A more stringent indication pathway may reduce unnecessary third molar removals, thus reducing the operation-related comorbidity and costs14. In vitro comparison of four different dental X-ray films and direct digital radiography for proximal caries detection. Training and testing the model with cropped premolars, incisors and canines might further increase the robustness and the generalizability to assess all caries on PR(s). Gudkina J, Amaechi BT, Abrams SH, Brinkmane A, Jelisejeva I. Eur J Dent. 1 0 obj White, Stuart C., and Michael J. Pharoah. PubMed The unique characteristics of a person's dentition reveal reliable and accurate information. Other non-invasive techniques for detection of early caries have been developed and investigated such as Quantitative Light-induced Fluorescence (QLF), DIAGNOdent (DD), Fibre-optic Transillumination (FOTI) and Electrical Conductance (EC). An imbalance in the continuum with a net demineralization over time results in the initiation of caries lesions. Detection and diagnosis of dental caries using a deep learning-based convolutional neural network algorithm. There are multiple ways to get in touch with our team of experts. The caries balance is affected by multiple social determinants favoring demineralization. The carious process results in demineralization, which is radiolucent, because the carious lesion attenuates the beam less than healthy tooth structure, resulting in more of the remnant beam reaching the Dental caries recurs if not completely excavated before restoration, and lesions appear as radiolucency adjacent to or beneath the restoration. On a processed radiograph, dental caries appear as: The most effective way to minimize cross-contamination between the patient and operator of to, Wear proper personal protective equipment, During a quality assurance check, safelight film fog was detected by, Words from textbook supplementary to vocab li, Julie S Snyder, Linda Lilley, Shelly Collins. A convolutional neural network (CNN) was trained on a . o+z?|g}{;OW{8kqryzD_Cv3}nv^Kz]BRGH=! Because radiographs are a 2-dimensional representation of a 3-dimensional tooth structure, it is not always possible to determine caries extension to the pulp chamber or pulp horn because of anatomic variations and presence of radiopaque restorations in the crowns. on PR(s), might improve the selection process whether to remove or not. Radiopaque dyes are used in radiology to enhance X-ray pictures of internal anatomic structures. Health Inform. (Tehran) 12, 290297 (2015). Enamel, Dentin, Cementum and bone: Enamel: is the most radiopaque structure. Basic? Lastly, transfer learning was used to prevent overfitting. 7 0 obj Dental radiographs are part of the dental record therefore, they are: Legislature sends laws to the state board of dental examiners who write laws to rules & regulation. Analog films are still being used in clinical practice; however, it is recommended that no dental radiographic film with speeds lower than E- or F-speed shall be used for intraoral radiography, as the dose is essentially halved from the older D-speed to E-plus or F-speeds. HHS Vulnerability Disclosure, Help Effects of healthcare policy and education on reading accuracy of bitewing radiographs for interproximal caries. To date, intraoral bitewing radiographs (BTW) are still the primary diagnostic tool used for the detection of interproximal caries despite several disadvantages, including radiation exposure and discomfort. Clean & disinfect the outside of the container. This pilot study assesses the capability of a deep learning model (MobileNet V2) to detect carious third molars on PR(s) and is therefore a mosaic stone in the picture of automation of M3 removal diagnostics. Appropriate kilovolt and milliampere as well as standardized exposure time are essential for optimally exposed radiographs. adjective Referring to a material or tissue that blocks passage of x-rays, and has a bone or near bone density; radiopaque structures are white or near white on conventional x-rays. Disinfection is the partial elimination of active growth stage . Article The mixed ecology of the biofilm may be naturally shifted in composition to a more acidic ecology by repeated exposure to fermentable carbohydrate. Submitted to Oral Surg Oral Med Oral Pathol oral Radiol, 2020). Sato H, Da Silva JD, Lee C, Yonemoto H, Kuwajima Y, Ohyama H, Lambert RF, Izumisawa M, Takahashi N, Nagai S. Dentomaxillofac Radiol. Material safety data sheets MSDS will contain information about: The use of physical or chemical means to remove, inactivate or destroy pathogenic microorganisms on a surface or item to the extent that they are no longer capable of transmitting infectious disease; the surface or item is rendered safe for handling. A carious lesion appears radiolucent in a radiographic image because the demineralized area of the tooth does not absorb as many X-ray photons as the unaffected mineralized portion. The ROC curve is created by plotting the true positive rate against the false positive rate at different thresholds. 