Comprehensive and accurate diagnosis and treatment planning is crucial in successful orthodontics. An essential part of the diagnostic exercise is to determine whether there is a tooth size/arch length discrepancy (Bishara, 2001). The mixed dentition space analysis is one method of determining this (Moyers, 1973). The procedure requires the measurement of the anteroposterior dimension of the crowns of erupted teeth and the prediction of the size of the crowns of the unerupted permanent canine and premolar teeth. The comparison of tooth sizes enables the calculation of the ‘leeway space’, which may provide for the transition to the full intercuspation of the first permanent first molars as well as the relief of a certain amount of crowding in the arch (Gianelly, 1995). To date, the application of data of methods of measuring and estimating tooth size have been limited by the relative complexities of the method (Paredes et al, 2006), and the application of the data has been limited by the demographic profile of the patient (Schirmer and Wiltshire, 1997; Khan, 2006). The aim of this study is to develop a technique of precisely measuring the mesiodistal tooth size of the crowns of teeth from computerized images of panoramic x-rays, using the Leica QWin© System of Image Analysis (Leica, UK(Pty) Ltd). Ideally, this method would be accurate, reproducible and easy to use by a clinician. Thirty sets of study casts and the corresponding panoramic radiographs of patients in the mixed dentition stage of dental development were chosen, according to specific criteria, from the archived records of the Undergraduate Clinic at The School of Oral Health Sciences, University of the Witwatersrand. On the study casts, the mesio-distal widths of the second deciduous molar (‘e’) and of the first permanent molar (‘6’) teeth in each quadrant were measured with a digital vernier caliper. The corresponding radiographs were digitally photographed at a fixed distance, and uploaded onto the computer programme. A magnification factor was determined using the image of a premeasured object. The images of the ‘e’ and the ‘6’, together with the image of the unerupted second premolar tooth (‘5’) were measured with the calibrated linear function of the Leica QWin© System. The data was thus corrected for by the relevant magnification factor. The size differential between the ‘e’ and the ‘5’, representative of the leeway space, was then calculated. A calculation of the intra-examiner repeatability demonstrated a low co-efficient of variation of the measurements recorded on both the study casts and on the computer. The measurements of the teeth taken on the study casts were compared with the corrected measurements of the same teeth taken from the computer images of the teeth. Tooth size measurements taken with the Leica QWin System were greater than those taken with the vernier calipers. In both methods the sizes of the teeth were larger in the mandible than in the maxilla. This observation was also reported by Kraus et al (1969). The values for leeway space were calculated in both jaws. The mean values of leeway space in the maxilla were 0.81mm on the left hand side and 1.08mm on the right hand side, and 2.43mm on the left hand side and 2.59mm on the right hand side in the mandible. These values were similar to those recorded by Nance (1947) and by Bishara et al (1988) who also found that values of leeway space were smaller in the maxilla than in the mandible. The accuracy of the measurements taken with the proposed method was found to be dependent upon correct patient positioning in the focal trough of the machine at the time of panoramic radiographic exposure, the use of a marker known in size placed at the site to be measured in order to correct measurements for magnification and the definition of corresponding mesio-distal points on the teeth from which measurements would be taken on both sets of records.

The purpose of this study was to assess the accuracy of digital radiographs and hence their effectiveness in templating. The methodology involved a retrospective study of post operative radiographs of patients with hemiarthroplasty of the hip. Three observers made observations blinded to each other¿s measurements. A statistical analysis of the data highlights magnification varying from 6 to 31 percent. There is a statistically significant relationship between the size of the error (size measured on radiograph minus implant size, i.e. magnification) and the implant size (p = 0.005) but the percentage error (error/implant size x 100) is independent of implant size (p = 0.505). It is our impression that digital radiographs and templating on the digital radiographs should not be considered a precise process.

