Validation of assessment of intraoral digital photography for evaluation of dental restorations in clinical research

Comparing modified USPHS and FDI criteria for the assessment of glass ionomer restorations in primary molars utilising clinical and photographic evaluation

PURPOSE

To compare the applicability of modified US Public Health Service (USPHS) and FDI criteria for evaluating glass ionomer cement (GIC) restorations in primary posterior teeth through digital image analysis.

METHODS

This comparative analytic study was conducted at the Children's Dental Clinic RSKGM FKG UI, involving 40 GIC restorations on lower first primary molars in children aged 4-9 years. After cleaning, the restorations were assessed clinically using modified USPHS and FDI criteria before taking digital images, then the collected images were re-evaluated using both sets of criteria, and the clinical assessment results were compared to the digital image assessment results.

RESULTS

Statistical analysis revealed significant differences between the clinical evaluation of GIC restorations in primary teeth and their corresponding digital photographs when using the modified USPHS criteria, and although the use of FDI criteria yielded different results, these differences were not statistically significant.

CONCLUSION

The assessment of GIC restorations through digital images aligns more closely with clinical assessments using the FDI criteria compared to the modified USPHS criteria.

A comparison between clinical and digital images with various resolutions to evaluate glass ionomer cement restoration on primary teeth

Introduction

Dental photography has increasingly been used in practice. One of the purposes of dental photography is for treatment evaluation. Notably, photo resolution affects a picture's quality. Glass ionomer cement (GIC) restorations are frequently used on pediatric teeth and must be evaluated periodically. In this digital era, digital photos can be used to evaluate restorations. The evaluation of restorations using FDI criteria is typically effective in clinical uses.

Objective

This study aims to compare differences in digital photo resolution and clinical results to evaluate GIC restoration in primary teeth.

Materials and methods

Forty mandibular primary first molars from 31 pediatric patients aged 4 to 9 years from Universitas Indonesia dental hospital were included in this study. All teeth were examined and clinically evaluated, and photos were taken using a DSLR camera with low resolution (8 MP), medium resolution (15 MP), and high resolution (32 MP). The photos were then evaluated. Clinical GIC restorations and digital photographs were evaluated using FDI criteria. All of the collected data were analyzed using a Pearson's chi-square categorical comparative test with a significance level of p < 0.05.

Result

Based on the comparative test, there were no statistically significant differences in the clinical groups with low resolution, medium resolution, and high resolution for evaluating GIC restorations in primary teeth.

Conclusion

Digital photography can be used to support the evaluation of restoration status. Digital photos can indicate the clinical state of GIC restorations. This study recommends using digital photos between low and medium resolution (8-15.3 MP) as media in dental practices to evaluate GIC restorations in primary teeth, comparable to smartphone cameras or pocket cameras.

Dental students' ability to judge the quality of composite restorations' exemplars depicted in photographs and their impact on preclinical skills

INTRODUCTION

Assessing exemplars as a formative activity is thought to promote students' learning. This study aimed to investigate dental students' ability to judge the quality of composite restorations' exemplars depicted in photographs and their impact on students' preclinical skills.

MATERIALS AND METHODS

In a non-randomised controlled crossover trial with two intervention arms, 92 undergraduates in their first preclinical course self-enrolled in into the intervention group (A1-INT) or control group (B1-CT). The intervention group assessed photographic images of composite restorations before restoring an ivorine premolar with composite while the control group restored the same tooth without assessing the photographic exemplars. Intervention and control groups were swapped 3 days later in a second iteration (B2-INT, A2-CT). Data were analysed in SPSS® version 27 using nonparametric tests.

RESULTS

Students who did not complete all activities in the study were excluded. Therefore, 57 out of the 92 student participants were included in the study analysis. No significant differences were observed between intervention and control groups' ability to assess quality of photographic exemplars or restoring a tooth in both iterations.

CONCLUSION

Students were able to identify the quality of composite restorations in photographic exemplars. It appears that assessing photographic exemplars did not have an immediate impact on students' ability to restore a tooth with composite.