5 0 obj Certain types of dental caries are difficult to visualize intraorally, and therefore, the diagnosis need to be made based solely on the radiographs. Rev. PubMed When removing needles from reusable syringes, which of the following are acceptable? Am. tooth decay) Bone loss caused by periodontal disease (a.k.a. The only radiographically certain way of determining pulp exposure is the visualization of secondary caries and periapical changes in the alveolar process, such as widened periodontal ligament space or lack of continuity of lamina dura. When using the panoramic machine there is no need to wrap the unit. Advanced caries lesion: Advanced mineral loss with cavitation through enamel. Appl. Oral Maxillofac Surg. This is seldom possible because few of the drains now in use are radiopaque. 2007 Sep-Oct;32(5):504-9. doi: 10.2341/06-148. A convolutional neural network (CNN) was trained on a reference data set consisted of 400 cropped panoramic images in the classification of carious lesions in mandibular and maxillary third molars, based on the CNN MobileNet V2. MeSH Which tooth structure is the most radiopaque? Akkaya N, Kansu O, Kansu H, Cagirankaya LB, Arslan U. Dentomaxillofac Radiol. Most of periapical radiolucencies are the result of inflammation such as pulpal disease due to infection or trauma. ), The collar on a lead apron reduces the dose of radiation to the, The beam of radiation for a panoramic radiograph is a narrow silt, Which tissue is considered to be radiobiologically critical, When compared to the actual length of the tooth, the elongated image will appear, One of the advantages of being able to enhance a digital image is that, The purpose of this film is to record a major portion of the maxilla or mandible on one film, preventing cross contamination when exposing dental films can be achieved by the use of, Film placed backwards in the mouth has the appearance of (incorrect film placement), Solution exposure to air &light with the manual processing technique can be avoided by using, Lead and silver are heavy solutions and are very toxic, Developing time is determined by the developer temperature, The optimium condition for processing in a manual processor is to develop for 10 minutes at 68-70 degrees, When using the panoramic machine there is no need to wrap the unit, The following statements are true about panoramic X-rays except, Produce enlarged image that is more accurate than a full mouth series, Some of the advantages of digital radiographs include, Instant viewing, less radiation exposure to patient; remove consultation, images sent by email, Whether using the manual or automatic processing techniques, improper handling can result in. ADVERTISEMENT: Supporters see fewer/no ads. In conclusion, a convolutional neural network (CNN) was developed that achieved a F1 score of 0.86 for caries classification on third molars using panoramic radiographs. Zi En Lim, Henry F. Duncan, Advan Moorthy &. These characteristics make the MobileNet V2 less prone to overfitting. PubMed Central It simply means that, using the criteria established by the systematic review, the evidence is inadequate to validate the method. Pure rubber is not, and does not cast an x-ray shadow in contrast to the surrounding tissues. Finally, U-net with EfficientNet-B5 as an encoder was used to segment caries on bitewings with an accuracy of 0.89. thyroid The beam of radiation for a panoramic radiograph is a narrow silt True X-ray filters are usually made of Aluminum Which tissue is considered to be radiobiologically critical thyroid When compared to the actual length of the tooth, the elongated image will appear Longer One of the advantages of being able to enhance a digital image is that This forms a promising foundation for the further development of automatic third molar removal assessment. 2019-5232). Cariogenic bacteria are essential to the disease process. Sci Rep 11, 12609 (2021). Taking every prudent measure or precaution to prevent occasionally and non-occupationally exposed persons from excessive radiation reverts to which concept? Shifting toward a conservative, noninvasive approach to caries management has resulted in the development of innovative-sensitive technologies. If cavities aren't treated, they get larger and affect deeper layers of your teeth. The MobileNet V2 was used in this study. Digital radiographic sensors are an objective and reproducible technique; however, its sensitivity for detection of early and recurrent caries is suboptimal, , with reported sensitivity being as low as 0.30. , Caries detection can be affected by a variety of factors during acquisition or interpretation, such as variation in image capture, detector placement, status of the detector, focus to object distance, kilovolt or milliampere used for capture of the radiograph, ambient lighting for interpretation, or the experience of the clinician. Vinayahalingam, S., Kempers, S., Limon, L. et al. Google Scholar. 