Yes / We read with interest the recent article by Yun et al. [1] comparing acetabular and hip measurements across pelvis, hip and lumbar spine radiographs. The authors assert that lumbar radiographs can be utilised in place of routine pelvis radiographs for these measurements. The example lumbar spine radiograph (figure 2) appears to be an abdominal image, with a contrast urogram. Indeed, standard texts [2,3] confirm that the anteroposterior lumbar spine radiograph should not include any coverage of the hips as appropriate collimation should limit the anatomy to T12 superiorly, lower sacrum inferiorly and the sacroiliac joints laterally, which would exclude the hip joints. Thus assessing any hip measurements on an appropriately collimated lumbar spine radiograph should not be possible. This is further compounded by the description of the centring point within their study (iliac crest), which varies from the internationally recognised standard of lower costal margin/L3 [2,3].

As modificações provocadas pelo edentulismo no padrão fonético, mastigatório e estético dos pacientes, implicam em alterações do comportamento social, emocional e psicológico. A fim de que a saúde bucal dos pacientes seja preservada, uma adequada reabilitação oral deve ser realizada, respeitando-se os princípios biomecânicos para a confecção das próteses. Para tanto, o cirurgião dentista pode contar com um aparato de imagens radiográficas que podem auxiliar em várias etapas do processo reabilitador. O objetivo do trabalho foi avaliar a contribuição de diferentes técnicas radiográficas no diagnóstico, planejamento e proservação na reabilitação com prótese total, propondo o emprego de uma documentação radiográfica. Foram utilizadas radiografias das articulações têmporo-mandibulares (ATMs), para avaliação dos espaços articulares anterior, posterior e superior, antes e após o tratamento reabilitador; radiografias panorâmicas e carpais, para avaliação de índices radiomorfométricos mentual, goníaco e metacarpal, para a pesquisa da presença de osteoporose; e telerradiografias laterais cefalométricas antes e após a colocação das próteses totais, verificando a presença da proporção áurea nas medidas craniofaciais. Foram feitas análises estatísticas para correlacionar os dados obtidos das análises radiográficas. Para as radiografias das ATMs, encontrou-se um aumento bilateral do espaço anterior, e uma conseqüente diminuição do espaço posterior, enquanto que o espaço superior aumentou levemente na articulação esquerda e diminuiu levemente na articulação direita. Nas radiografias panorâmicas e carpais observou-se uma diminuição dos valores dos índices radiomorfométricos conforme o aumento da idade. Nas telerradiografias laterais observou-se melhora do perfil com a colocação da prótese, e proximidade de algumas razões com a proporção áurea. Concluiu-se que: as radiografias de ATMs trazem informações importantes acerca da anatomia e relacionamento da cabeça da mandíbula com a fossa articular; os índices radiomorfométricos panorâmicos são importantes para detecção da diminuição da massa óssea, podendo contribuir para a detecção de sinais precoces de osteoporose e propiciar o encaminhamento desses pacientes para cuidados médicos adequados; o índice metacarpal propiciou informações muito semelhantes aos índices panorâmicos, não havendo, portanto, necessidade dessa radiografia compor a documentação, uma vez que a panorâmica pode contribuir com um maior número de informações; e que as telerradiografias laterais mostrou que, além de auxiliar no diagnóstico, através de medidas da dimensão vertical, posicionamento dos dentes artificiais, entre outros, ainda possibilitou avaliação da estética facial, tornando-se uma ferramenta da qual o cirurgião dentista pode lançar mão utilizando a proporção áurea como instrumento auxiliar na busca e favorecimento de planos de tratamento eficazes. / The changes caused by tooth loss in the standard phonetic, chewing and aesthetic of the patients, result in changes in social behavior, emotional and psychological. In order that the oral health of patients is preserved, adequate oral rehabilitation must be performed respecting the biomechanical principles for the manufacture of prostheses. Thus, the dentist may have an apparatus of radiographic images that can help in various stages of rehabilitation. The objective of this study was to evaluate the contribution of different radiographic techniques in the diagnosis, planning and proservation in the rehabilitation with dentures, proposing the use of a radiographic documentation. The TMJ radiographs