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Radiopacity Measurement of Restorative Resins Using Film and Three Digital Systems for Comparison with ISO 4049: International Standard

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Radiopacity Measurement of Restorative Resins Using Film and Three Digital Systems for Comparison with ISO 4049: International Standard Bull Tokyo Dent Coll (2015) 56(4): 207–214 Original Article Radiopacity Measurement of Restorative Resins Using Film and Three Digital Systems for Comparison with ISO 4049: International Standard Rishabh Kapila1), Yukiko Matsuda1), Kazuyuki Araki1), Tomohiro Okano1), Keiichi Nishikawa2) and Tsukasa Sano1) 1) Division of Radiology, Department of Oral Diagnostic Sciences, Showa University School of Dentistry, 2-1-1 Kita-senzoku, Ota-ku, Tokyo 145-8515, Japan 2) Department of Oral and Maxillofacial Radiology, Tokyo Dental College, 2-9-18 Misaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan Received 7 April, 2014/Accepted for publication 29 May, 2015 Abstract This study compared Ultra Speed Occlusal Film (USOF) and 3 digital systems in determining the radiopacity of 5 different restorative resins in terms of equivalents of aluminum thickness. Whether those digital systems could be used to determine whether radiopacity was in line with International Organization for Standardization (ISO) recommendations was also investigated. Disks of each of 5 restorative resins and an aluminum step wedge were exposed at 65 kVp and 10 mA on USOF and imaged with each digital system. Optical density on the film was measured with a transmission densitometer and the gray values on the digital images using Image J software. Graphs showing gray value/optical density to step wedge thickness were constructed. The aluminum equivalent was then calculated for all the resins using a regression equation. All the resins were more radiopaque than 1 mm of aluminum, and therefore met the ISO 4049 recommendations for restorative resins. Some resins showed statistically higher aluminum equivalents with digital imaging. The use of traditional X-ray films is declining, and digital systems offer many advantages, including an easy, fast, and reliable means of determining the radiopacity of dental materials. Key words: Radiopacity — Restorative resins — Digital system Introduction It is important to evaluate restorations accurately and in detail, which means the Radiopacity is a prerequisite of dental dentist must be able to ascertain whether materials, including restorative composite secondary caries or marginal defects are resins. A standardized method for measuring present, what the contours of the restorations the radiopacity of dental materials was are, whether there is contact with adjacent established3). teeth, and whether there are any cement 207 208 Kapila R et al. Table 1 Light cure composite resin materials Material Manufacturer Sorare® P GC Dental (Tokyo, Japan) Gradia® DirectX GC Dental (Tokyo, Japan) Estelite® Sigma Quick Tokuyama Dental Corp. (Tokyo, Japan) Clearfil® AP-X Kuraray Medical Inc. (Tokyo, Japan) Beautiful® II Shofu Inc. (Kyoto, Japan) overhangs or interfacial gaps, for example. films and densitometers or spectrophotome- Therefore, the materials used in such resto- ters1). A digital system for dentistry was first rations need to be sufficiently radiopaque introduced in 1989, since which time digital to allow them to be distinguished from radiography has found its way into dental background enamel and dentin. Radiopaque practice. Several types of sensor are available materials offer a number of advantages over for imaging: a charge-coupled device (CCD), those that are radiolucent: for example, they a complementary metal oxide semiconductor make detection of recurrent dental caries and (CMOS), and photo-stimulable phosphor visualisation of the radiographic interface plates. The most important advantages of between the materials and the tooth substrates digital radiographic systems are that they are easier5). more sensitive than silver halide film and Several factors may affect the radiopacity allow exposure to radiation to be reduced. In of dental materials, but composition seems digital imaging, the gray scale has an inverse to be most important. Additional factors relationship with optical density, with white include material thickness, type of X-ray film being allotted a value of 255 (for an 8-bit used, and alteration of powder/liquid ratio of image) and black 0. Unless performed with luting materials1). It has been demonstrated great care, traditional film development can that the radiopacity of dentin is approximately produce significant variations in the final equivalent to that of aluminum of the same radiograph. The results of digital imaging, on thickness, and that enamel has approximately the other hand, are more consistent4). twice the radiopacity of aluminum of the same The aim of the present study was to thickness9). According to the International determine the radiopacity of 5 different restor- Organization for Standardization (ISO), the ative resins in terms of equivalent aluminum radiopacity of a material should