26, 10191034. RADIOLOGY OF DENTAL CARIES. Shintaro Sukegawa, Tamamo Matsuyama, Yoshihiko Furuki, Shankeeth Vinayahalingam, Tong Xi, Guido de Jong, Fahad Parvez Mahdi, Kota Motoki & Syoji Kobashi, Sung-Hwi Hur, Eun-Young Lee, Jae Seok Lim, Gloria Hyunjung Kwak, Eun-Jung Kwak, Jae Joon Hwang, Irma Dumbryte, Donatas Narbutis, Mangirdas Malinauskas, Scientific Reports Importantly, an increase in the quantity of sugar consumed alone is not a predictor of increased caries, as many communities around the world have increased caries preventive strategies over the same time period as sugar consumption has increased. Tong Xi. The carious lesion (the demineralized area of the tooth that allows greater infiltration of x-rays) is darker (i.e., As these parameters differed between the studies, a direct comparison of these studies would be misleading. <>/Metadata 915 0 R/Pages 2 0 R/StructTreeRoot 118 0 R/Type /Catalog/ViewerPreferences 916 0 R>> Being able to detect dental caries on radiographs is an essential skill needed for providing comprehensive dental treatment. For example, on typical radiographs, bones look white or light gray (radiopaque), whereas muscle and skin look black or dark gray, being mostly invisible (radiolucent). On the other hand, bitewing radiographs capture the crown and a third of the root of the maxillary and mandibular teeth with its accompanying interalveolar bone ( Fig. J. 2020 Mar 17;20(6):1659. doi: 10.3390/s20061659. Recent guidelines recommend the removal of pathologically erupting third molars in order to prevent future complications1,2. The accumulated PR(s) were acquired with a Cranex Novus e device (Soredex, Helsinki, Finland), operated at 90kV and 10mA, using a CCD sensor. Sudden stopping of high speed electrons as they collide with a target, Fire and explosive data, hazardous ingredients, spill procedures. Dental caries. 3 0 obj In order to minimize the gag reflex, it is helpful to start the radiographic procedure by first exposing the, When digital X-rays are used they require no film pack and no lead foil, and chemicals, The image sharpness on a processed radiograph is termed, What are the three basic method to reduce occupation exposure. Classification metrics are reported as follows for the test set: accuracy=\(\frac{TP+TN}{TP+TN+FP+FN}\), precision = \(\frac{TP}{TP+FP}\) (also known as positive predictive value), dice = \(\frac{2TP}{2TP+FP+FN}\) (also known as the F1-score), recall = \(\frac{TP}{TP+FN}\) (also known as sensitivity), specificity=\(\frac{TN}{TN+FP}\), negative predictive value=\(\frac{TN}{TN+FN}\). Active lesions are shiny/glossy and smooth to touch; inactive/arrested lesions are frosty/matte in luster with a roughened surface. When the outside of the biopsy specimen bottle shows visible contamination, what should be done? Unauthorized use of these marks is strictly prohibited. Bookshelf endobj The most commonly used radiographic method for detecting caries lesions is the bitewing technique. The image sharpness on a processed radiograph is termed: Taking every prudent measure or precaution to prevent occupationally & nonoccupationally exposed persons from excessive radiation refers to which concept? Our clear glass board uses LED lights for a modern take on the traditional classroom whiteboard. Mandibular Tori Subpontic Hyperostosis August 2016 References Koenig. Grieco P, Jivraj A, Da Silva J, Kuwajima Y, Ishida Y, Ogawa K, Ohyama H, Ishikawa-Nagai S. Ann Transl Med. Direct-acting cholinergic parasympathomimetic agents, such as Pilocarpine hydrochloride , or muscarinic agonist, like Cevimeline, are used for treatment of xerostomia. Employs a reusable intramural sensor, traditional x-ray tubehead can be used, reduces radiation exposure by 90%. A dental assistant who does not expose or process x-rays must be registered I'n the state of Texas. DEN/DHY 104 - Dental Radiology Exam #4 Review Chapter 21 (8 questions) Know the degree of angulation for occlusal radiograph technique Know if a dental image and the object on the film are 2-D or 3-D Know the SLOB rule and what each letter stands for Know what each type of occlusal projection examines and a brief description of when we use them Chapter 18 (9 questions) Know the vertical . Developing time is determined by the developer temperature, All these settings affect the quality of the x-ray. uBEATS helps students develop the knowledge needed for an incredible future in health care. endobj Dental caries is a complex biofilm disease that creates prolonged periods of low pH in the mouth, resulting in a net mineral loss from the teeth. Article Of the following statement about filmless digital system which are true? Required film mount information would include all of the following except the: The