were used for assessment of joint spaces anterior, posterior and upper before and after rehabilitation treatment, panoramic and carpal radiographs for evaluation radiomorphometric index mental, gonial and metacarpal, for the detection of the presence of osteoporosis, and radiographs lateral cephalometric before and after placement of dentures, verifying the presence of the golden ratio in craniofacial measures. Statistical analysis was made to correlate the data obtained from the radiographic analysis. For Radiographs of the ATMs, found a bilateral increase in anterior space, and a consequent reduction of the posterior space, while the upper space in the joint increased slightly left and slightly decreased in the right joint. In the panoramic radiographs and carpal observed a decrease in values of radiomorphometric index increase with age. In the lateral cephalometric radiographs showed improvements of the profile with the placement of the prosthesis, and proximity to some reasons with the golden ratio. Was concluded that: the TMJs radiographs provide important information about the anatomy and relationship of the condyle with the glenoid fossa; radiomorphometric index are important for detection of low bone mass and may contribute to the detection of early signs of osteoporosis and to facilitate the referral of patients to proper medical care, and the index metacarpal provided information very similar to the panoramic indices, and there is therefore need for such radiography compose documentation, since the panoramic can contribute to a greater amount of information, and that the lateral cephalometric radiographs showed that in addition to aid in the diagnosis, through measures of the vertical dimension, positioning of artificial teeth, among others, has enabled evaluation of facial aesthetics, becoming a tool from which the dentist can resort to using the the golden ratio as an aid in search and favoring effective treatment plans.

As modificações provocadas pelo edentulismo no padrão fonético, mastigatório e estético dos pacientes, implicam em alterações do comportamento social, emocional e psicológico. A fim de que a saúde bucal dos pacientes seja preservada, uma adequada reabilitação oral deve ser realizada, respeitando-se os princípios biomecânicos para a confecção das próteses. Para tanto, o cirurgião dentista pode contar com um aparato de imagens radiográficas que podem auxiliar em várias etapas do processo reabilitador. O objetivo do trabalho foi avaliar a contribuição de diferentes técnicas radiográficas no diagnóstico, planejamento e proservação na reabilitação com prótese total, propondo o emprego de uma documentação radiográfica. Foram utilizadas radiografias das articulações têmporo-mandibulares (ATMs), para avaliação dos espaços articulares anterior, posterior e superior, antes e após o tratamento reabilitador; radiografias panorâmicas e carpais, para avaliação de índices radiomorfométricos mentual, goníaco e metacarpal, para a pesquisa da presença de osteoporose; e telerradiografias laterais cefalométricas antes e após a colocação das próteses totais, verificando a presença da proporção áurea nas medidas craniofaciais. Foram feitas análises estatísticas para correlacionar os dados obtidos das análises radiográficas. Para as radiografias das ATMs, encontrou-se um aumento bilateral do espaço anterior, e uma conseqüente diminuição do espaço posterior, enquanto que o espaço superior aumentou levemente na articulação esquerda e diminuiu levemente na articulação direita. Nas radiografias panorâmicas e carpais observou-se uma diminuição dos valores dos índices radiomorfométricos conforme o aumento da idade. Nas telerradiografias laterais observou-se melhora do perfil com a colocação da prótese, e proximidade de algumas razões com a proporção áurea. Concluiu-se que: as radiografias de ATMs trazem informações importantes acerca da anatomia e relacionamento da cabeça da mandíbula com a fossa articular; os índices radiomorfométricos panorâmicos são importantes para detecção da diminuição da massa óssea, podendo contribuir para a detecção de sinais precoces de osteoporose e propiciar o encaminhamento desses pacientes para cuidados médicos adequados; o índice metacarpal propiciou informações muito semelhantes aos índices panorâmicos, não havendo, portanto, necessidade dessa radiografia compor a documentação, uma vez que a panorâmica pode contribuir com um maior número de informações; e que as telerradiografias laterais mostrou que, além de auxiliar no diagnóstico, através de medidas da dimensão vertical, posicionamento dos dentes