Risk Factors for a False Positive Test Outcome in Diagnosis of Caries in Approximal Surfaces: Impact of Radiographic Modality and Observer Characteristics

The aim of this study was to evaluate the impact of image modality and observer characteristics on radiographic caries diagnosis with particular emphasis on the false positive (FP) test outcome. Eighty human teeth were radiographed by eight digital modalities and film. Eight observers scored caries lesions in each approximal tooth surface. Their use of image enhancement and time spent in assessing an image was recorded. Microscopy served as validation for the presence/absence of a lesion. Of 160 approximal surfaces, 63% were sound and 37% had lesions. Multivariate logistic regression analysis was performed with the FP test outcome as the dependent variable and the radiographic modality and observer’s gender, experience, employment, image enhancement, and time use as the independent variables. The significant risk factors for an FP test outcome were: (1) gender: males scored fewer FP than females (OR 0.26, CI 0.18–0.36); (2) experience: observers with no experience with digital radiography had a six times higher risk for an FP (OR 6.09, CI 4.9–8.1); (3) radiographic modality: two of the digital systems had a significantly lower risk for an FP [a phosphor plate system (OR 0.55, CI 0.37–0.73) and a sensor-based system (OR 0.65, CI 0.46–0.93)] and one phosphor plate system had a higher risk (OR 1.57, CI 1.17–2.13) than film; (4) time use: more time was spent when scoring an FP (OR 1.05, CI 1.03–1.05) than for any other test outcome. Type of employment and the use of image enhancement had no significant impact on the risk for an FP diagnosis.

[1]  S. Kositbowornchai,et al.  Accuracy of diagnosing occlusal caries using enhanced digital images. , 2004, Dento maxillo facial radiology.

[2]  A Wenzel,et al.  Computer-aided image manipulation of intraoral radiographs to enhance diagnosis in dental practice: a review. , 1993, International dental journal.

[3]  I. Mejàre,et al.  Clinical and radiographic diagnosis , 2003 .

[4]  W H Bowen,et al.  Dental caries. , 1972, Archives of disease in childhood.

[5]  S. Haßfeld,et al.  Effect of digital filtering on the measurement of the depth of proximal caries under different exposure conditions. , 2004, American journal of dentistry.

[6]  B. Potter,et al.  Comparison of direct digital and conventional radiography for the detection of proximal surface caries in the mixed dentition. , 2000, Pediatric dentistry.

[7]  M. Frydenberg,et al.  Accuracy of caries detection with four storage phosphor systems and E-speed radiographs. , 2002, Dento maxillo facial radiology.

[8]  P. Mileman,et al.  Comparing the accuracy of Dutch dentists and dental students in the radiographic diagnosis of dentinal caries. , 2002, Dento maxillo facial radiology.

[9]  M. Abreu,et al.  Performance of a new F-speed film for caries detection. , 2001, Dento maxillo facial radiology.

[10]  M. Nair,et al.  An in–vitro Evaluation of Kodak Insight and Ektaspeed Plus Film with a CMOS Detector for Natural Proximal Caries: ROC Analysis , 2001, Caries Research.

[11]  A. Tveit,et al.  A comparison of radiographic occlusal and approximal caries diagnoses made by 240 dentists , 2001, Acta odontologica Scandinavica.

[12]  Elizabeth A. Krupinski,et al.  Differential Use of Image Enhancement Techniques by Experienced and Inexperienced Observers , 2005, Journal of Digital Imaging.

[13]  I. Mejàre,et al.  Restorative treatment decisions on occlusal caries in Scandinavia , 2001, Acta odontologica Scandinavica.

[14]  A. Wenzel,et al.  Influence of spatial resolution and bit depth on detection of small caries lesions with digital receptors. , 2007, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[15]  E. Medici Filho,et al.  Comparison of direct digital and conventional imaging with Ekta Speed Plus and INSIGHT films for the detection of approximal caries. , 2005, American journal of dentistry.

[16]  H. Gröndahl,et al.  Observers' use of image enhancement in assessing caries in radiographs taken by four intra-oral digital systems. , 1996, Dento maxillo facial radiology.

[17]  A. Wenzel.  A review of dentists' use of digital radiography and caries diagnosis with digital systems. , 2006, Dento maxillo facial radiology.

[18]  A. Lussi,et al.  The effect of experience and training on the diagnosis of approximal coronal caries from bitewing radiographs. A Swiss-American comparison. , 1994, Schweizer Monatsschrift fur Zahnmedizin = Revue mensuelle suisse d'odonto-stomatologie = Rivista mensile svizzera di odontologia e stomatologia.

[19]  R. Haak,et al.  Grey-scale reversed radiographic display in the detection of approximal caries. , 2005, Journal of dentistry.

[20]  Francisco Haiter-Neto,et al.  Influência da experiência profissional no diagnóstico radiográfico de cáries , 2010, Brazilian Dental Science.

[21]  A. Wenzel,et al.  Students' attitudes to digital radiography and measurement accuracy of two digital systems in connection with root canal treatment. , 2004, European journal of dental education : official journal of the Association for Dental Education in Europe.

[22]  A. Wenzel,et al.  Relationship between Histological and Radiographic Caries Lesion Depth Measured in Images from Four Digital Radiography Systems , 2003, Caries Research.

[23]  A. Lussi,et al.  Radiographic evaluation of occlusal caries: effect of training and experience. , 1995, Caries research.

[24]  U Welander,et al.  Detection of approximal caries in digital radiographs before and after correction for attenuation and visual response. An in vitro study. , 2002, Dento maxillo facial radiology.

[25]  M. Semiz,et al.  Approximal carious lesion depth assessment with insight and ultraspeed films. , 2005, Operative dentistry.

[26]  O. Topuz,et al.  The efficiency of three different films and radiovisiography in detecting approximal carious lesions. , 2005, Quintessence international.

[27]  A Wenzel,et al.  The choice of gold standard for evaluating tests for caries diagnosis. , 1999, Dento maxillo facial radiology.

[28]  G C Sanderink,et al.  Radiographic detection of approximal caries: a comparison of dental films and digital imaging systems. , 2000, Dento maxillo facial radiology.

[29]  T. A. Larheim,et al.  Approximal Caries Depth Assessment with Storage Phosphor versus Film Radiography , 2000, Caries Research.

[30]  S. White,et al.  Comparative performance of digital and conventional images for detecting proximal surface caries. , 1997, Dento maxillo facial radiology.

[31]  F. V. Van Ginkel,et al.  Comparison of standard and task-specific enhancement of Digora storage phosphor images for approximal caries diagnosis. , 2003, Dento maxillo facial radiology.

[32]  A. Wenzel,et al.  Influence of the validation method on diagnostic accuracy for caries. A comparison of six digital and two conventional radiographic systems. , 2002, Dento maxillo facial radiology.