Evaluation of three radiographic methods for detecting occlusal caries lesions

Aim: To compare, in vitro, the performance of three radiographic methods for the detection of occlusal caries in permanent teeth. Methods: A total of 96 extracted molars with no apparent occlusal cavitation were selected, they were photographed and radiographed under standardized conditions using conventional E-plus films and two digital systems, CDR and Sidexis. Two examiners analyzed all films and images, recording the presence and lesion depth. One quarter of the teeth were re-examined for intra- and interexaminer agreements. The teeth were subsequently bisected and examined under a stereomicroscope. The intra and interexaminer agreements and the diagnostic performance (sensitivity, specificity, accuracy and the area under receiver operating characteristic, ROC curve) of each method were evaluated. Results: Out of 96 occlusal surfaces, 41 were sound, 31 had lesions in enamel, and 24 had dentin lesions. Weighted Kappa values for intraexaminer agreement varied widely, depending on both the observer and method. The interexaminer agreement was higher for the digital images than for the conventional films. The area under the ROC curve for enamel and dentin caries (at D1 diagnostic threshold) was 0.55 for films, 0.60 for Schick and 0.54 for Sirona, which were not significantly different from each other. Conclusions: Digital images presented better results of interexaminer agreement; however, no additional effect in the diagnostic performance could be observed in comparison to conventional films.

[1]  E. Kidd,et al.  An in vitro assessment of the extent of caries under small occlusal cavities. , 1992, Caries research.

[2]  H G Gröndahl,et al.  Assessments of the physical performance of 2 generations of 2 direct digital intraoral sensors. , 1999, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[3]  M. Heinzel-Gutenbrunner,et al.  Occlusal caries: Evaluation of direct microscopy versus digital imaging used for two histological classification systems. , 2009, Journal of dentistry.

[4]  N. Pitts,et al.  Electrical Methods in Occlusal Caries Diagnosis: An in vitro Comparison with Visual Inspection and Bite–Wing Radiography , 1998, Caries Research.

[5]  D. Purdie,et al.  Visual-tactile examination compared with conventional radiography, digital radiography, and Diagnodent in the diagnosis of occlusal occult caries in extracted premolars. , 2003, Pediatric dentistry.

[6]  H. Gröndahl,et al.  Accuracy of caries diagnosis in digital images from charge-coupled device and storage phosphor systems: an in vitro study. , 1995, Dento maxillo facial radiology.

[7]  H. Hintze,et al.  Clinical and laboratory radiographic caries diagnosis. A study of the same teeth. , 1996, Dento maxillo facial radiology.

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

[9]  E. Kidd,et al.  Clinical and radiographic diagnosis of occlusal caries: a study in vitro. , 1995, Journal of oral rehabilitation.

[10]  M. Frydenberg,et al.  A comparison of older and newer versions of intraoral digital radiography systems: diagnosing noncavitated proximal carious lesions. , 2007, Journal of the American Dental Association.

[11]  V. Baelum,et al.  A Comparison of Clinical and Radiographic Caries Diagnoses in Posterior Teeth of 12–Year–Old Lithuanian Children , 1999, Caries Research.

[12]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[13]  G. Eckert,et al.  Validity of caries detection on occlusal surfaces and treatment decisions based on results from multiple caries-detection methods. , 2009, European journal of oral sciences.

[14]  L. Forner Navarro,et al.  Clinical and radiographic diagnosis of approximal and occlusal dental caries in a low risk population. , 2007, Medicina oral, patologia oral y cirugia bucal.

[15]  A. Hugoson,et al.  Caries prevalence and distribution in 20-80-year-olds in Jönköping, Sweden, in 1973, 1983, and 1993. , 2000, Community dentistry and oral epidemiology.

[16]  R M Davies,et al.  Occlusal caries diagnosis: an in vitro histological validation of the Electronic Caries Monitor (ECM) and other methods. , 1998, Journal of dentistry.

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

[18]  D. Tyndall,et al.  A comparison of Kodak Ektaspeed Plus film and the Siemens Sidexis digital imaging system for caries detection using receiver operating characteristic analysis. , 1998, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[19]  E. Kidd,et al.  Reproducibility and accuracy of three methods for assessment of demineralization depth of the occlusal surface: an in vitro examination. , 1997, Caries research.

[20]  P Pfeiffer,et al.  Effects of different exposure values on diagnostic accuracy of digital images. , 2000, Quintessence international.

[21]  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.

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

[23]  H. Hintze.  Diagnostic accuracy of two software modalities for detection of caries lesions in digital radiographs from four dental systems. , 2006, Dento maxillo facial radiology.

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

[25]  Richardson Ps,et al.  The difference between clinical and bitewing detection of approximal and occlusal caries in Royal Air Force recruits. , 1996 .

[26]  H. Johansson,et al.  Caries Development from 11 to 22 Years of Age: A Prospective Radiographic StudyPrevalence and Distribution , 1997, Caries Research.

[27]  I. McIntyre,et al.  The difference between clinical and bitewing detection of approximal and occlusal caries in Royal Air Force recruits. , 1996, Community dental health.

[28]  A. Hugoson,et al.  Caries prevalence and distribution in 3-20-year-olds in Jönköping, Sweden, in 1973, 1978, 1983, and 1993. , 2000, Community dentistry and oral epidemiology.

[29]  M. Braga,et al.  Performance of a Pen-Type Laser Fluorescence Device and Conventional Methods in Detecting Approximal Caries Lesions in Primary Teeth – in vivo Study , 2009, Caries Research.