Table Of Content............................
Monographs in Oral Science
..
............................
Monographs in Oral Science
Vol. 17
Series Editor
G.M. Whitford, Augusta, Ga.
............................
Assessment of Oral Health
Diagnostic Techniques and Validation Criteria
Volume Editor
R.V. Faller, Mason, Ohio
81 figures, 17 in color, and 20 tables, 2000
............................
R.V. Faller
The Procter & Gamble Company
Health Care Research Center
8700 Mason-Montgomery Road
Mason, OH 45040-9462
Library of Congress Cataloging-in-Publication Data
Assessment of oral health : diagnostic techniques and validation criteria / volume editor,
R.V. Faller.
p. ; cm. – (Monographs in oral science, ISSN 0077-0892; vol. 17)
Includes bibliographical references and indexes.
ISBN 3805570309 (alk. paper)
1. Mouth – Diseases – Diagnosis.
2. Teeth – Diseases – Diagnosis.
3. Oral manifestations
of general diseases.
I. Faller, R.V.
II. Series.
[DNLM:
1. Diagnosis, Oral – methods.
2. Mouth Diseases – diagnosis.
3. Tooth
Diseases – diagnosis.
WU 141 A846 2000]
RC815.A856 2000
616. 3�1075–dc21
00–038432
Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and
dosage set forth in this text are in accord with current recommendations and practice at the time of publication.
However, in view of ongoing research, changes in government regulations, and the constant flow of information
relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for
any change in indications and dosage and for added warnings and precautions. This is particularly important
when the recommended agent is a new and/or infrequently employed drug.
All rights reserved. No part of this publication may be translated into other languages, reproduced or
utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying,
or by any information storage and retrieval system, without permission in writing from the publisher.
Ó Copyright 2000 by S. Karger AG, P.O. Box, CH–4009 Basel (Switzerland)
www.karger.com
Printed in Switzerland on acid-free paper by Reinhardt Druck, Basel
ISSN 0077–0892
ISBN 3–8055–7030–9
............................
Contents
VII Preface
1 Direct Digital Radiography for Caries Detection and Analysis
Analoui, M.; Stookey, G.K. (Indianapolis, Ind.)
20 Relationship of Surface Epithelium Concentrations of IL-1� and IL-1�
to Cinical Inflammation during Experimental Gingivitis
Biesbrock, A.; Yeh, C.H. (Cincinnati, Ohio)
32 Imaging of the Oral Cavity Using Optical Coherence Tomography
Colston, B.W., Jr.; Everett, M.J.; Sathyam, U.S.; DaSilva, L.B. (Livermore, Calif.);
Otis, L.L. (Stanford, Conn.)
56 Advances in Measurements of Periodontal Bone and
Attachment Loss
Jeffcoat, M.K., Reddy, M.S. (Birmingham, Ala.)
73 Analysis of the Morphology of Oral Structures from 3-D Co-Ordinate
Data
Jovanovski, V.; Lynch, E. (London)
130 Objective Quantification of Plaque Using Digital Image Analysis
Sagel, P.A.; Lapujade, P.G.; Miller, J.M.; Sunberg, R.J. (Mason, Ohio)
144 Application of Quantitative Light-Induced Fluorescence for Assessing
Early Caries Lesions
van der Veen, M.H.; de Josselin de Jong, E. (Amsterdam)
163 Recent Advances in Methods for the Assessment of Dental Calculus –
Research and Clinical Implications
White, D.J. (Cincinnati, Ohio)
174 Characterization and Validation of Diagnostic Methods
ten Bosch J.J. (Groningen); Angmar-Ma˚nsson, B. (Huddinge)
190 Author Index
191 Subject Index
VI
Contents
............................
Preface
Over the past several years, a number of new methods have been developed
for use in the diagnosis of oral disease states. Some of these methods may be
applicable to dental practitioners and others may have greater applicability in
a clinical situation. This volume of Monographs in Oral Science provides a
description of a wide range of new oral diagnostic methods. A number of
these methods are focused toward the specific assessment of disease states
such as caries, calculus, plaque, gingivitis and periodontal disease. Other
methods are more broad, focusing on methods to measure specific changes
in oral morphology. Regardless of the method described, similarities exist
when it comes to the validation of each method for general acceptance and
use. Each method must be critically assessed in order to determine whether
or not an appropriate validation has been done to confirm the robust nature
of the technique or application.
