally so subtle that they may be imperceptible to human experts, limiting its potential use as an adjunct clinical diagnostic feature. Aim: This study aimed to investigate the feasibility of an image‐analysis technique based on the convolutional neural network (CNN) to detect irreversible pulpitis in primary molars on periapical radiographs (PRs). Design: This retrospective study was performed in two health centres. Patients who received indirect pulp therapy at Peking University Hospital for Stomatology were retrospectively identified and randomly divided into training and validation sets (8:2). Using PRs as input to an EfficientNet CNN, the model was trained to categorise cases into either the success or failure group and externally tested on patients who presented to our affiliate institution. Model performance was evaluated using sensitivity, specificity, accuracy and F1 score. Results: A total of 348 PRs with deep caries were enrolled from the two centres. The deep learning model achieved the highest accuracy of 0.90 (95% confidence interval: 0.79–0.96) in the internal validation set, with an overall accuracy of 0.85 in the external test set. The mean greyscale value was higher in the failure group than in the success group (p =.013). Conclusion: The deep learning‐based model could detect irreversible pulpitis in primary molars with deep caries on PRs. Moreover, this study provides a convenient and complementary method for assessing pulp status. [ABSTRACT FROM AUTHOR]

Periapical radiography is a regular radiographic procedure performed by dentists. However, at times, it may not be possible to position the image receptor into a patient's mouth in an optimized or practical way. For these cases, some dentists advocated the use of extraoral periapical radiography (EOPA). This literature review aimed to review the dental literature on the use of EOPA. In October 2023, PubMed, Web of Science, and Scopus were searched to identify papers that reported on the use of EOPA, supplemented by manual reference tracing and Google Scholar searches. After screening, 18 papers published between 2003 and 2022 were identified, including 14 original articles and 4 reviews. From very limited and conflicting evidence, it was found that root length/working length measurements between EOPA and IOPA did not significantly differ or EOPA showed inferiority. No data were available to compare EOPA with other extraoral modalities such as panoramic radiography. The technique used in EOPA to visualize posterior teeth in the maxilla and mandible varied across studies, such as the vertical angulation of the primary beam, whether mouth should be opened or closed, and whether a holder should be used or not. At the current time, EOPA probably should not be advocated for regular use. [ABSTRACT FROM AUTHOR]

Since electronic apex locators (EALs) were developed and innovated, they offered the property of being a determinant for the termination or end point of root canal treatments. Multiple studies have evaluated the efficacy of EAL. These studies suggested that EALs are accurate and reliable for determining working length more than radiographs alone. Two databases have been searched for topics related to EALs: PubMed and Google Scholar. To find out the most relevant articles related to the study's aim, search was done to review articles between 2004 and 2022. Since many brands have different EALs with different generations, the study has been done using Root ZX and Raypex 5 of EAL, concluding that both the Root ZX and Raypex 5 give accuracy up to 96.6% and 93%, respectively, for detecting the apical constriction. In addition, the systematic review results revealed no significant difference among the four generations of apex locators for the determination of working length. EALs can measure working length control and determine apical constriction, even in the presence of blood or irrigants. In addition, this device is a reliable tool for detecting perforations, whether small or large. Therefore, EALs are an essential tool in endodontics and should be combined with radiographs to achieve a higher level of prognosis and success. [ABSTRACT FROM AUTHOR]

Periapical radiography is a regular radiographic procedure performed by dentists. However, at times, it may not be possible to position the image receptor into a patient’s mouth in an optimized or practical way. For these cases, some dentists advocated the use of extraoral periapical radiography (EOPA). This literature review aimed to review the dental literature on the use of EOPA. In October 2023, PubMed, Web of Science, and Scopus were searched to identify papers that reported on the use of EOPA, supplemented by manual reference tracing and Google Scholar searches. After screening, 18 papers published between 2003 and 2022 were identified, including 14 original articles and 4 reviews. From very limited and conflicting evidence, it was found that root length/working length measurements between EOPA and IOPA did not significantly differ or EOPA showed inferiority. No data were available to compare EOPA with other extraoral modalities such as panoramic radiography. The technique used in EOPA to visualize posterior teeth in the maxilla and mandible varied across studies, such as the vertical angulation of the primary beam, whether mouth should be opened or closed, and whether a holder should be used or not. At the current time, EOPA probably should not be advocated for regular use.

Aim: To report the radiographic preferences during dental implant therapy in Palestine. Materials and Methods: Fourteen multiple-choice questions were delivered in electronic and hardcopy formats questionnaires during the Sixth International Implantology Conference (Palestine). The questions investigated the radiographic techniques that are mostly used based on various clinical scenarios and treatment phases. Results: One hundred and thirty-seven responses were captured. The majority of the participants were general dentists with implant experience (79.6%). Less than a third of the participants (27.2%) were members of the Palestinian Association of Dental Implantology. The majority (85.9%) of them have their practice in a city zone. Panoramic radiograph (PAN) combined with cone beam computed tomography (CBCT) was the most preferred radiographic technique during the planning stage. Conclusion: PAN and CBCT was the preferred choice during the planning stages. A PAN was preferred postoperatively and if no complications were associated. In the case of symptomatic patients, CBCT was the radiograph of choice.