Evaluation of the Color Stability of Three Resin-Ceramic Materials Using a Spectrophotometer and a Digital Photography Software

Background

Computer-aided design/computer-aided manufacturing (CAD/CAM) resin ceramics allow easier milling than glass ceramics but are suspected to be more stainable. Although Photoshop® is widely used for picture analysis, its potential for shade selection has not been properly assessed.

Aim

Purpose primary: To evaluate the color stability of three CAD/CAM resin ceramics and Lithium Disilicate. Secondary: to compare the color evaluation between a spectrophotometer (Vita Easyshade compact) and Photoshop software.

Materials and Methods

Three CAD/CAM resin ceramic materials (n = 10) and a fourth group of lithium disilicate were used. Half of each group were thermocycled (5°C and 55°C; 3000 cycles). All samples were immersed in colored beverages (coffee, tea and red wine) for 30 days. Values were obtained by spectrophotometry and photographs analyzed using Photoshop software. The parameters measured were CIEL*a*b, and the color difference (ΔE) was analyzed. A mixed model test was used to compare the results through time and materials (α = 0.05). The comparison between the spectrophotometer and Photoshop results was performed using the bivariate Pearson's correlation test.

Results

Lithium disilicate glass ceramic exhibited less color change (ΔE = 14) than resin ceramics (15.7 < ΔE < 18.7). The least change was noted with GC Cerasmart (ΔE = 15.7) followed by Vita Enamic (ΔE = 17*) and Brilliant Crios (ΔE = 18.7*). Spectrophotometer and Photoshop values showed low correlations.

Conclusions

Resin ceramics may suffer from color change in clinical use. Photoshop is technique sensitive; pictures are easily affected by the light conditions and camera settings.

Development of clinical criteria for the evaluation of indirect restorations

OBJECTIVE

To propose the development and validation of criteria for evaluating the clinical performance of indirect restorations, considering the variables related to the operator, material, and/or patient.

MATERIALS AND METHODS

The experimental design of this study was divided into three stages. Stage 1: development of the new criteria items by specialists in Prosthodontics. Step 2: creation of the criteria, named UERJ criteria, with the description of the parameters that indicate the quality of the restoration, the possible associated complications, and a detailed description of each classification. As well as the development of a form of variables. Step 3: validation of the UERJ criteria.

RESULTS

Cohen's Kappa statistic registered for both intra- and inter-examiner agreements a coefficient >0.91 with a p-value <0.0001. The validity of the UERJ criteria was evaluated by tests of sensitivity (0.96) and specificity (0.91) and had a satisfactory accuracy (92.7%), a positive (10.99), and negative (0.05) likelihood ratio and high values predictive variables, with positive (PPV) 0.84 (high specificity) and negative (VPN) 0.98 (high sensitivity), with a confidence interval of 95%.

CONCLUSION

The UERJ criteria is a valid instrument for evaluating the clinical performance of indirect restorations.

CLINICAL SIGNIFICANCE

The UERJ criteria, developed exclusively for the analysis of indirect restorations, elucidates the details necessary to identify the causes of failures and complications of these restorations.

Comparison between intraoral scanning and direct visual analysis for the assessment of developmental defects of enamel

OBJECTIVE

To compare direct visual analysis (DVA) and intraoral scanning (IOS) for the assessment of developmental defects of the enamel (DDE).

METHODS

Thirty-nine extracted permanent human teeth with DDE were selected by an experienced examiner and digitised using IOS. The scanning was recorded using the OBS Studio software parallel to the IOS software to obtain a coloured high-definition MP4 file of the process. Two other experienced, blinded, and calibrated examiners randomly analysed the same teeth through DVA and IOS. A third examiner resolved any disagreements between the two examiners. Descriptive statistics were used to analyse the frequencies of the scores. Cohen's kappa test was used to determine whether the DVA scores were different from those assigned using IOS. Spearman's test was used to verify non-random examiner errors. The Chi-square test was used to compare score frequencies. Statistical significance was set at p <0.05.

