Title:
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Quantitative image processing as an objective alternative to dental clinical indices
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Most research in dentistry is based on clinical assessment by dentists. This is
naturally subjective and qualitative. The most common means of standardising this
assessment is to use a clinical index, which lays out clear criteria against which
to make the assessment. This works well, but lacks the precision and objectivity
of an automated, quantitative method. The increased statistical power offered by
quantitative methods allows more research to be done more quickly, cheaply and
safely, and the objectivity makes inter-study comparisons more valid and can help
improve blinding. The use of imaging methods offers the chance to archive large
amounts of information for alternative analysis later.
An algorithm was developed to automatically assess caries penetration in micro-
CT scans of extracted teeth. This was tested against Quantitative Light-Induced
Fluorescence (QLF), an Electric Caries Meter (ECM), Fibre-Optic Transillumination
(FOTI) examination and histological assessments, and found to be effective in
measuring depth in dentine (ICC = .822 with histology; N = 45, p < .001), but insufficient
supporting evidence was found to recommend its use in measuring enamel
caries. Further work, with higher-resolution scans and a healthier sample space,
would be required to establish a suitable micro-CT-based gold standard for enamel
caries.
Automated planimetry already offers objective quantification of dental plaque;
however, all present systems use extra-oral photography and measure only or principally
the buccal surfaces of anterior teeth. Due to physical and chemical differences
between different areas of the mouth, this may not be sufficient to assess treatment
effects throughout the mouth. Therefore two versions of an intra-oral planimetry system
were developed and trialled by comparing known-antibacterial cetylpyridinium
chloride to placebo. The first uses a standard QLF imaging system with red disclosing
agent, while the second uses an illuminant with 470nm peak wavelength to
excite fluorescein dye. It was found, using the QLF system, that statistically significant
(p = .032) whole-mouth effects did not appear on anterior buccal surfaces
(p = .526), showing that intra-oral planimetry is required to fully evaluate product
effects. The fluorescein-based system did not separate the products. This is believed
to be because of compliance issues.
Objective quantification of stain covering an entire tooth surface is well established,
but discrete patches of dark stain must still be measured using indices such
as Lobene. Here, an algorithm is developed to measure the area of such stain using
QLF, and it is tested in a six-week stain-growth study comparing stannous fluoride,
chlorhexidine and a control. This was found to correlate well with clinical
assessments (Pearson's = .835) and separate groups (p < .001).
It is clear from this work that quantitative methodologies have a role in the areas
tested here. The methodologies are in their early stages and should be refined before
routine use.
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