Radiography is essential in assessing osseointegration, specifically when using periapical radiography, a technique designed for evaluating osseointegration in dental implants. Therefore, this study aimed to analyze the density and microstructure of the osseointegration process in dental implants, both with and without the addition of gambir (Uncaria gambir Roxb.), through periapical radiography. The method used was an observational analytic comparative with a cross-sectional design involving a total sampling of rabbit tibia bone with dental implants installed on days 3, 14, and 28. In total, 24 periapical radiography images of the samples, taken over a span of 28 days, were selected using a total sampling technique, covering both gambir and control groups. The normality test was performed using the Shapiro-Wilk test, the qualitative assessment employed the Mann-Whitney test, and the quantitative assessment involved one-way ANOVA along with post hoc tests. The results showed that the average values per time in both gambir and control groups had p-values > 0.05 for all variables. However, for bone volume/total volume (BV/TV) in the control group over time, the p-value was < 0.05. A descriptive trend emerged, showing superior values in density and microstructure between gambir and control groups across different time intervals of days 3, 14, and 28 when employing periapical radiography. Additionally, it was important to note that no statistically significant differences were observed. [ABSTRACT FROM AUTHOR]

Abstract Background Introducing artificial intelligence (AI) into the medical field proved beneficial in automating tasks and streamlining the practitioners’ lives. Hence, this study was conducted to design and evaluate an AI tool called Make Sure Caries Detector and Classifier (MSc) for detecting pathological exposure of pulp on digital periapical radiographs and to compare its performance with dentists. Methods This study was a diagnostic, multi-centric study, with 3461 digital periapical radiographs from three countries and seven centers. MSc was built using Yolov5-x model, and it was used for exposed and unexposed pulp detection. The dataset was split into a train, validate, and test dataset; the ratio was 8–1-1 to prevent overfitting. 345 images with 752 labels were randomly allocated to test MSc. The performance metrics used to test MSc performance included mean average precision (mAP), precision, F1 score, recall, and area under receiver operating characteristic curve (AUC). The metrics used to compare the performance with that of 10 certified dentists were: right diagnosis exposed (RDE), right diagnosis not exposed (RDNE), false diagnosis exposed (FDE), false diagnosis not exposed (FDNE), missed diagnosis (MD), and over diagnosis (OD). Results MSc achieved a performance of more than 90% in all metrics examined: an average precision of 0.928, recall of 0.918, F1-score of 0.922, and AUC of 0.956 (P

Background : Introducing artificial intelligence (AI) into the medical field proved beneficial in automating tasks and streamlining the practitioners' lives. Hence, this study was conducted to design and evaluate an AI tool called Make Sure Caries Detector and Classifier (MSc) for detecting pathological exposure of pulp on digital periapical radiographs and to compare its performance with dentists. Methods : This study was a diagnostic, multi-centric study, with 3461 digital periapical radiographs from three countries and seven centers. MSc was built using Yolov5-x model, and it was used for exposed and unexposed pulp detection. The dataset was split into a train, validate, and test dataset; the ratio was 8–1-1 to prevent overfitting. 345 images with 752 labels were randomly allocated to test MSc. The performance metrics used to test MSc performance included mean average precision (mAP), precision, F1 score, recall, and area under receiver operating characteristic curve (AUC). The metrics used to compare the performance with that of 10 certified dentists were: right diagnosis exposed (RDE), right diagnosis not exposed (RDNE), false diagnosis exposed (FDE), false diagnosis not exposed (FDNE), missed diagnosis (MD), and over diagnosis (OD). Results: MSc achieved a performance of more than 90% in all metrics examined: an average precision of 0.928, recall of 0.918, F1-score of 0.922, and AUC of 0.956 (P<.05). The results showed a higher mean of 1.94 for all right (correct) diagnosis parameters in MSc group, while a higher mean of 0.64 for all wrong diagnosis parameters in the dentists group (P<.05). Conclusions: The designed MSc tool proved itself reliable in the detection and differentiating between exposed and unexposed pulp in the internally validated model. It also showed a better performance for the detection of exposed and unexposed pulp when compared to the 10 dentists' consensus. [ABSTRACT FROM AUTHOR]

Furcation defects pose a significant challenge in the diagnosis and treatment planning of periodontal diseases. The accurate detection of furcation involvements (FI) on periapical radiographs (PAs) is crucial for the success of periodontal therapy. This research proposes a deep learning-based approach to furcation defect detection using convolutional neural networks (CNN) with an accuracy rate of 95%. This research has undergone a rigorous review by the Institutional Review Board (IRB) and has received accreditation under number 202002030B0C505. A dataset of 300 periapical radiographs of teeth with and without FI were collected and preprocessed to enhance the quality of the images. The efficient and innovative image masking technique used in this research better enhances the contrast between FI symptoms and other areas. Moreover, this technology highlights the region of interest (ROI) for the subsequent CNN models training with a combination of transfer learning and fine-tuning techniques. The proposed segmentation algorithm demonstrates exceptional performance with an overall accuracy up to 94.97%, surpassing other conventional methods. Moreover, in comparison with existing CNN technology for identifying dental problems, this research proposes an improved adaptive threshold preprocessing technique that produces clearer distinctions between teeth and interdental molars. The proposed model achieves impressive results in detecting FI with identification rates ranging from 92.96% to a remarkable 94.97%. These findings suggest that our deep learning approach holds significant potential for improving the accuracy and efficiency of dental diagnosis. Such AI-assisted dental diagnosis has the potential to improve periodontal diagnosis, treatment planning, and patient outcomes. This research demonstrates the feasibility and effectiveness of using deep learning algorithms for furcation defect detection on periapical radiographs and highlights the potential for AI-assisted dental diagnosis. With the improvement of dental abnormality detection, earlier intervention could be enabled and could ultimately lead to improved patient outcomes. [ABSTRACT FROM AUTHOR]