The first eight chapters of this monograph provide descriptions of a range
of new oral diagnostic techniques, the final chapter discusses considerations
that must be taken into account regarding the validation requirements for
each. While this monograph provides an overview of a series of specific new
oral diagnostic methods, these are certainly not the only new methods under
development for assessing oral disease states or morphology. Regardless of
the technique being developed, the validation criteria laid out are applicable
to any new oral diagnostic method.
R.V. Faller
VII
Faller RV (ed): Assessment of Oral Health.
Monogr Oral Sci. Basel, Karger, 2000, vol 17, pp 1–19
............................
Direct Digital Radiography for
Caries Detection and Analysis
Mostafa Analoui, George K. Stookey
Indiana University School of Dentistry, Indianapolis, Ind., USA
Abstract
Recent developments in the field of electronic imaging have provided a new set of
imaging tools for intra-oral imaging and clinical diagnosis. In this chapter, we review the
general structure and characteristics of image sensors used in digital radiography and their
application for clinical caries detection and analysis. An overview of the literature, comparing
the diagnostic accuracy of digital and film-based radiography and the impact of image-
processing methods, is provided. We also describe several approaches for quantitative assess-
ment of radiographic images for caries detection and assessment. Examples include digital
subtraction radiography, and 2-D and 3-D density profiling. To increase the accuracy and
reduce observer variability the use of 3-D imaging and computer-aided diagnosis is presented
as future direction for clinical caries diagnosis.
Copyright Ó 2000 S. Karger AG, Basel
Introduction
The discovery of X-ray in 1895 was a historical step leading to the develop-
ment of a broad class of diagnostic imaging methods commonly called ‘radiog-
raphy’. Shortly after its discovery, radiography found its application in dentistry
in 1896 [1]. In the past 100 years, while maintaining the same principles of
image formation, intra-oral radiography has made significant improvements
[2]. These improvements include increased quality of X-ray production, under-
standing and reducing hazards associated with ionizing radiation and, more
importantly, the constant evolution of radiographic image receptors. Through-
out the first century of dental radiography, film has been the primary medium
for radiographic imaging for both intra- and extra-oral applications. During
this period, continuous developments in film technology focused on increasing
film sensitivity and latitude, while reducing artifacts and processing time. Visual
examination, often aided with various optical enhancements, constituted the
primary mode of examination for radiographic images.
Introduction of digital computers in the early 1940s fueled a revolutionary
chain of rapid developments in various fields of science, including the beginning
steps in digital imaging for diagnostic applications. The computational power
of digital computers, coupled with image and signal-processing algorithms,
provided a wide range of options for image enhancement and analysis. The
early approach for digital radiography involved scanning (digitizing) film-
based radiographs into a computer, followed by image processing and display.
This two-step process, also known as indirect digital radiography, gained
significant popularity in research activities but not much use in clinical proce-
dures. Moreover, such an indirectly formed digital image had, at best, the
same information content as the film-based radiograph along with its charac-
teristics and artifacts. The introduction of electronic image receptors in the
late 1960s and their rapid improvements not only made the direct digital
radiography (DDR) possible, but also led to the introduction of computed
diagnostic imaging methods, such as computed tomography (CT).
The primary focus of this chapter is to review and assess the application
of DDR for caries detection and analysis. The general characteristics of DDR
systems will be discussed, followed by discussion of the attributes impacting
their application in caries diagnosis. The impact of image enhancement
methods on the visual examination of digital images, along with quantitative
methods will be examined using some examples. This chapter will also offer
a glimpse into future developments in imaging approaches for caries diagnosis.
Anatomy of a DDR System
Figure 1 shows a general block diagram depicting elements involved in
a direct digital radiographic system. To better describe the functionality of
each module in this diagram, the image acquisition ensemble is divided into
three modules: (1) image receptor; (2) analog-to-digital converter (ADC), and
(3) digital computer. Note that the ADC is typically integrated either within
the sensor or in the computer. The combination of these three modules defines
the difference between DDR and film-based radiography. The radiation reach-
ing the surface of the image receptor is stored in an array of sensitive cells.
The stored charge in each cell is then converted to a discrete level by ADC
and transferred to the digital computer for storage, display and processing.
Currently, there are two technologies in use for digital dental imaging.
2
Analoui/Stookey
