Abstract
The purpose of this study was to evaluate the ability of radiographic densitometry in detecting the early demineralization of human enamel and cementum in irradiated and non-irradiated teeth. Sixty extracted teeth were divided into two groups: irradiated group and non-irradiated group. After irradiation, the groups were subjected to demineralization–remineralization (PH) cycling. Radiographic densitometric measurements (gray values) of a selected area of interest in the enamel and in the cementum of each tooth were performed at baseline and after PH cycling. After PH cycling, there was a significant reduction in gray values for both groups. The difference between “baseline” and “after PH cycling” values represents the reduction in the mineral content of the hard tissue, i.e., the demineralization. Results show that the demineralization of irradiated tooth enamel and cementum was significantly higher compared to that of non-irradiated tissues as determined by gray-level values. It is concluded that densitometric measurements by means of digital radiographs allow for the detection of demineralization of enamel and cementum, and can be used successfully for diagnosis of the early carious lesions in patients who received head and neck radiotherapy. This will allow implementation of remineralizing therapy and avoid the risk of progression of radiation caries. Furthermore, it is concluded that gamma irradiation with typical therapeutic doses for head and neck carcinoma is a direct cause of demineralization of tooth enamel and cementum.
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Abdalla R, Niazy MA, Jamil WE, Hazzaa HA, Elbatouti AA (2017) The role of fluoride and chlorhexidine in preserving hardness and mineralization of enamel and cementum after gamma irradiation. Radiat Environ Biophys 56:187–192
Alkurt MT, Peker I, Bala O, Altunkaynak B (2007) In vitro comparison of four different dental X-ray films and direct digital radiography for proximal caries detection. Oper Dent 32:504–509
Amaechi BT, Podoleanu AG, Komarov G, Higham SM, Jackson DA (2004) Quantification of root caries using optical coherence tomography and microradiography: a correlational study. Oral Health Prev Dent 2:377–382
Berry HM Jr (1983) Cervical burnout and Mach band: two shadows of doubt in radiologic interpretation of carious lesions. JADA 106:622–625
Bragger U, Pasquali L, Rylander H, Carnes D, Kornman KS (1988) Computer-assisted densitometric image analysis in periodontal radiography. A methodological study. J Clin Periodontol 15:27–37
Bragger U, Burgin W, Fourmousis I, Lang NP (1992) Image processing for the evaluation of dental implants. Dentomaxillofac Radiol 21:208–212
Bragger U, Schild U, Lang NP (1994) Effect of chlorhexidine (0.12%) rinses on periodontal tissue healing after tooth extraction. (II). Radiographic parameters. J Clin Periodontol 21:422–430
Bragger U, Muhle T, Fourmousis I, Lang NP, Mombelli A (1997) Effect of the NSAID flurbiprofen on remodelling after periodontal surgery. J Periodontal Res 32:575–582
Carneiro LS, Nunes CA, Silva MA, Leles CR, Mendonca EF (2009) In vivo study of pixel grey-measurement in digital subtraction radiography for monitoring caries remineralization. Dentomaxillofac Radiol 38:73–78
Diniz MB, Rodrigues JA, Lussi A (2012) Traditional and novel caries detection method. In: Li MY (ed) Contemporary approach to dental caries, InTech, pp 106–128
Dove SB (2001) Radiographic diagnosis of dental caries. J Dent Educ 65:985–990
Espelid I, Tveit AB, Fjelltveit A (1994) Variations among dentists in radiographic detection of occlusal caries. Caries Res 28:169–175
Fränzel W, Gerlach R, Hein HJ, Schaller HG (2006) Effect of tumor therapeutic irradiation on the mechanical properties of teeth tissue. Z Med Phys 16:148–154
Hu JU, Chen XC, Li YQ, Smales RJ, Yip KH (2005) Radiation induced root surface caries restored with glass ionomer cement placed in conventional and ART cavity preparations: results at two years. Aus Dent J 50:186–190
JADA 142 (9) (2011) Dental radiographs benefits and safety. http://jada.ada.org. Accessed 1 Nov 2017
Katz RV (1981) Root caries: clinical implications of the current epidemiologic data. Northwest Dent 60:306–310
Khalid I, Kumar Y, Rao S (2011) Use of computer assisted image analysis in assessing bone density changes in extraction socket. Indian J Stomatol 2:168–171
Kielbassa AM, Hellwig E, Meyer-Lueckel H (2006) Effects of Irradiation on in situ remineralization of human and bovine enamel demineralized in vitro. Caries Res 40:130–135
Konjhodzic-Prcici A, Keros J, Ajanovic M, Smajkic N, Hasic-Brankovic L (2010) Incidence of radiation caries in patients undergoing radiation therapy in the head and neck region. Pesq Bras Odontoped Clin Integr João Pessoa 10:489–492
Leite-Ribeiro P, de Oliveira TF, Mathias P, Campo Ede J, Sarmento VA (2014) Conventional and digital radiographic assessment of tooth enamel de-/remineralization processes: an experimental study. Indian J Dent Res 25:214–219