Vertical distortion plays an important role in determining the working length of endodontic treatment. The objective of this study was to determine the mean value of vertical distortion on the periapical radiographs of maxillary and mandibular teeth based on the measurement of the difference in the radiographic and actual size of the tooth length. The study was carried out on 120 samples of medical records, along with periapical radiographs of endodontic patients, divided into 60 samples of maxillary teeth and 60 samples of mandibular teeth. The measurement of clinical tooth length was obtained by using the value of actual working length plus 1 mm, as recorded in the patient's endodontic dental record data. The radiographic tooth length measurement was obtained using the patient's initial periapical radiograph. The value of vertical distortion was obtained by measuring the difference between the radiographic measurement and the clinical tooth length. Intraobserver and interobserver reliability tests were performed using the Intra Correlation Coefficient (ICC) test, and comparative analysis was performed using the Student T-test independent. The analysis showed that the mean vertical distortion in the maxillary teeth was 1.58 mm, with a maximum value of 5.53 mm. The mean value of vertical distortion in the mandibular teeth was 1.48 mm, with a maximum value of 3.96 mm. A total of 52 (43.33%) samples were elongated, 55 (45.83%) samples were shortened, and 13 (10.83%) samples were not distorted. This study's results indicate no statistical difference in vertical distortion between estimated clinical tooth length and tooth length measurements on the radiographs. [ABSTRACT FROM AUTHOR]

The primary objective of this paper is to explore the diverse range of radiographic imaging techniques available for implant diagnosis and treatment planning. Pre-placement examination heavily relies on the utilization of these imaging modalities, as they play a critical role in ensuring the success of dental implant restorations by providing comprehensive diagnostic information about the patient's orofacial bony structures. Advancements in radiographic imaging have revolutionized the field of implant dentistry, offering dental professionals a wide array of imaging options to assess and plan implant procedures accurately. Having access to a variety of radiographic imaging techniques empowers dental practitioners to make well-informed decisions during implant treatment planning. It ensures that the implant procedure is tailored to the patient's unique anatomy and increases the chances of long-term success for dental implant restorations. [ABSTRACT FROM AUTHOR]

Periapical radiography is a routine radiographic procedure performed by dentists on a daily basis. It can be taken with two techniques, the paralleling technique (P tech) and the bisecting angle technique (B tech). This systematic review aimed to identify the relevant literature, compare the use of P and B techs across various dental specialties, and determine the most appropriate technique to be used for different purposes in taking periapical radiographs. In January 2023, we searched PubMed, Web of Science, Scopus, and Google Scholar to identify the studies that compared the two radiographic techniques. The search string was: (paralleling AND ("bisecting angle" OR "bisected angle")). Manual reference tracing was also performed to identify the studies potentially missed. After screening, 26 studies were included for the qualitative review. The 26 included studies were published between 1976 and 2021. Ten of the studies were about general dentistry (dental radiology in general applications), whereas another ten studies were related to endodontics, such as working length estimation. Most studies advocated the use of the P tech for general, endodontics, implantology, and other indications. B tech was advocated for patients with a low palatal height. More future studies are needed to evaluate their performance in different scenarios with standardized equipment and radiographic positioning. [ABSTRACT FROM AUTHOR]

As the popularity of dental implants continues to grow at a rate of about 14% per year, so do the risks associated with the procedure. Complications such as sinusitis and nerve damage are not uncommon, and inadequate cleaning can lead to peri-implantitis around the implant, jeopardizing its stability and potentially necessitating retreatment. To address this issue, this research proposes a new system for evaluating the degree of periodontal damage around implants using Periapical film (PA). The system utilizes two Convolutional Neural Networks (CNN) models to accurately detect the location of the implant and assess the extent of damage caused by peri-implantitis. One of the CNN models is designed to determine the location of the implant in the PA with an accuracy of up to 89.31%, while the other model is responsible for assessing the degree of Peri-implantitis damage around the implant, achieving an accuracy of 90.45%. The system combines image cropping based on position information obtained from the first CNN with image enhancement techniques such as Histogram Equalization and Adaptive Histogram Equalization (AHE) to improve the visibility of the implant and gums. The result is a more accurate assessment of whether peri-implantitis has eroded to the first thread, a critical indicator of implant stability. To ensure the ethical and regulatory standards of our research, this proposal has been certified by the Institutional Review Board (IRB) under number 202102023B0C503. With no existing technology to evaluate Peri-implantitis damage around dental implants, this CNN-based system has the potential to revolutionize implant dentistry and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Aim: To report the radiographic preferences during dental implant therapy in Palestine. Materials and Methods: Fourteen multiple-choice questions were delivered in electronic and hardcopy formats questionnaires during the Sixth International Implantology Conference (Palestine). The questions investigated the radiographic techniques that are mostly used based on various clinical scenarios and treatment phases. Results: One hundred and thirty-seven responses were captured. The majority of the participants were general dentists with implant experience (79.6%). Less than a third of the participants (27.2%) were members of the Palestinian Association of Dental Implantology. The majority (85.9%) of them have their practice in a city zone. Panoramic radiograph (PAN) combined with cone beam computed tomography (CBCT) was the most preferred radiographic technique during the planning stage. Conclusion: PAN and CBCT was the preferred choice during the planning stages. A PAN was preferred postoperatively and if no complications were associated. In the case of symptomatic patients, CBCT was the radiograph of choice. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the quality of mandibular trabecular structure in postmenopausal women using periapical radiographs. Postmenopausal women are subjected to low bone quality; hence, early detection methods are needed. In addition to bone mineral density (BMD), trabecular architecture must be assessed to determine bone quality. The mandible represents bone quality and allows the assessment of trabecular structure from periapical radiographs. Material and Methods: Lumbar (BMDL) and femoral BMD (BMDF) examinations were performed using dual-energy X-ray absorptiometry (DXA) in 31 postmenopausal women and divided into normal, osteopenia, and osteoporotic groups. Periapical radiographs were taken at both posterior sites of the mandible. The region of interest was taken 2 mm from the apical root of the first molar. Trabecular parameters consisting of trabecular thickness (Tb.Th) and bone percentage (BA/TA) were measured using BoneJ. Results: Both trabecular parameters were significantly correlated with BMDF [BA/TA ​​(r = 0.3796; p 0.05). Conclusion: Changes in mandibular trabeculae structure in postmenopausal women can be assessed using periapical radiographs.