two main purposes of the fixing solution are to expose the silver halide crystals, and to turn the entire crystals into a block of metallic silver, X-rays are produced when a high speed electron strikes a, Anatomical structures that appear dark gray to black on a processed radiograph are described as being, Before exposure of any type of radiographs You must obtain an informed consent from the patient, Sudden stopping off high speed electrons as they collide with a target. Furthermore, the area-under-the-curve-receiver-operating-characteristics-curve (AUC) and confusion matrix are presented. The optimum condition for processing I'n a manual processor is Develop for 10 minutes @ 68-70 degrees, Must take a course & exit exam to be offered through self study, computer courses & Internet or lecture courses. The second molar is frequently disrupting the eruption path of the third molar, evoking it to only erupt partially or not at all, which can adversely affect periodontal health of the second molar. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Watch completed modules to see examples of the information and interactions used to keep students engaged. official website and that any information you provide is encrypted 2 0 obj 1. 4 0 obj The left column shows the cropped carious M3s. Currently, there is a shift toward early detection and minimal intervention dentistry (MID). May lead to bacterial contamination of the existing soap Consent for release of privileged information must be: A herringbone or tire track pattern on a radiograph is a result of: On a processed radiograph, dental caries appear as: Film holders are not necessary with the paralleling technique. Vinayahalingam, S., Xi, T. & Berg, S. Automated detection of third molars and mandibular nerve by deep learning. uBEATS makes a teachers job easier by giving a simple, easy way to offer advanced content. This situation may lead . Also, the potential bias in these algorithms with possible risks of limited robustness, generalizability and reproducibility has to be assessed in future studies using external datasets and is a necessary step to further implement deep learning successfully in daily clinical practice. Write a statement that will dynamically allocate an integer variable and store its address in ip. https://doi.org/10.1016/j.joms.2014.12.039 (2015). This modern view started with the definition by Miller 1890 of a 2-step process whereby bacteria on the tooth, exposed to fermentable carbohydrates, produce acid, and in a second step, dissolve the surface of the tooth. Toothache can become severe when the pulp cavity becomes exposed. The detection of pathologies associated with third molars on PR is the first step in the automation of M3 removal diagnostics. Bethesda, MD 20894, Web Policies <> The optimization algorithm employed was the Adam optimizer, at a learning rate of 0.0001, with a batch-size of 32 and batch normalization. Accessibility Oral Maxillofac Surg. A daily dilemma in dentistry and oral surgery is to determine whether a third molar should be removed or not. The overall lightness and darkness of an image is referred to as: The purpose of this film is to record a major portion of the maxilla or mandible on one film: When recapping a needle, which of the following should be used? Confusion matrix showing the classification results. CAS Poor contrast (. Simply fill out the registration form to begin using uBEATS in your class. Lee, J.-H., Kim, D.-H., Jeong, S.-N. & Choi, S.-H. Res. 2 This highlights the need for regular radiographic assessment of dental caries if an individual is . S.K. Caries detection with near-infrared transillumination using deep learning. An official website of the United States government. A survey on deep learning in medical image analysis. 2 ) or horizontal. Amirsys. Solid-state sensors, also known as direct digital sensors, are of 2 types depending on how the image is captured: charge coupled device (CCD) and complementary metal oxide semiconductors. The lamina dura is radiographically visible as a radiopaque line that represents the dense compact bone lining the alveolus. x_K0,7IkYq Sci Rep. 2022 Apr 12;12(1):6139. doi: 10.1038/s41598-022-10126-x. The model achieved an AUC of 0.90 (Fig. Lee JH et al. PMC volume11, Articlenumber:12609 (2021) 77, 106111. Liu, L. Z. et al. The classification accuracy and the area-under-the-curve (AUC) were calculated. The confusion matrix is presented in Fig. Impacted or partially erupted third molars are often the cause for various pathology such as pericoronitis, cysts, periodontal disease, damage to the adjacent tooth and carious lesions3. The alveolar margin is the cortical bone that extends within 1-2 mm apically to the cemetoenamel junction. At least 2 major groups of bacteria, namely, the streptococci species (chiefly Streptococcus mutans ) and the Iactobacilli species (chiefly Lactobacillus fermentum , Lactobacillus casei/paracasei , and Lactobacillus salivarius ), can produce organic acids during metabolism of fermentable carbohydrates and are known as acidogenic. Some advantages of digital radiographs include: Which tissue is considered to be radiobiologically critical. 