artificiais, entre outros, ainda possibilitou avaliação da estética facial, tornando-se uma ferramenta da qual o cirurgião dentista pode lançar mão utilizando a proporção áurea como instrumento auxiliar na busca e favorecimento de planos de tratamento eficazes. / The changes caused by tooth loss in the standard phonetic, chewing and aesthetic of the patients, result in changes in social behavior, emotional and psychological. In order that the oral health of patients is preserved, adequate oral rehabilitation must be performed respecting the biomechanical principles for the manufacture of prostheses. Thus, the dentist may have an apparatus of radiographic images that can help in various stages of rehabilitation. The objective of this study was to evaluate the contribution of different radiographic techniques in the diagnosis, planning and proservation in the rehabilitation with dentures, proposing the use of a radiographic documentation. The TMJ radiographs were used for assessment of joint spaces anterior, posterior and upper before and after rehabilitation treatment, panoramic and carpal radiographs for evaluation radiomorphometric index mental, gonial and metacarpal, for the detection of the presence of osteoporosis, and radiographs lateral cephalometric before and after placement of dentures, verifying the presence of the golden ratio in craniofacial measures. Statistical analysis was made to correlate the data obtained from the radiographic analysis. For Radiographs of the ATMs, found a bilateral increase in anterior space, and a consequent reduction of the posterior space, while the upper space in the joint increased slightly left and slightly decreased in the right joint. In the panoramic radiographs and carpal observed a decrease in values of radiomorphometric index increase with age. In the lateral cephalometric radiographs showed improvements of the profile with the placement of the prosthesis, and proximity to some reasons with the golden ratio. Was concluded that: the TMJs radiographs provide important information about the anatomy and relationship of the condyle with the glenoid fossa; radiomorphometric index are important for detection of low bone mass and may contribute to the detection of early signs of osteoporosis and to facilitate the referral of patients to proper medical care, and the index metacarpal provided information very similar to the panoramic indices, and there is therefore need for such radiography compose documentation, since the panoramic can contribute to a greater amount of information, and that the lateral cephalometric radiographs showed that in addition to aid in the diagnosis, through measures of the vertical dimension, positioning of artificial teeth, among others, has enabled evaluation of facial aesthetics, becoming a tool from which the dentist can resort to using the the golden ratio as an aid in search and favoring effective treatment plans.

>Magister Scientiae - MSc / Background: Changing trends have been observed in the prevalence, etiology, imaging practice and pattern of presentation of mid facial fractures in different geographical regions. Conventional (plain) radiographs remain the most common initial investigative tool for general appraisal of suspected fractures, while advanced imaging is currently the most common final investigation. This study explored the clinico-radiologic patterns of mid facial fractures with main focus on demographic characteristics, etiology, fracture patterns and imaging practice. Aim: To determine the Prevalence, Clinical and Radiologic patterns of mid-facial fractures at Tygerberg Oral Health Centre, Faculty of Dentistry, University of the Western Cape Methodology: A retrospective cross sectional quantitative descriptive study of mid facial fractures was conducted at The University of the Western Cape’s Faculty of Dentistry based at the Tygerberg Oral Health Centre (TOHC). The study population comprised 239 patients who presented with mid facial fractures over 2 years, from January 2015 to December 2016. The data captured included demographic details, etiology, fracture site(s) and radiological investigations performed. Results: A vast male predominance was observed (M: F=5.3:1). The age range was 7-76 years (mean 31.94; SD 13.13). The most affected age category was 21 to 30 years (39.7%) while the least affected groups were children aged 0 to 10 years and patients above 70 years old. A total of 285 individual fractures were identified among the 239 patients (mean of 1.2 fractures per patient). The most common pattern of fracture was zygomatic complex (24.9%) while Le Fort fractures were the least common (5.3%). 