Periapical radiography is a routine radiographic procedure performed by dentists on a daily basis. It can be taken with two techniques, the paralleling technique (P tech) and the bisecting angle technique (B tech). This systematic review aimed to identify the relevant literature, compare the use of P and B techs across various dental specialties, and determine the most appropriate technique to be used for different purposes in taking periapical radiographs. In January 2023, we searched PubMed, Web of Science, Scopus, and Google Scholar to identify the studies that compared the two radiographic techniques. The search string was: (paralleling AND (“bisecting angle” OR “bisected angle”)). Manual reference tracing was also performed to identify the studies potentially missed. After screening, 26 studies were included for the qualitative review. The 26 included studies were published between 1976 and 2021. Ten of the studies were about general dentistry (dental radiology in general applications), whereas another ten studies were related to endodontics, such as working length estimation. Most studies advocated the use of the P tech for general, endodontics, implantology, and other indications. B tech was advocated for patients with a low palatal height. More future studies are needed to evaluate their performance in different scenarios with standardized equipment and radiographic positioning.

Periapical Inflammation (PI) is one of the most popular diseases in adults due to complication of endodontitis or dental trauma with corresponding consequences to quality-of-life like tiredness and signs of infection. Specifically, patients having severe PI are often tiredness and high fever accompanied by signs of infection such as dry lips, dirty tongue, lymph node reaction in the area under the jaw. In X-Ray images, PI could be recognized by vague boundaries with signs of periapical ligament extensions. It is necessary to design a computerized diagnosis system based on the Deep Learning models for supporting clinicians in diagnosis of PI from X-Ray images. In this paper, we propose a new medical system called VNU for diagnosis of PI from X-Rays images. The VNU system uses Deep Learning to classify whether X-Ray images being PI or not. The Residual Neural Network (ResNet) with 34 layers is utilized with proper data augmentation and learning algorithms. The system is designed based on 7-layer enterprise architecture (User, Business, Application, Data, Technology, Infrastructure, and Security). It is used by both the clinicians and IT operators. The system has been validated on real data from Hanoi Medical University, Vietnam consisting of 900 images with PI and 500 normal images. Two scenarios of validation namely hyperparameter selection and performance comparison with other CNN-based Deep Learning models have been performed. It has been found from the experiments that the proposed system has better performance than the others in terms of sensitivity and specificity with the corresponding values of 96.70% and 93.87%. The system is deployed on the web interface that offers flexibility for clinicians in diagnosis and training. [ABSTRACT FROM AUTHOR]

The present study aimed to evaluate the performance of convolutional neural networks (CNNs) that were trained with small datasets using different strategies in the detection of proximal caries at different levels of severity on periapical radiographs. Small datasets containing 800 periapical radiographs were randomly categorized into a training and validation dataset (n = 600) and a test dataset (n = 200). A pretrained Cifar-10Net CNN was used in the present study. Different training strategies were used to train the CNN model independently; these strategies were defined as image recognition (IR), edge extraction (EE), and image segmentation (IS). Different metrics, such as sensitivity and area under the receiver operating characteristic curve (AUC), for the trained CNN and human observers were analysed to evaluate the performance in detecting proximal caries. IR, EE, and IS recognition modes and human eyes achieved AUCs of 0.805, 0.860, 0.549, and 0.767, respectively, with the EE recognition mode having the highest values (p all < 0.05). The EE recognition mode was significantly more sensitive in detecting both enamel and dentin caries than human eyes (p all < 0.05). The CNN trained with the EE strategy, the best performer in the present study, showed potential utility in detecting proximal caries on periapical radiographs when using small datasets. [ABSTRACT FROM AUTHOR]

To analyze the quality of mandibular trabecular structure in postmenopausal women using periapical radiographs. Postmenopausal women are subjected to low bone quality; hence, early detection methods are needed. In addition to bone mineral density (BMD), trabecular architecture must be assessed to determine bone quality. The mandible represents bone quality and allows the assessment of trabecular structure from periapical radiographs. Lumbar (BMDL) and femoral BMD (BMDF) examinations were performed using dual-energy X-ray absorptiometry (DXA) in 31 postmenopausal women and divided into normal, osteopenia, and osteoporotic groups. Periapical radiographs were taken at both posterior sites of the mandible. The region of interest was taken 2 mm from the apical root of the first molar. Trabecular parameters consisting of trabecular thickness (Tb.Th) and bone percentage (BA/TA) were measured using BoneJ. Both trabecular parameters were significantly correlated with BMDF [BA/TA ​​(r = 0.3796; p < 0.05) and Tb.Th (r = 0.508; p < 0.05)]. BA/TA and Tb.Th were significantly different between the osteoporosis and normal groups (p < 0.05) contrast to osteopenia and normal groups (p > 0.05). Changes in mandibular trabeculae structure in postmenopausal women can be assessed using periapical radiographs. [ABSTRACT FROM AUTHOR]