RESULTS

Scores indicating more severe and extended DDE (p <0.05) were more frequently assigned with IOS than with DVA (IOS: 25.64%, 25.64%, 38.46%, and 35.90% between one-third to two-third of the lingual, occlusal, mesial, and distal surfaces, respectively; vs. DVA: 10.26%, 7.69%, 15.38%, and 10.26% for the respective aforementioned tooth surfaces). Contrarily, 'no visible enamel defect' was significantly less assigned for IOS than for DVA (IOS: 15.38%, 43.59%, 35.90%, 15.38%, and 17.95% for buccal, lingual, occlusal, mesial, and distal surfaces, respectively; vs. DVA: 38.46%, 66.67%, 56.41%, 51.28%, and 43.59% for the respective aforementioned tooth surfaces). Kappa agreement ranged from fair to moderate when comparing DVA and IOS; the correlation between both methods was positive, indicating that the examiners assigned the scores properly and the differences arose from employing different methods.

CONCLUSION

The assessment of DDE differed depending on the method used. IOS scores indicated more severe and extended DDE than DVA scores. Clinical investigation is the next step in validating the use of IOS for DDE diagnosis.

CLINICAL SIGNIFICANCE

This study showed that DDE can be assessed differently using IOS. It is clinically relevant as it directly affects the determination of the severity of the defect and dental treatment planning.

Smartphone Photography as a Teledentistry Method to Evaluate Anterior Composite Restorations

Objective

Today, teledentistry have gain more attention than past due to the advances in technology. The aim of this study was to compare the use of smartphone photography as a method in teledentistry with the face-to-face examination in the evaluation of anterior composite restorations.

Materials and Methods

In this study, photographs of 24 composite restorations in patients attended to the clinic of Ardabil Dental School were obtained using a smartphone without any additional equipment and sent by email to 10 remote observers. As a gold standard method, these restorations were evaluated by an experienced expert in restorative dentistry a face-to-face examination. In both methods FDI criteria were used to evaluate the restorations and classified them as acceptable or not. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of the photographic method relative to face-to-face method were calculated. Furthermore the Mann-Whitney U test was used to statistically compare the two methods in detail.

Results

The sensitivity, specificity, positive predictive value, and negative predictive value of the smartphone photography method was 69.35%, 48.72%, 87.34%, and 23.75%, respectively. A diagnostic accuracy of 65.97% was obtained. Statistically, in overall the photographic method rated the restorations as better than they were in reality (face-to-face examination) (p = 0.002).

Conclusions

The diagnostic accuracy of the method of evaluating anterior composite restorations by smartphone photography was moderate and the use of this method in teledentistry, although was promising, needs to be improved.

Patients´ satisfaction concerning direct anterior dental restoration

The objective of this study was to observe patients' satisfaction with their in-service direct anterior dental restorations and to compare it with clinical evaluation using FDI (Federation Dental International) criteria. Patients scored their own anterior dental restorations regarding satisfaction (satisfactory /dissatisfactory). If dissatisfaction was mentioned, then, they would be interviewed about the complaint. In the same session, the dental restorations were clinically evaluated by two dentists using FDI criteria (1-5 score) concerning esthetic, functional, and biological domains. Descriptive statistics were used for frequencies of scores attributed by patients and clinicians. In order to compare patients' to clinicians' frequencies, the Chi-square test was applied (p ≤ 0.05). A total of 106 restorations were evaluated by patients and clinicians. Patients reported 52.8% of restorations satisfactory and 47.8% dissatisfactory. Overall, clinicians reported the same restorations as 82,3% satisfactory and 17,6% dissatisfactory. Patients' most frequent complaints referred to color, followed by anatomical form, fracture of material and retention, and approximal anatomical form. Comparing patients' satisfaction and dissatisfaction rates to clinicians' evaluation per criteria, there was no difference regarding esthetics. The frequency of dissatisfactory restorations by clinicians was significantly lower when functional and biological properties were compared with patients' opinions. Direct anterior dental restorations were more frequently reported as satisfactory by patients and clinicians, being the main complaints related to esthetic issues. When clinicians and patients' evaluations were compared, it was observed that the frequencies of satisfactory restoration by patients and clinicians were similar regarding esthetic properties, and significantly different regarding functional and biological properties.

