The radiographs were made to mimic a bitewing radiograph with high image quality. The X-ray focal distance to the subject was 22 cm. A Prostyle intra-X-ray unit (Planmeca Oy ®, Helsinki, Finland) was used with exposure settings of 63 kV, 8 mA and 0.1 s. A 1 cm thick Plexiglas plate was used to simulate soft tissue and was placed in front of the digital sensor (Schick CDR Wireless 2 Schick Technologies Inc., Long Island City, NY). Figure 1 shows an example of a radiograph. Standard radiographs were taken for each block. 30 blocks were made of President putty (Coltène ® Whaledent AG, Cuyahoga Falls, OH), with three or four teeth mounted in each block. Half (50%) of the selected teeth were sound to visual inspection, whereas half had carious lesions of varying degree.
On visual inspection, the selected teeth had no carious lesions or just small ones of varying sizes on the proximal surfaces. above 1000 lux.ġ00 extracted human teeth (40 premolars and 60 molars), in total 200 proximal surfaces, were selected from a large number of teeth. The underlying hypothesis was that accuracy for diagnosing carious lesions was compromised when ambient lighting in the dental treatment room complied with current recommendations by the Swedish Standards Institute, 12 i.e. The aim was therefore to investigate whether different calibration modes of a monitor under various ambient light levels could display digital radiographs with diagnostic accuracy maintained for the detection of carious lesions on the proximal surface of teeth. Consequently, there is still a pressing need to find a way to compensate for high ambient light levels in the dental office when evaluating digital radiographs. However, Pakkala et al 11 concluded that different displays and room illuminance levels did not affect the overall accuracy of radiographic caries detection. 10 One way to address this matter could be to use a high-luminance monitor. It has also been shown that the ability to detect carious lesions by experienced clinicians may be improved by hooding laptop displays in bright clinical environments. Previous studies 4, 5 have shown that very faint objects, such as carious lesions on digital radiographs, are more easily discernible when the ambient light level is reduced to less than 50 lux. For practical reasons, it is difficult to reduce the light to a level at which radiographs can be evaluated on the monitor in accordance with recommendations. 9 Over time, it has become obvious that high ambient light in a dentist's treatment room is of major concern when working with digital technology. 9ĭICOM Part 14 also discusses evaluation room illuminance level. These guidelines are described under “Greyscale standard display function”, Part 14 of the Digital Imaging and Communication in Medicine (DICOM) standard. This type of correction is often performed on monitors used in medical radiology and meets American Association of Physicists in Medicine 8 (AAPM) recommendations for use of standard monitors to evaluate digital radiographs.
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7 Barten calibration is a small software program that adjusts the monitor especially in low-luminance areas. One previous study 5 showed no difference in the diagnostic accuracy of carious lesions whether the monitor was either manually calibrated or pre-calibrated according to Barten's model. Studies 3– 6 have concluded that monitors must be calibrated with respect to brightness and contrast to improve visibility of low-contrast details, such as carious lesions. The final link in the digital chain is the display monitor. Previous studies 1, 2 have shown that digital receptors all show similar performance with respect to diagnostic accuracy.
The diagnosis of carious lesions based on dental radiographs is perhaps one of the most difficult tasks in general dentistry. Many technical issues remain to be addressed regarding the digital technique and the level of knowledge, and awareness among general dental practitioners must be raised to achieve good image quality. Digital technology in dental radiography still lags many years behind medical radiography for a variety of reasons.
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