Background: The second premolar is one of the teeth which are crucial both aesthetically as well as functionally and one of the most commonly endodontically treated tooth. Aim of the study was to assess the number of canals in maxillary second premolar by clinical and radiographic evaluation in Pakistani sub population. It was a cross sectional study conducted in Endodontic Department of Rehmat Memorial Dental Teaching Hospital, Abbottabad, from January 2019 to January 2020. Method: One hundred and five patients were selected for the study, based on nonprobability sampling technique. All patients were examined clinically by exploration of pulp chamber followed by intra oral peri-apical radiograph to verify the clinical exploration of canals. Result: One hundred and five patients (46 males (43.8%) and 59 females (56.2%)} were selected for the study. Out of total 105 patients 47 (44.8%) had one canal and 58 (55.2%) had two canals. Out of 46 males 25 (54.3%) had two canals and out of 59 females 33 (56.9%) had two canals. Statistical analysis showed no significant difference (p=0.1871) of canals arrangements between genders. Conclusion: Clinicians should be careful whenever doing root canal treatment of maxillary second premolars because of the extreme variability of the anatomy of those teeth, there is always risk of missing the second canal. Frequency of two canals was high, which is not age or gender dependant. [ABSTRACT FROM AUTHOR]

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Before choosing a treatment plan, the diagnosis must be well known. The diagnosis is based on the signs and symptoms, but an important role is played by the paraclinical examination, the radiograph. Our article highlights the case of a 24 years old woman who came to the Departament of Endodontology for treating the second left maxillary premolar. According to the signs and symptoms she presented and periapical radiograph which revealed a periapical radiolucency. We made the diagnosis of symptomatic periodontitis. To be able to measure 3D the size of the periapical lesion, we indicated a CBCT. The CBCT cross sections revealed a periapical radiolucency at the first left maxillary molar, affecting the roots both at periapical and interradicular level, but the patient was asymptomatic even though she had a metallic post and a crown. At the second clinical examination she remembered that she had repeated endodontic retreatments. After an interdisciplinary discussion between endodontist, surgeon and radiologist, we decided to treat the premolar and extract the molar, followed by an implant.

Objectives: The aim of this study was to evaluate the accuracy of cone beam computed tomography (CBCT), periapical radiograph, and intrasurgical linear measurements in the assessment of molars with furcation defects. Materials and methods: This parallel, single-blinded, randomised controlled trial (RCT) consisted of 22 periodontitis patients who had molar with advanced furcation involvement (FI). All patients followed the same inclusion criteria and were treated following the same protocol, except for radiographic evaluation (CBCT vs. periapical). This study proposed and evaluated five parameters that represent the extent and severity of furcation defects in molars teeth, including CEJ-BD (clinical attachment loss), BL-H (depth), BL-V (height), RT (root trunk), and FW (width). Results: There were no statistically significant differences between CBCT and intrasurgical linear measurements for any clinical parameter (p > 0.05). However, there were statistically significant differences in BL-V measurements (p < 0.05) between periapical and intrasurgical measurements in maxillary molars. Meanwhile, the sensitivity were 62.8% and 56.9% for CBCT and periapical, respectively. Conclusions: Overall, when compared to the intrasurgical measurements, CBCT provided better diagnostic, sensitivity, and quantitative information on CAL, height, depth, and width of the furcation defects than periapical radiograph. Clinical relevance: An accurate presurgical furcation diagnostic can guide the clinicians from the stage of diagnosis to definitive management so that unnecessary periodontal surgical interventions can be prevented. [ABSTRACT FROM AUTHOR]

For any dental implant procedure that is being carried out, the success will depend on a thorough preoperative investigation. The quality, quantity and the volume of available bone at the planned implant site has to be assessed properly when planning a dental implant placement. When we speak of the forementioned aspects pre-surgical imaging and its co-relation to clinical findings help assess the relation to the amount of bone available from underlying vital parts namely the sinus cavities, nasal floor, nerves, teeth and vessels. Different radiographic modalities have been advocated for its assessment. Intra Oral Periapical radiograph (two-dimensional) is one such modality that has lost its importance after the introduction of more advanced techniques like Cone Beam Tomography (three-dimensional). This article will help us understand how two-dimensional and three-dimensional imaging modalities go hand in hand while treating dental patients. It will also explain why the conventional imaging technologies are still required in this era of modern methods of imaging. [ABSTRACT FROM AUTHOR]

Dentists and oral and maxillofacial radiologists have used periapical, occlusal, panoramic, and cephalometric radiographs for many years for diagnosing dental anomalies, especially before orthodontic or surgical treatment. Cone beam computed tomography was developed in recent years especially for the dental and maxillofacial region. Thus it has become the imaging modality of choice for many clinical situations, such as the assessment of dental impaction and structural teeth anomalies or other associated diseases and disorders (e.g., Gardner's syndrome, cleidocranial dysplasia). This article reviews different aspects of dental impaction and its possible effects on adjacent structures such as external root resorption, marginal bone loss, as well as describing structural dental anomalies. It provides a systematic analysis of their characteristic features and imaging findings for general radiologists to achieve a precise diagnosis and an optimal interpretation. [ABSTRACT FROM AUTHOR]