Evaluation of the marginal adaptation and gingival status of full-crown restorations using an intraoral camera

Objective

The purpose of this study was to compare the usefulness of intraoral photographs, acquired with a household intraoral camera operating in conventional, calibrated, and polarized modes, with clinical examinations for assessing the marginal adaptation and gingival status of full-crown restorations.

Methods

Clinical examinations were performed by a prosthodontist who classified the marginal adaptation of full-crown restorations according to FDI World Dental Federation criteria, and a periodontal expert who classified gingival status according to the Modified Gingival Index (MGI). The margins and gingival status of the conventional, calibration, and polarization groups of full-crown restorations were independently assessed by three evaluators who obtained photographs using an intraoral camera. Cases where at least two of three assessors were in agreement were analyzed using Cohen’s kappa coefficient and the chi-square test, and the sensitivity and specificity were calculated.

Results

The conventional, calibration, and polarization groups differed significantly in marginal and gingival status of full-crown restorations. In the calibration group, there was good agreement between the camera-based and oral clinical examinations in terms of the gingival status of full-crown restorations (kappa = 0.945), with 100% sensitivity and 91.67% specificity; this was also the case in the polarization group with respect to the margins of full-crown restorations (kappa = 0.917, sensitivity = 97.22%, specificity = 94.44%).

Conclusions

An intraoral camera with black and white calibrated images is useful to assess the gingival status of full-crown restorations. Polarization mode can be used to assess the marginal adaptation of full-crown restorations. The camera is a feasible and valid diagnostic aid.

Evaluation of direct restorations using the revised FDI criteria: results from a reliability study

Objectives

The purpose of this in vitro reliability study was to determine the intra- and inter-examiner agreement of the revised FDI criteria including the categories “fracture of material and retention” (F1) and “caries at restoration margin” (B1).

Materials and methods

Forty-nine photographs of direct tooth-coloured posterior (n = 25) and anterior (n = 24) restorations with common deficiencies were included. Ten dental experts repeated the assessment in three blinded rounds. Later, the experts re-evaluated together all photographs and agreed on a reference standard. Statistical analysis included the calculation of Cohen’s (Cκ), Fleiss’ (Fκ), and weighted Kappa (wκ), the development of a logistic regression with a backward elimination model and Bland/Altman plots.

Results

Intra- and inter-examiner reliability exhibited mostly moderate to substantial Cκ, Fκ, and wκ values for posterior restorations (e.g. Intra: F1 Cκ = 0.57, wκ = 0.74; B1 Cκ = 0.57, wκ = 0.73/Inter F1 Fκ = 0.32, wκ = 0.53; B1 Fκ = 0.41, wκ = 0.64) and anterior restorations (e.g. Intra F1 Cκ = 0.63, wκ = 0.76; B1 Cκ = 0.48, wκ = 0.68/Inter F1 Fκ = 0.42, wκ = 0.57; B1 Fκ = 0.40, wκ = 0.51). Logistic regression analyses revealed significant differences between the evaluation rounds, examiners, categories, and tooth type. Both the intra- and inter-examiner reliability increased along with the evaluation rounds. The overall agreement was higher for anterior restorations compared to posterior restorations.

Conclusions

The overall reliability of the revised FDI criteria set was found to be moderate to substantial.

Clinical relevance

If properly trained, the revised FDI criteria set are a valid tool to evaluate direct and indirect restorations in a standardized way. However, training and calibration are needed to ensure reliable application.

Deterioration of anterior resin composite restorations in moderate to severe tooth wear patients: 3-year results

OBJECTIVES

Deterioration in anterior resin composite restorations placed in tooth wear patients was investigated after 36 months.