3 and 4. 2019 Jul;13(3):413-419. doi: 10.1055/s-0039-1700250. To obtain endobj J. Dent. J. Dent. Dental caries forms through a complex interaction over time between acid-producing bacteria and fermentable carbohydrate, and many host factors, including teeth and saliva. Schwendicke, F., Golla, T., Dreher, M. & Krois, J. Convolutional neural networks for dental image diagnostics: A scoping review. The ADEX Dental Hygiene Examination is based on specific performance criteria used to measure clinical competence. MathSciNet Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-52069, View Yuranga Weerakkody's current disclosures, see full revision history and disclosures. The prevalence of carious lesions in third molars is reported to range between 2.5% and 86%4. What pOH range is considered acidic? It is challenging to make an early diagnosis of . Which tooth structure is the most radiolucent? Diagnostic Imaging: Oral and Maxillofacial. Intraoral radiography has been an integral part of the diagnostic arsenal for more than 100years. 10 0 obj Problems of occlusion. Sci. Unable to load your collection due to an error, Unable to load your delegates due to an error. Of the following statements which is more true? Disclaimer. The .gov means its official. sharing sensitive information, make sure youre on a federal extends into dentin and appears as a very thin radiolucent line. Students can leave their mark on health science education by changing the way future students learn. 253 preoperative PR(s) of patients who underwent third molar removal were retrospectively selected from the Department of Oral and Maxillofacial Surgery of Radboud University Nijmegen Medical Centre, Netherlands (mean age of 31.7years, standard deviation of 12.7, age range of 1680years, 140 males and 113 females)6. https://doi.org/10.1177/0022034519871884 (2019). https://doi.org/10.1016/j.jdent.2018.07.015 (2018). Article Initial caries lesion: Early lesions that demonstrate net mineral loss in enamel or exposed dentin that may only be visible when the tooth is dried by air or color change toward white. The aim of this study is to train a CNN-based deep learning model for the classification of caries on third molars on PR(s) and to assess the diagnostic accuracy. Scientific Reports (Sci Rep) They're especially common in children, teenagers and older adults. Adding interactivity to courses is easier than you think when faculty partner with students. British Dental Journal 234 , 233-240 ( 2023) Cite this article. Friedman, J. W. The prophylactic extraction of third molars: A public health hazard. <> Syst. The systematic review evaluated the dental literature from 1966 to 1999. It is an extra-oral radiograph that approximates the focal trough of the mandible. Several factors are associated with the model performance. The two types of digital systems include: Instant viewing, less radiation exposure to the patient, remote consultation, images sent by email. Caries activity is defined as active or inactive/arrested. These elements are more concentrated in enamel than in dentin, making enamel more radiopaque than dentin. PubMedGoogle Scholar. https://doi.org/10.29220/Csam.2019.26.6.591 (2019). : Supervision, writing article, article review. 1). A more centered and focused region of interest is found for carious M3(s). Which Is More Stable Thiophene Or Pyridine. Caries classification on third molars using PR(s) is flawed by limited and varying accuracy of individual examiners leading to inconsistent decisions and consequently suboptimal care9. x]O0#?FjJvQAs1QV'oIxNRJPJ:dH[Y|l&[,Kn. Classification of caries in third molars on panoramic radiographs using deep learning. applied a pre-trained GoogLeNet Inception v3 CNN network on periapical radiographs achieving accuracies up to 0.898. The class activation heatmaps (CAM) for carious third molar and non-carious third molar are illustrated in Figs. approximal: occur between teeth. A limitation of the present study is that only cropped images of third molars were included. 1 st Edition. and JavaScript. Radiographic detection of dental caries and the methods used for detection have changed over the years. 