The purpose of this in vivo study was to evaluate the accuracy of small-volume cone-beam computed tomographic (CBCT) imaging compared with conventional periapical radiography (CPR) in the diagnosis of vertical root fractures (VRFs) using exploratory surgery as the reference standard. Eighty-two dental records of 85 teeth with suspected VRFs that underwent CPR, CBCT imaging, and exploratory surgery were included. Two observers assessed CPR and CBCT images independently for the presence or absence of root fractures, and findings from the exploratory surgery were considered the reference standard. Diagnostic sensitivity, specificity, accuracy, and the receiver operating characteristic curve values were obtained. The effect of single- and multirooted teeth on diagnostic accuracy as well as the association between clinical symptoms and the presence of VRFs were also assessed. VRFs were surgically detected in 64 of the 85 teeth (75.3%), of which 62.5% were multirooted and 76.6% had intracanal posts. CBCT imaging was more sensitive and accurate (65.6% and 64%) than CPR (27.3% and 40.5%). Both CPR and CBCT diagnostic accuracies were higher in single- than multirooted teeth. Pain on percussion, a localized periodontal pocket, and tooth mobility were associated with the presence of VRFs (P <.05; odds ratio = 4.15, 13.5 and 4.1, respectively). The accuracy of CBCT imaging for the diagnosis of VRFs was poor, although it was higher than with CPR. Multirooted teeth in the presence of intracanal posts may limit its diagnostic value. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate whether naturally occurring periradicular lesions confined to cancellous bone can be detected on periapical digital radiography and whether the size of the lesion had any effect on lesion detection. One hundred twenty-nine roots were chosen based on cone-beam computed tomographic imaging and categorized as having no lesion, a lesion confined to cancellous bone, a lesion that encroaches on junctional corticocancellous trabeculae, or a lesion with cortical involvement. The largest buccolingual dimension of the lesions was measured on cone-beam computed tomographic imaging. Two observers separately viewed the corresponding periapical radiographs in their original version as well as in the edge-enhanced setting on MiPACS (LEAD Technologies Inc, Charlotte, NC). Observers were asked to evaluate and interpret the periapical radiographs as having a lesion present, absent, or "unsure." Evaluations of images were conducted at 2 times 1 week apart. Data were analyzed, and the level of significance was set at P =.05. Lesion size, not the degree of cortical involvement, significantly affected the observers' ability to accurately detect lesions. As the size of the lesion increased, the probability of correctly identifying a lesion increased (P =.0008). Lesions were correctly identified 97.6%, 94.1%, 91.6%, and 89.3% of the time, respectively, when in cortical bone, at the junction of corticocancellous bone, in cancellous bone, and when no lesion was present. Observers were "unsure" whether a lesion was present or absent 10.7% of the time. Only lesions in cortical bone significantly increased observers' certainty in making a diagnosis. This study concluded that lesions confined to cancellous bone can be detected radiographically at a high rate. Lesion size was positively correlated with correct lesion identification, whereas the degree of cortical involvement had no significant effect. This suggests that lesion size may be a better predictor for correct lesion identification than lesion location. [ABSTRACT FROM AUTHOR]

Purpose: This randomised double-blind placebo-controlled trial was carried out to investigate the effect of a one-week post-operative course of 600 mg of ibuprofen taken four times a day on marginal bone level around dental implants. Materials and methods: A total of 61 patients were allocated to the ibuprofen (31 patients) or placebo group (30 patients). Overall, 132 implants were inserted, 67 implants in the ibuprofen group and 65 implants in the placebo group. Preparation of the implant sites was carried out with an intermittent drilling sequence adapted to the fixture diameter and the local bone quality according to the Astra Tech implant installation guide. The primary outcome measure was the change in marginal bone level around dental implants from the baseline (2 weeks post-placement) to the 3- and 6-month radiographic examinations. The paralleling technique and a film holder coupled to a beamaiming device were used to take the periapical radiographs. Measurement of changes in bone level was made using a viewing box and ×8 magnifier. Results: Two patients from the ibuprofen group were unable to complete the prescribed course of ibuprofen owing to a minor self-reported stomach upset. A patient from the control group did not attend any of the scheduled appointments following implant placement. A total of three patients dropped out. All implants survived in either group during the 6-month observation period. The mean marginal bone level changes from the baseline were (-0.33 mm) at the 3-month and (-0.29 mm) at the 6-month follow-up for the ibuprofen group while the corresponding values for the placebo group were (-0.12 mm) and (-0.30 mm). There were no statistically significant differences between groups for mean marginal bone level changes at 3 months (P = 0.27) or 6 months (P = 0.97). Conclusions: Administration of a short course of systemic ibuprofen for post-operative pain management subsequent to implant placement may not have a significant effect on the marginal bone around dental implants in the early healing period. [ABSTRACT FROM AUTHOR]

Objective: This study was conducted to compare vertical and horizontal periodontal measurements of posterior teeth on standardized panoramic and intraoral radiographs. Methods and materials: Standardized panoramic and periapical radiographs were made of 16 human skulls using ball bearings placed on the maxillary first molars to allow adjustment for horizontal and vertical magnification. Results: At 14 of 19 measurement sites there was no significant difference between measurements on the 2 radiographic film types. At 4 sites vertical measurements on panoramic radiographs were significantly larger than on periapical radiographs (0.80 to 1.37 mm). At one site horizontal measurements were significantly greater on periapical radiographs (0.88 mm). Conclusions: If there is adjustment of the raw data for magnification as suggested in this study, panoramic radiographs may be used for measurement studies in the posterior region once the patients are positioned appropriately within the focal trough of the machines and the magnification range for the posterior focal trough is used for adjustment of data. [ABSTRACT FROM AUTHOR]