MATERIALS AND METHODS

Data collected prospectively for 47 participants of the Radboud Tooth Wear Project were used (41 ± 8 years, 90% male, n = 270 restorations). Restorations were individually evaluated using intraoral photographs and 3D scans to rate modified FDI scores and to record the presence of degradation features. Four groups with distinct combinations of composites and techniques were assessed, and multivariable logistic regression models were used to analyze the data (p < 0.05).

RESULTS

For all groups together, early degradation signs were present at 1 month: irregularities (41.5%) and ditching (7.4%) were observed at the surface and adhesive interfaces. The frequency of irregularities decreased in the 36-month evaluation (37%), but ditching (12.2%) and fractures (10.7%) were more common. The most frequent deterioration (based on photographs) was observed for staining (44%) and loss of luster (31%). In 3D scans, the most frequent were for wear (25%), marginal adaptation (24%), and the presence of irregularities (19%). Canines had 5.5 times more chances of deterioration by ditching than incisors (p < 0.001). The differences between composites and restorative techniques were minor.

CONCLUSIONS

A continuous degradation process of restorations placed in tooth wear patients was observed in anterior teeth restored with different composites, with a progression of the deterioration over 36 months.

CLINICAL RELEVANCE

When placing anterior resin composite restorations in tooth wear patients, it could be important to establish realistic expectations and the need for checkup appointments.

Remote assessment of DMFT and number of implants with intraoral digital photography in an elderly patient population – a comparative study

Objectives

This comparative study aimed to evaluate intraoral digital photography (IODP) as assessment-tool for DMFT and number of implants (IMPL) compared to clinical diagnosis (CLIN) in an elderly population with high restorative status. Secondary research questions were whether an additional evaluation of panoramic radiographs (PAN-X) or raters’ clinical experience influence the agreement.

Methods

Fifty patients (70.98±7.60 years) were enrolled for standardized CLIN and IODP. The clinical reference examiner and ten blinded raters evaluated the photographs without and with a PAN-X regarding DMFT and IMPL. CLIN were used as reference standard and differences to IODP and IODP-PAN-X findings were analysed descriptively. To assess intra-rater agreement, pairwise Gwet’s AC1s of the three diagnostic methods CLIN, IODP and IODP+PAN-X were calculated.

Results

Compared to a DMFT of 22.10±3.75 (CLIN), blinded raters evaluated a DMFT of 21.54±3.40 (IODP) and 22.12±3.45 (IODP+PAN-X). Mean values for “Decayed” were 0.18±0.52 (CLIN), 0.45±0.46 (IODP) and 0.48±0.47 (IODP-PAN-X), while 11.02±5.97 (CLIN), 10.66±5.78 (IODP) and 10.93±5.91 (IODP+PAN-X) were determined for “Missing” and 10.90±5.61 (CLIN), 10.43±4.85 (IODP) and 10.71±5.11 (IODP+PAN-X) for “Filled”. IMPL were 0.78±2.04 (CLIN), 0.58±1.43 (IODP), 0.78±2.04 (IODP+PAN-X). Gwet’s AC1 using the mode of the blinded raters’ assessment of "Decayed", "Missing" and IMPL compared to CLIN ranged from 0.81 to 0.89 (IODP) and 0.87 to 1.00 (IODP+PAN-X), while for "Filled" and DMFT they were 0.29 and 0.36 (IODP) as well as 0.33 and 0.36 (IODP+PAN-X), respectively. Clinical experience did not influence the agreement.

Conclusions

Assessment of “Decayed”, “Missing” and IMPL by IODP showed almost perfect agreement, whereas of “Filled” and DMFT revealed fair to moderate agreement with clinical findings. Additional PAN-X-evaluation increased agreement compared to IODP-diagnostics alone. IODP for the assessment of DMFT and IMPL might be a suitable method in large-scale epidemiological studies, considering high agreement in total values and miscellaneous agreement at patient-level.