20.1% of patients had concomitant fractures of other bones of the face and skull. There was no association between gender and site of fracture (p = 0.812). Panoramic radiography was the most common initial investigation. A panoramic radiograph in combination with various conventional extraoral views were sufficient for diagnosis in 18.8% of the patients. However, majority (53.6%) had all the three types of imaging performed (panoramic radiograph, conventional extra oral views and advanced imaging). The most common etiological factor was assault (73.6%). There was no association between gender and aetiology of fracture (p = 0.537)

Magister Scientiae Dentium - MSc(Dent) / Aim: Analysis of the occurrence of taurodont molars among patients attending the Tygerberg Oral Health Centre. Methodology: A retrospective descriptive study comprising 1608 panoramic radiographs of patient records, 815 females and 793 males, ranging in ages from 18 to 68 years old. The panoramic radiographs were evaluated for presence of taurodontism. Gender predilection and location of taurodont molars were analysed using a chi-square test. Results: Taurodontism was found in 52 (3.23%) radiographs distributed according to gender (30 females and 22 males [P > 0.05]). The overall prevalence of taurodont molars was (0.73%) from a total of 17148 molars that were examined. The mandibular molar teeth were more affected than the maxillary molar teeth and the second mandibular tooth was the most affected. Conclusion: Taurodontism was not uncommon in a group of patients that attended the Tygerberg Oral Health Centre, UWC. Further larger scale studies are required to assess its distribution in the general population of South Africa to compare it with other ethnic groups and to establish any associations. However, taurodontism in mandibular teeth is a condition that should be taken into consideration, especially the second mandibular tooth, to avoid complications.

Concurrent meniscal injury in dogs with cranial cruciate ligament tears ranges from 10-70%, and these injuries can increase the risk of developing osteoarthritis. Studies regarding joint space width on knee radiographs in people have indicated correlations between joint space width and meniscal injuries. The aim of this study was to determine if there was correlation between stifle joint space width on three different radiographic projections and meniscal injuries identified at surgery in dogs. Four blinded observers measured the radiographic joint space width three times, and the measurements were compared to surgical findings. Intraclass correlation coefficients for inter- and intraobserver variability ranged from moderate to excellent. There was significance between dogs with a meniscal tear and the corresponding joint space width on standard TPLO lateral radiographic projections. Joint space narrowing is seen with meniscal tears in dogs, and radiography may be a noninvasive way to identify meniscal tears prior to surgery.

Purpose: The purpose of this study was to assess the radiographic changes in periapical status and analysis of healing determined using periapical radiographs (PA) versus cone beam computed tomography (CBCT) pre-operatively and at 3-64 months following endodontic treatment. Methods: Pre/post treatment radiograph and CBCT scans of patients who had NSRCT, NSReTx, or SRCT from July 2011-December 2018 at VCU Graduate Endodontic clinic were included in this study. Volumetric and linear measurements of periapical lesions on initial and recall PA and CBCT images were performed using three calibrated examiners. Changes and differences in the estimated area from PA to CBCT were compared using the Wilcoxon signed-rank test. McNemar’s chi-squared test was used to determine agreement in the proportion of lesions that were absent (0x0) between the PA and corresponding view of CBCT. This data was used to calculate the sensitivity, specificity, positive predictive value (PPV), and negative predicative value (NPV). Results: A total of 51 patients with a median healing time of 13 months were included in the analysis. Significant healing was observed on both PA and CBCT images (p-value Conclusion: Assessment using CBCT revealed a lower healing rate for all treatment categories compared with periapical radiographs. CBCT was more likely to detect the presence of a PARL, whereas a periapical radiograph would be less sensitive to detection of a PARL. Significant healing cannot be detected at an earlier point in time with PA radiographs or CBCT.