Aims: The aims of the study are to evaluate the radiographical views, OPG and periapical views on the changes in peri- implant bony tissue around dental implant at time of placement and another reading after 16 weeks before functional prosthetic loading and regard it as a prognostic parameter. Material and methods: Nineteen cases with 24 implant were enrolled for standardization. Radiographical measurement undertaken by a periapical and OPG radiographs after implant placement, then after16 weeks later, again a second periapical and OPG radiographs were taken for measurements using Dimaxis 3.2.1. Software program to estimate marginal bone height of both sides of implant and its changes during times of evaluation. Results: 19 medically fit patients, male and female with age 22-65 years, twenty four implants with average bone loss 0.59 mm mesialy and 0.60 mm distally at T0 as standered base line in compared to 0.98mm mesialy and 1.11mm distally at T1as average bone loss. There was a significant bone resorption in both sides in relation of implant size and in comparison to time of placement and after 16 weeks according to statistical analysis. Conclusion: OPG and periapical views are a good parameter for evaluation of successful implant and monitoring of the prognosis and stability and durability, as these radiographs more available in most dental centers and clinics with less cost.

Aims: To investigate the effect of defect morphology, bone thickness and examiner experience on the accuracy to detect the presence, the type and the depth of peri‐implant defects with digital periapical radiographs (PAs) and cone beam computed tomography (CBCT) in an in vitro model. Methods: Thirty six implants were placed in fresh porcine rib bone with different types of standardized defects while sites with no defect served as control. Fourteen masked examiners evaluated 324 PAs and 108 CBCT images. The presence and type of defect, the location of the bottom of the defect and the location of first bone‐to‐implant contact were recorded. The sensitivity, specificity, accuracy, positive and negative predictive values were calculated for each type of defect using actual measurements as the gold standard. Results: The diagnostic accuracy for PAs was affected by defect morphology, exposure time, thickness of bone walls and the level of experience of the examiner. The overall diagnostic accuracy of CBCT was high (>96%) for all types of defects. Conclusion: Cone beam computed tomography showed better diagnostic accuracy in the detection of peri‐implant defects, this can be attributed to the fact that CBCT seems to be less affected by variables that contribute to the poorer performance of PAs. [ABSTRACT FROM AUTHOR]

Abstract Background The aim of this study was to compare the degree of external apical root resorption (EARR) in patients treated with self-ligating Damon appliances and with conventional preadjusted appliances. Methods The sample comprised 52 patients, divided into two groups. Group 1 consisted of 25 patients treated with self-ligating Damon appliances, with an initial age of 16.04 years, final age of 18.06 years, and treatment time of 2.02 years. Group 2 consisted of 27 patients, treated with conventional preadjusted appliances, with an initial age of 16.77 years, final age of 18.47 years and treatment time of 1.70 years. The groups were matched regarding the initial and final ages, treatment time, type of malocclusion, and treatment protocol without extractions. Root resorption was evaluated on periapical radiographs of the maxillary and mandibular incisors at the end of orthodontic treatment with the scores of Levander and Malmgren. Intergroup comparisons of root resorption were performed with Mann-Whitney tests. Results No significant difference in the degree of root resorption between the two groups was found. Conclusions Similar degrees of resorption can be expected after non-extraction treatment with Damon self-ligating or conventional preadjusted appliances.

Aim: The aim of the present study was to determine the prevalence of and the relationship between pulp and renal in affected patients and in healthy adults. Materials and methods: A total of 240 patients participated in the study. Group A consisted of 120 patients who had renal calculi and Group B had 120 randomly selected controls for the study. The periapical radiographs for all patients were evaluated for the presence or absence of the narrowing of dental pulp chambers and pulp canals. The radiographs were also evaluated to determine the presence or absence of pulp stones. The results were compared and analyzed using the Chi-square test (p 0.001) and also between pulp stones and renal stones (p > 0.001). Conclusion: However, there was no significant correlation between the presence of pulp stones and renal stones, and the incidental findings of pulp stones on periapical radiographs can provide useful information in the early diagnosis of the systemic calcifications.

Vertical root fracture (VRF) is defined as a root fracture in the longitudinal direction, extending from the root to the crown on facial or lingual surfaces. Most VRFs occur in endodontically treated teeth, and the symptoms are similar to those of chronic apical periodontitis or chronic periodontitis. Diagnosing VRF with periapical radiography is difficult. Conversely, cone beam computed tomography (CBCT) provides three-dimensional images and is better at diagnosing VRF than periapical radiography. Therefore, dentists should know how to operate CBCT to obtain clear images and reduce image artifact interferences, thus achieving higher diagnostic accuracy. CBCT imaging includes acquisition configuration, image detection, image reconstruction, and image display. We retrospectively examined four human studies and 19 in vitro studies and focused on certain imaging parameters: field of view selection, voxel size, proper detectors, different image processing methods, and the influence of posts on clear image acquisition. Finally, we discuss the experimental design faults in the reviewed in vitro studies and suggest improvements for future CBCT techniques to achieve higher VRF diagnostic accuracy.