Liang X, Zhang JY, Cheng IK, Li JY (2016) Effect of high energy X-ray irradiation on the nano-mechanical properties of human enamel and dentine. Braz Oral Res 30:1–9
Maghraby E, Badr N, Mahmoud E (2005) Effect of γ-radiation on selected mechanical properties of tooth-colored restorative materials. Egypt Dent J 51:805–818
Mariath AA, Casagrande L, de Araujo FB (2007) Grey levels and radiolucent lesion depth as cavity predictors for approximal dentin caries lesions in primary teeth. Dentomaxillofac Radiol 36:377–381
Mohammadi N, Seyednejad F, Oskoee PA, Savadi Oskoee S, Ebrahimi Chaharom ME (2008) Evaluation of radiation-induced class V dental caries in patients with head and neck cancers undergoing radiotherapy. J Dent Res Dent Clin Dent Prospect 2:82–84
Mohanraj M, Prabhu VR, Senthil R (2016) Diagnostic methods for early detection of dental caries—a review. Int J Pedod Rehabil 1:29–36
Morea C, Dominguez GC, Coutinho A, Chilvarquer I (2010) Quantitative analysis of bone density in direct digital radiographs evaluated by means of computerized analysis of digital images. Dentomaxillofac Rad 39:356–361
National Council on Radiation Protection and Measurements (2009) Ionizing radiation exposure of the population of the United States. Bethesda, MD: National Council on Radiation Protection and Measurements; NCRP Report No. 160. Web. http://www.ncrponline.org/Publications/Press_Releases/160press.html. Accessed 15 June 2012
Naves LZ, Novais VR, Armstrong SR, Correr-Sobrinho L, Soares CJ (2012) Effect of gamma radiation on bonding to human enamel and dentin. Support Care Cancer 20:2873–2878
Onem E, Baks BG, Şen BH, Mert A (2012) Diagnostic accuracy of digora optime storage phosphor plates for proximal subsurface demineralization: effect of different exposure times. Oral Surg Oral Med Oral Pathol Oral Radiol 114:78–84
Pakbaznejad Esmaeili E, Pakkala T, Haukka J, Siukosaari P (2018) Low reproducibility between oral radiologists and general dentists with regards to radiographicdiagnosis of caries. Acta Odontol Scand 12:1–5
Pioch T, Golfels D, Staehle HJ (1992) An experimental study of the stability of irradiated teeth in the region of the dentinoenamel junction. Endod Dent Traumatol 8:241–244
Rodrigues LKA, Jaime AC, Marines N (2004) The effect of gamma radiation on enamel hardness and its resistance to demineralization in vitro. J Oral Sci 46:215–220
Sabel N, Robertson A, Nietzsche S, Norén JG (2012) Demineralization of enamel in primary second molars related to properties of the enamel. Sci World J. Article ID 587254
Schmidlin PR, Tepper SA, Scriba H, Lutz F (2002) In vitro assessment of incipient approximal carious lesions using computer-assisted densitometric image analysis. J Dent 30:305–311
Senel B, Kamburoğlu K, Ucok O, Yuksel SP, Ozen T, Avsever H (2010) Diagnostic accuracy of different imaging modalities in detection of proximal caries. Dentomaxillofac Radiol 39:501–511
Soares CJ, Castro CG, Neiva NA, Soares PV, Santos-Filho PCF, Naves LZ (2010a) Effect of gamma irradiation on ultimate tensile strength of enamel and dentin. J Dent Res 89:159–164
Soares CJ, Moura CCG, Soars PB, Naves LZ (2010b) Scanning electric microscopy used to analyze the effect of gamma irradiation on enamel and dentin. Microscopy: science, technology, applications and education microscopy book series, Badajoz, Vol 1, pp 372–378
Strtid KG, Kalebo P (1998) Bone mass determination from microradiographs by computer-assisted videodensitometry. Acta Radiol 29:465–472
Torres MGG, Santos A, Da S, Neves FS, Arriaga ML, Campos PSF, Crusoé-rebello I (2011) Assessment of enamel-dentin caries lesions detection using bitewing PSP digital images. J Appl Oral Sci 19:462–468
Verna A, Botta SB, Seino PY, Ana PA, Mathor MB, Matos AB, Oda M (2010) Microhardness evaluation of bovine teeth after gamma radiation sterilization. Dissertation, School of Dentistry University of São Paulo
Warren JJ, Levy SM, Wefel JS (2003) Explorer probing of root caries lesions: an in vitro study. Spec Care Dentist 23:18–21
Wefei JS (1994) Root caries histopathology and chemistry. Am J Dent 7:261–265
Wenzel A (2008) Dental Caries. In: White SC, Pharoah MJ (eds) Oral radiology: principles and interpretation, 6th edn. Mosby Elsevier, St. Louis, Mo, pp 270–281
Xu P, Luo H, Huang G-L, Yin X-H, Luo S-Y, Song J-K (2015) Exposure to Ionizing radiation during dental X-rays is not associated with risk of developing meningioma: a meta-analysis based on seven case–control studies. PLoS One 10(2):e0113210. https://doi.org/10.1371/journal.pone
Yang J, Dutra V (2005) Utility of radiology, laser fluorescence, and transillumination. Dent Clin North Am 49:739–752
Yokota ET, Miles DA, Newton CW, Brown CE (1994) Interpretation of periapical lesions using radiovisiography. J Endodon 20:490–494
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Abdalla, R., Omar, A. & Eid, K. Detecting demineralization of enamel and cementum after gamma irradiation using radiographic densitometry. Radiat Environ Biophys 57, 293–299 (2018). https://doi.org/10.1007/s00411-018-0749-2
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DOI: https://doi.org/10.1007/s00411-018-0749-2