Abstract Today, digital imaging is widely used in dentistry. In medical radiography, the importance of displays and room illuminance has been shown in many studies, whereas the effect of these factors in the diagnosis of dental radiography is not clear and remains controversial. There is limited knowledge among dentists as to how observer performance is affected by the type of display, level of ambient light or grayscale calibration. The aim of this thesis was to compare observer performance in the detection of both anatomical structures and pathology in panoramic and bitewing radiographs using consumer grade display with γ 2.2- and DICOM-calibration, a tablet (3rd generation Apple iPad® and a 6 MegaPixel (MP) display under different lighting conditions. Furthermore, the thesis aimed at providing recommendations for type of display and acceptable illuminance levels in the room for interpretation of dental radiographs. Thirty panoramic and bitewing radiographs were randomly evaluated on four displays under bright (510 lx) and dim (16 lx) ambient lighting by two observers. Both anatomical structures and pathology were evaluated because they provided both low- and high-contrast structure. Consensus was considered as reference. Intra- and inter-observer agreement was determined. The proportion of equivalent ratings and weighted kappa were used to assess the reliability. The level of significance was set to P<0.05. DICOM calibration may improve observer performance in the detection of pathology in panoramic radiographs regardless of the room illuminance level. DICOM calibration improves the detection of enamel and dentinal caries in bitewing radiographs, particularly in bright lighting conditions. On the other hand, in dental practice the room illuminance level is often higher, and it is thus recommended that the overall lighting level should be decreased. Furthermore, a DICOM-calibrated consumer grade display can be used instead of a medical display in dental practice without compromising the diagnostic quality and it saves costs. Tablet displays are recommended to use with care in dental radiography. / Tiivistelmä Hammaslääketieteessä käytetään nykyään pääasiassa digitaalista kuvantamista. Lääketieteellisessä radiologiassa näyttöjen ja käyttöympäristön valaistuksen merkitys kuvien katseluun on osoitettu lukuisissa tutkimuksissa, kun taas hammaslääketieteellisten tutkimusten tulokset näiden tekijöiden vaikutuksista röntgenkuvien tulkintaan eivät ole yksiselitteisiä ja niissä on ristiriitaisuutta. Hammaslääkäreiden tiedot näyttöjen, kalibroinnin ja ympäröivän valaistuksen vaikutuksesta röntgenkuvan tulkintaan ovat puutteellisia. Tämän väitöskirjan tarkoituksena oli vertailla näyttöjen suorituskykyä panoraama- ja purusiivekekuvien tulkinnassa eri valaistusolosuhteissa. Tutkimuksessa vertailtiin γ 2.2- ja DICOM-kalibroitua perusnäyttöä, tablettia (kolmannen polven Apple iPad®) sekä 6 MegaPikselin (MP) lääketieteelliseen käyttöön tarkoitettua näyttöä. Lisäksi väitöskirjan tarkoituksena oli antaa hammaslääketieteellisten röntgenkuvien katseluun soveltuvia näyttöjä ja käyttöympäristön valaistusta koskevia suosituksia. Kaksi tulkitsijaa arvioi 30 panoraama- ja purusiivekeröntgenkuvaa satunnaisessa järjestyksessä neljältä eri näytöltä kirkkaassa (510 luksia) ja hämärässä (16 luksia) valaistuksessa. Tutkimuksessa arvioitiin sekä korkeakontrastisia anatomisia rakenteita että matalakontrastisia patologisia löydöksiä. Tuloksia verrattiin tutkijoiden väliseen yhteisluentaan. Luotettavuuden arviointiin käytettiin yhdenmukaisuusosuutta sekä painotettua kappaa. Toistettavuuden arvioimiseksi laskettiin kapat toisen alkuperäisten ja uusintaluentojen sekä molempien tulkitsijoiden alkuperäisluentojen välille. Merkitsevyystasoksi määriteltiin p<0,05. DICOM-kalibrointi voi parantaa patologisten löydösten tulkintaa panoraamakuvissa molemmissa valaistusolosuhteissa. DICOM-kalibrointi parantaa selvästi purusiivekekuvien hammaskiille- ja hammasluukarieksen tulkintaa erityisesti kirkkaassa valaistuksessa. Hammaslääkäreiden työskentelytilojen valaistus on yleensä korkeampi kuin tutkimuksessa käytetty, joten näyttöjen käyttöympäristön valaistusta tulisi laskea toimistovalaistusta vastaavaksi. DICOM-kalibroitua perusnäyttöä voidaan suositella käytettäväksi kalliiden medikaalinäyttöjen sijaan. Tablettia tulee sen sijaan käyttää harkiten hammaskuvien tulkintaan.