be equal to or thickness by using an ultra-speed film and greater than the same thickness of aluminum, 3 different digital systems. Whether those and should not be less than 0.5 mm of any digital systems could be used to determine value claimed by the manufacturer3). whether radiopacity was in line with ISO One of the most highly recommended recommendations was also investigated. methods of measuring radiopacity involves using an aluminum step wedge as a reference standard. The ISO and American National Materials and Methods Standards Institute/American Dental Associa- tion have published standardized procedures 1. Preparation of specimens for quantifying the radiopacity of several types The 5 restorative resins used in the study of dental material which use a ≥98% pure are summarized in Table 1. All were obtained aluminum step wedge as a reference8). directly from the maker and were manu- Radiographic image density is commonly factured in accordance with ISO standards. evaluated by means of conventional X-ray The test specimens were prepared by using Digital Evaluation of Radiopacity 209 Table 2 Digital imaging systems used in study System Manufacturer Charged-coupled device Kodak RVG 5000 (Rochester, NY, USA) Imaging plate Soredex Digora (Tuusula, Finland) Imaging plate Array Corporation Arcana (Tokyo, Japan) the method described in ISO 4049:20093). Disk-shaped specimens 10 mm in diameter and 1.0 mm in thickness were made from Fig. 1 Images obtained each of the 5 resins. The thickness of each A: Ultra Speed Occlusal Film; B: Arcana; C: Digora; and D: RVG. specimen was measured to an accuracy of ±0.01 mm using a micrometer. An aluminum step wedge was also fabricated according to ISO recommendations with an aluminum RVG owing to the small size of the imaging purity exceeding 98%. The aluminum step plate and sensor, respectively. To reduce wedge had steps of 1.0, 1.5, 2.0, 3.0, 4.0, 6.0, variation in the intensity of radiation in the 8.0 and 10.0 mm in thickness. central X-ray beam due to the anode heel effect, the film and specimen were placed 2. Film and digital systems perpendicular to the cathode-anode axis. Kodak Ultra Speed Occlusal Film (USOF: Exposure was set at 65 kVp and 10 mA, with a DF-50, Carestream Health, Rochester, NY, USA) 30-cm focus to film distance. The X-ray unit was used. Table 2 shows the 3 digital imaging was kept in the same position throughout systems employed: Arcana, RVG, and Digora. the experiment. Exposure time was 0.05 and 0.25 sec for RVG, Digora, and Arcana, and 3. Exposure conditions 0.25 sec for USOF. These exposure parameters In ISO 4049:2009, it is recommended that were selected so that the individual steps of the dental X-rays be taken with a single-phase unit aluminum step wedge would be clearly visible with a total filtration of 1.5 mm aluminum on the images produced. Three exposures and capable of operating at 65±5 kVp. were made for each of the settings for the Currently, single phase X-ray units are being USOF and 3 digital systems. replaced by constant-potential machines, which The images produced on USOF were pro- yield a longer contrast scale and reduce patient cessed immediately in an automatic processor exposure to radiation8). In the present study, (Dent-X, AFP Imaging, Elmsford, NY, USA) X-rays were produced by an inverter-type operating at 28°C with a Dent-X developer constant-potential dental X-ray unit, the Max- and fixer (Dent-X, AFP Imaging). The imaging DC70 ( J. Morita, Kyoto, Japan), with spot sizes plates produced with Digora and Arcana were of 0.8 and 2.5 mm aluminum filtration for scanned immediately, whereas direct digital each exposure. images were displayed with RVG (Fig. 1). All 5 disk shaped specimens were placed on the USOF along with the aluminum step 4. Image analysis wedge. All 5 disk shaped specimens were Optical density on the USOF images was also subsequently placed on the imaging plate measured by using a transmission densitom- of the Arcana. Only one resin disk shaped eter (Konica Densitometer PDA-15; Konica specimen at a time was used for Digora and Minolta Holdings, Tokyo, Japan) with an 210 Kapila R et al. Fig. 3 Sample graph with polynomial equation used to obtain equivalent of aluminum thickness in mm sheet (ver. 2007), with the Y axis equalling Fig. 2 Sample image used for mean gray value the step wedge thickness in millimeters and measurement in Arcana using Image J software X axis the corresponding gray value/optical 50×50-pixel regions of interest were set in each density of the step wedge. A regression step and resin disks. equation was obtained from each graph using the polynomial method to the third degree up to 10 decimal places. The regression curve and reliability of each plot exceeded 0.99, aperture of 1 mm in diameter. The optical indicating that there was no deviation from densities were measured for all 1 mm thick disk linearity for the different thicknesses of the resin specimens and each step of aluminium aluminum step wedge. According to ISO step wedge on each film. Each film was recommendations, the slope of the graph measured three times.
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