2013;201(6):W843-53. Classification of caries in third molars on panoramic radiographs using deep learning, https://doi.org/10.1038/s41598-021-92121-2. & Faghihian, E. Accuracy of digital bitewing radiography versus different views of digital panoramic radiography for detection of proximal caries. Transfer learning is a technique that pre-trains very deep networks on large datasets in order to learn the generic and low-level features in the early layers of the network. For this pilot study, the trained MobileNet V2 was applied on a test set consisting of 100 cropped PR(s). Dental assistant registration after September 1, 2006. I'n order to minimize the gag reflex, it is helpful to start the radiographic procedure by first exposing the: Unprofessional conduct would be considered: Collect fees by fraud, orally soliciting dental business to a particular dental practice, claiming superiority I'n providing dental care. T.M. Subsequently, the best model was used to perform predictions on the test set. Caries can also be detected radiographically by looking at the approximal surface of teeth. The low-dimensional compressed representation is expanded to a higher dimension with a lightweight depthwise convolution. A list of recommended sites for royalty-free graphics and audio. A drain must be sufficiently opaque to x-rays to be easily seen in any part of the body. Rep. 9, 9007. https://doi.org/10.1038/s41598-019-45487-3 (2019). One major disadvantage of the phosphor plates is that after extensive usage, they sustain irreversible damage because of their susceptibility to scratches, bite marks, and creasing. The data used in this study can be made available if needed within the regulation boundaries for data protection. Shao, L., Zhu, F. & Li, X. Initial exvivo studies have shown that intraoral bitewing radiography (IOBWR) is superior to extraoral bitewing radiography (EOBWR). Although considerable attention has been placed on a few bacterial species as the cause of dental caries (eg, S mutans , Lactobacillus ), there is general agreement today that the dental biofilm exists as a complex ecosystem that can shift from a neutral pH to a more acidic ecosystem. https://doi.org/10.1002/14651858.CD003879.pub5 (2020). Visual inspection and intraoral radiographs are vital in caries detection, although they are of suboptimal sensitivity for early caries lesions. Decreases in saliva flow can also favor a shift in the caries balance toward demineralization, resulting in an increase in caries progression. Detection of Caries in Radiographs Detection of caries and the most common reason for radiographs University Oxnard College Course Beginning Radiology For Dental Assisting (DA R011) Uploaded by Violet Pantoja Academic year2022/2023 Helpful? 3. endobj The line pair resolution of digital dental radiographs is about 20 line pairs per millimeter. 2006 May;35(3):170-4. doi: 10.1259/dmfr/26750940. Radiotherapy for head and neck cancers lead to decreased salivation especially if the salivary glands are in the direct path of radiation. It is known that the short-term loss of function in the salivary glands leads to clinical xerostomia, which further accentuates clinical caries, especially rapidly advancing root caries. A vertical left premolar bitewing showing interproximal contacts and crestal bone levels. Right premolar bitewing showing carious lesions (E1, E2) in the maxillary right premolars. Acids produced by these bacteria include lactic, acetic, formic, and propionic acid, all of which readily dissolve the mineral content of enamel and dentin. High-speed handpieces should be run to discharge water and air for a minimum of 20-30 seconds after use on each patient. Write a statement that will free the memory allocated in the statement you wrote above. 73, 804805. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Another study compared the detection accuracy of proximal caries and crestal bone loss using EOBWR or IOBWR and concluded that although EOBWR has promise, clinicians should be aware of the false positive diagnoses of proximal caries and crestal bone loss when using EOBWR. 3 ) was recommended as a guideline, because of the possibility of creation of aerosols during intraoral procedures, more so in exaggerated gag and cough reflex cases (Personal communication from Dr. David MacDonald, University of British Columbia (UBC), Vancouver, Canada Oral and Maxillofacial Imaging guidelines during COVID-19 pandemic. The systematic review was commissioned as part of the NIH Consensus Development Conference on Diagnosis and Management of Dental Caries Throughout Life. Hub clamping device When removing needles from reusable syringes, which of the following are acceptable? Certain types of dental caries are difficult to visualize intraorally, and therefore, the diagnosis need to be made based solely on the radiographs. ImageNet: A large-scale hierarchical image database. A single cavity can also be referred to as a carious lesion to avoid ambiguity. Comparison of direct digital and conventional radiography for the detection of proximal surface caries in the mixed dentition. Stephan demonstrated that this production of acid after exposure to fermentable carbohydrate resulted in a localized drop in pH within the plaque followed by a subsequent return to the baseline pH over time hence establishing the concept of caries being a cyclic event of demineralization/neutrality/remineralization.