Knowledge of the internal and external root anatomy is essential for accurate determination of working length which often is taken as the apical terminus during endodontic therapy. The objective of this study is to determine the distance from the anatomical root apex to the major apical foramen in relation to radiographic findings and the position of the major foramen on the root apex by using micro-CT. A total of 100 extracted teeth for which a pre-extraction periapical radiograph available was analysed in this study. Each tooth was scanned using microcomputed tomographic (micro-CT) machine and images were constructed using software (NRecon version 1.6.3.3, SkyScan N.V, Belgium). Three-dimensional volume rendering of each specimen was performed using the MeVislab 2.1 freeware (Mevis Research, Bremen, Germany). The distance between the anatomical root apex to the mid-point of the apical foramen was measured in software (ImageJ 1.44; National Institutes of Health, MD, USA). The data were correlated to the presence of periapical radiolucency, if any. When resorption or an eroded apical area was observed in the 3- dimensional reconstructed images, the tooth was processed for histological confirmation. Mean distance between major apical foramen and anatomical root apex ranged from 0.391 mm for mandibular incisors to 0.798 mm for the mandibular premolars. T-test (p>0.05) showed no significant difference of foramen-to-apex distance between two periapical statuses. Major apical foramens of maxillary incisors (57.1%) were in a central position at the root apex. Radiographic findings showed no significant influence on the foramen-to-apex distance, which distance did not exceed 1 mm. The majority of the apical foramen seemed to be located in the centre of the root apex. [ABSTRACT FROM AUTHOR]

Introduction The visual search patterns of dentists and the areas that attract their attention when interpreting dental periapical radiographs are currently unknown. This research identifies areas and patterns of visual fixation when observing dental periapical radiographs. Methods In an observational study using eye tracking technology and a convenience sample of 44 observers, the interpretations of 4 dental periapical radiographs were recorded using Camtasia Software (TechSmith, Okemos, MI) with a gaze tracking “bubble” denoting where within the radiograph the observers' eyes gazed. The recorded observations included the scanning pattern, the area of first fixation, and revisits of areas. Also noted was whether the area of first fixation or revisit was radiopaque, radiolucent, or of normal radiodensity and whether it was a coronal or radicular area. Results The first fixation is more likely to be an area of high contrast that is either radiopaque or radiolucent compared with areas that were normal or of average gray scale. Significantly more revisits occurred on areas that were radiopaque and located in the radicular area. Of the 4 categorized scanning patterns, tooth by tooth scanning predominated. Conclusions When interpreting dental periapical radiographs, significantly more observers initially fixated on areas of the radiograph that were of high contrast (ie, radiopaque or radiolucent) compared with “normal areas.” A tooth by tooth scanning pattern was most commonly used. [ABSTRACT FROM AUTHOR]

Aim: Pulp stones are discrete calcified bodies found in the dental pulp. The aim of the present study was to determine the prevalence of pulp stones in patients with renal stones and to determine the relationship between the pulp stones and renal stones. Materials and Methods: A total of 240 patients participated in the study. Group A consisted of 120 patients who had renal calculi, and Group B had 120 randomly selected controls for the study. The periapical radiographs for all patients were evaluated for the presence or absence of the narrowing of dental pulp chambers and pulp canals. The radiographs were also evaluated to determine the presence or absence of pulp stones. The results were compared and analyzed using the Chi-square test (P < 0.001). Results: A total of 163 patients had pulp narrowing, and 112 patients had pulp stones, which included 55 controls and 57 renal calculi patients. There was no statistical correlation between pulp narrowing and renal stones (P > 0.001) and also between pulp stones and renal stones (P > 0.001). Conclusion: However, there was no significant correlation between the presence of pulp stones and renal stones, the incidental findings of pulp stones on periapical radiographs can provide useful information in the early diagnosis of the systemic calcifications.

Introduction: Detection of root fracture is challenging both clinically and radiographically. Root fractures occur in different planes with unpredictable presentations. Aim: The aim of the study was to evaluate the diagnostic accuracy of selected digital image enhancement tools in the detection of horizontal Root Fracture (RF). Materials and Methods: Fifty three roots, of single and multirooted teeth, in eight dentate human cadaver mandibles were selected for this study. Following minimally traumatic extraction of the teeth, horizontal fractures were induced in 23 roots and remounted in the empty sockets of their respective human dry mandibles. The remaining teeth with no fractures were used as the control group. Twenty two periapical radiographs were obtained by using the paralleling technique and using Complementary Metal Oxide Semiconductor (CMOS). Image J software was used to enhance the original images with the Inversion (IN), Histogram-Equalization (EQ) and Polynomial (Poly) tools. A total of 88 periapical images (original and three enhanced images) were reviewed independently by three Oral and Maxillofacial Radiologists and two Endodontists. Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the accuracy of fracture detection and the kappa statistic was used to assess agreement among reviewers. Results: The diagnostic accuracy for one of the observers was significantly different in detection of RF with only EQ enhancement tool. Sensitivity and specificity were not significantly different. Interobserver agreement showed no significant difference between imaging methods. Intra-observer agreement was high to moderate. Conclusion: There was no significant difference between the different imaging modalities. No statistical difference for the agreement was found among or between the endodontists and radiologists in this study.

The prevalence of vertical distortion in the periapical radiograph of the anterior maxillary teeth is quite significant and cingulum is commonly used as the reference of vertical distortion in anterior radiograph. Objective: To evaluate the limit of vertical angulation error that still can be tolerated. Methods: Periapical radiograph with vertical angle 0° was obtained from 30 maxillary incisors as reference, then the vertical angulation was changed into -10°, +10°, -15°, +15°, -20° and +20°. Long axis of the teeth was adjusted parallel to the film. Tooth length and cingulum width with vertical angulation alteration was measured and compared to the actual length. All of the measurement was tested using T test. Results: There were no significant differences between all the measurements of tooth length with the alteration in vertical angulation (p>0.05), whereas cingulum width had a significant difference at +15° and -10°, pConclusion: Tooth length in periapical radiograph of maxillary incisor with parallel position is still tolerable until 20º vertical angle errors. Cingulum width on radiograph with +15º vertical angle alteration is significantly narrowed and on radiograph with -10° vertical angle alteration is significantly widened.