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"Impacted third mandibular molar seems as a common and easy case but actually a difficult one when the odontectomy proceeds. besides, another unpredicted problems ofte appear such as fractured lip, traumatized and damaged of the mandibular canal. To decide the odontectomy procedure, a dentist has to do the examination systematically. In this case, radiographic examination is very important to perceive the location as well as shape of the third molar, especially its position to the adjacent anatomic structure that has to be considered during operation. This whole view will help dentist to decide appropriate approach.A special radiographic examination enables dentist to predict the treatment result more accurately, since the location and shape of the tooth correctly perceived. With this more complete diagnostic information, an appropriate treatment plan could be arranged and unfavorable risk could be limited, therefore complication and failure could be avoided."

"Indonesia Journal of Dentistry 2006; Edisi Khusus KPPIKG XIV: 308-311The temporomandibular join has a very important role in the stomatognathic system. It's main function is for the opening and closing movement, mastication, and speech. It is located anterior to the ear. The temporomandibular joint connects maxilla and mandible through the articular fossa, hence the slightest change that happens would cause serious matters such as pain, eating, speech disorder, difficulty in opening and closing movement, headache, and event trismus. In a child or an adolescent, the symptoms are often vague; everything is interpreted as "pain". This is probably why temporomandibular disorder are often undetect by dentists. Therefore, patience and accuracy is needed to determine the actual disorder through means of clinical and radiographic examination. The radiographic examination suitable for child is the transcranial projection. This projection is believed to be more accurate amongst other projections for child patients."

"Latar belakang: Karies merupakan penyakit dengan prevalensi paling tinggi di seluruh dunia. Terdapat beberapa metode untuk melakukan deteksi karies, metode yang paling sering digunakan adalah pemeriksaan klinis dan pemeriksaan radiografik. Namun salah satu kesulitan terbesar dalam melakukan deteksi karies dini menggunakan pemeriksaan radiografik adalah mendeteksi demineralisasi tahap awal yang hanya berdampak kepada enamel. Banyak kemajuan di bidang teknologi deteksi karies yang berfokus pada kemampuan mendeteksi perubahan sekecil apapun pada proses demineralisasi lesi. Salah satu teknik tersebut adalah teknik radiografi digital subtraksi. Saat ini sudah banyak piranti lunak digital yang dapat digunakan untuk melakukan teknik subtraksi tetapi dengan tingkat akurasi yang berbeda. Dari berbagai penelitian yang telah dilakukan, tingkat subjektifitas dan pengalaman pembaca termasuk faktor yang mempengaruhi akurasi dalam deteksi lesi karies. Oleh karena itu pada pengujian alat uji diagnostik baru sangat diperlukan pembuktian validitas melalui uji intra dan inter pembaca. Tujuan: Penelitian ini bertujuan mengetahui tingkat kesepakatan intra dan inter pembaca pada deteksi lesi karies dini menggunakan teknik radiografi digital subtraksi. Metode: Penelitian dilakukan menggunakan desain laboratorik eksperimen dengan metode uji intra dan inter pembaca. Penelitian dilakukan menggunakan data sekunder dalam bentuk radiograf sebelum dan sesudah pembuatan lesi karies menggunakan teknik radiografi digital subtraksi dengan piranti lunak Image Registration v2.0. Seluruh gambaran subtraksi dinilai oleh 4 observer yang menyatakan ada atau tidak ada lesi karies dini pada gambaran subtraksi tersebut. Hasil: Penilaian hasil subtraksi dilakukan pada 36 permukaan gigi yang memiliki lesi karies dini dan 42 permukaan gigi yang tidak memiliki lesi karies dini. Tingkat kesepakatan intra pembaca berada pada kisaran moderate (0.41 hingga 0.53) dan kesepakatan keseluruhan berkisar antara 62% hingga 70%. Tingkat kesepakatan inter pembaca berada pada kisaran rendah (0.15 dan 0.16), kisaran fair (0.22, 0.28, dan 0.37), dan kisaran moderate (0.46). Kesepakatan inter pembaca untuk permukaan gigi yang tidak memiliki lesi karies dini pada penilaian pertama (0.2) dan penilaian kedua (0.18). Kesepakatan inter pembaca untuk permukaan gigi yang memiliki lesi karies dini pada penilaian pertama (0.23) dan penilaian kedua (0.31). Pembaca mendeteksi dan menentukan lokasi lesi karies dengan benar pada 212 dari 312 permukaan gigi yang dibaca. Kesimpulan: Nilai indeks Kappa intra dan inter pembaca berada di kisaran rendah hingga moderate, akan tetapi didapatkan nilai rerata tingkat kesepakatan keseluruhan yang cukup baik pada deteksi lesi karies dini menggunakan teknik radiografi digital subtraksi.

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Background: Caries is still by far the most prevalent disease in the world. Early diagnosis of caries is noticeably assisted by clinical and radiographic examination. The greatest difficulty in caries detection involves early demineralization, which is confined only to the enamel. There are many advances in caries detection technology, for example is the ability to perform detailed monitoring of the caries process and the ability to detect and quantify small changes in lesion mineralization. One such technique is the digital subtraction radiography. Currently, there are many software that can be used to perform subtraction but with different levels of accuracy. From various studies that have been conducted, the level of subjectivity and observer experience are among the factors that influence the accuracy in detection of caries lesions. Therefore, in testing new diagnostic tools, it is necessary to prove its validity through intra and inter observer tests. Objective: This study aims to determine the level of intra and inter observer agreement on early caries lesion detection using digital subtraction radiography. Methods: This study was conducted using an experimental laboratory design with intra and inter observer test methods. The study was conducted using secondary data in the form of radiographic images (before and after caries lesions were made) using digital subtraction radiography using Image Registration v2.0 software. All subtraction images were assessed by 4 observers who indicated the presence or absence of early caries lesions in the subtraction images. Observer’s assessment data were analyzed to obtain an intra and inter observer agreement level. Results: Assessment of the results of the subtraction was carried out on 36 tooth surfaces with early caries lesions and 42 surfaces without early caries lesions. Intra-observer agreement levels are moderate (0.41 to 0.53) and overall agreement ranged from 62% to 70%. Inter- observer agreements level are in the low range (0.15 and 0.16), the fair range (0.22, 0.28, and 0.37), and the moderate range (0.46). Inter-observer agreement for tooth surfaces without early caries lesions in the first (0.2) and second (0.18) assessments. Inter-observer agreement for tooth surfaces that had early caries lesions in the first (0.23) and second (0.31) assessments. The observer detected and correctly located the caries lesion on 212 of the 312 tooth surfaces. Conclusion: The intra and inter- observer Kappa index scores are in the low to moderate range, however, the overall agreement level average is quite good for early caries lesion detection using digital subtraction radiography."