The purpose of this study was to describe the role played by the ability to estimate caries depth in successfully deciding to treat dentin caries when making use of bitewing radiographs as a diagnostic test. A 10% random sample (n = 444) of Dutch dental practitioners was sent a two-wave questionnaire concerning radiographic caries diagnosis and restorative treatment decision making. The second wave consisted of simulated bitewing radiographs of 105 tooth surfaces with and without dentin caries according to two measuring standards: (a) a micro-radiographic "gold" standard and (b) a norm of expert observers. The dentists were asked to diagnose caries at 4 depths of penetration using a 5-point certainty scoring system to measure diagnostic ability; and to make a treatment decision for each surface. The overall response was 61% (273). A regression analysis was carried out using the chance per dentist of correctly deciding to treat dentin caries as the dependent variable. The degree of agreement with the experts' diagnosis of radiographic caries depth was used to create variables measuring diagnostic ability. Five significant (P less than 0.05) variables explained 60% (R2 = 0.60) of the variation in decision making. The best diagnostic ability variable explained 47% of the variation while the treatment criterion reportedly used explained 3%. We conclude that the ability of practitioners to interpret radiographs plays a major role in treatment decision making and that their reported treatment decision making criteria should not be taken at face value.
'Deformed or flattened' X-ray projections of the mandibular condyle are incidentally reported in the literature. However, when studied longitudinally in a growing child, this characteristic appears to come and go in an unpredictable order. In addition, there is experimental evidence that in the rat elongated 'flattened' condyles can be cultured and that the rat condylar growth exhibits seasonal fluctuations. Therefore, the hypothesis was formulated that a part of the flattened condylar projections may reflect a temporarily active growth vector. The result of this study suggests that condylar flattened projections in children exhibit a seasonal variation and may possibly be interpreted as the reflection of a temporarily active growth vector.
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