Clinical decision-making in anterior resin composite restorations: a multicenter evaluation

OBJECTIVE

This study investigated whether a sample of anterior resin composite restorations could be differently evaluated in different centers of evaluation by clinical and lay evaluators.

METHODS

Anterior resin composite restorations on high-quality intraoral digital photography were evaluated using FDI criteria (1-5 score) by pairs of clinical and lay evaluators in Brazil (BR), France (FR), Peru (PE), and the United States of America (USA). Scores were allocated as maintenance (1, 2, 3), repair (4) and replacement (5) when comparing clinical evaluators and, as acceptable (1, 2, 3) and unacceptable (4, 5) when comparing clinical vs. lay evaluators and lay vs. lay evaluators. The Chi-square test compared the frequencies of scores among the centers.

RESULTS

The frequencies of maintaining, repairing, or replacing anterior resin composite restorations given by clinical evaluators varied depending on the evaluation center. BR and PE showed the highest frequencies for repair and replacement, while FR and USA showed the highest frequencies for maintenance. The comparison of frequencies of anterior resin composite restorations accepted or unaccepted by the clinical vs lay evaluators in the same centers showed a significantly higher frequency of acceptable dental restorations coming from clinical evaluators. Comparison between lay evaluators from different centers showed significant higher frequency of unacceptable dental restorations by BR, compared to other centers.

CONCLUSIONS

In the evaluation of anterior resin composite restorations, the maintenance, repair, or replacement trends can vary among different centers. The unacceptable rate came more frequently from lay than from clinical evaluators. Lay evaluators from different centers differed significantly.

CLINICAL SIGNIFICANCE

Clinical and lay evaluators in distant evaluation centers can present different trends when assessing anterior resin composite restoration. Multicenter evaluations can help to understand such differences and it is important because clinical decision-making based on scientific evidence comes from clinical studies done in different research centers.

Two-Dimensional Analysis of Digital Images through Vector Graphic Editors in Dentistry: New Calibration and Analysis Protocol Based on a Scoping Review

This review was carried out to analyse the functions of three Vector Graphic Editor applications (VGEs) applicable to clinical or research practice, and through this we propose a two-dimensional image analysis protocol in a VGE. We adapted the review method from the PRISMA-ScR protocol. Pubmed, Embase, Web of Science, and Scopus were searched until June 2020 with the following keywords: Vector Graphics Editor, Vector Graphics Editor Dentistry, Adobe Illustrator, Adobe Illustrator Dentistry, Coreldraw, Coreldraw Dentistry, Inkscape, Inkscape Dentistry. The publications found described the functions of the following VGEs: Adobe Illustrator, CorelDRAW, and Inkscape. The possibility of replicating the procedures to perform the VGE functions was analysed using each study's data. The search yielded 1032 publications. After the selection, 21 articles met the eligibility criteria. They described eight VGE functions: line tracing, landmarks tracing, linear measurement recording, angular measurement recording, image calibration, image overlay, file transfer, and vector graphics development. The features offered by the VGEs bring great precision and objectivity to two-dimensional image analysis. The image analysis and editing procedures are currently not protocolised. Thus, a protocol for image calibration and measurement recording is proposed in order to guarantee the protocol's replication.

Digital photography vs. clinical assessment of resin composite restorations

PURPOSE

To compare direct clinical and indirect digital photographic assessment of resin composite restorations. Ninety-two posterior resin composite restorations were classified using World Dental Federation (FDI) criteria by two different clinical examiners (C1 and C2). In the same appointment of clinical assessment, intraoral high-quality digital photographs were taken and posteriorly two different digital examiners (D1 and D2) classified the images of each restoration. Restorations of each patient were assessed once by C1 and C2 independently. D1 and D2 assessed the digital images from different locations and in different time. Data were analyzed using the Cohen's kappa coefficient, Kruskal-Wallis non-parametric test and Dunn's multiple shared test, with 95% confidence. Agreement levels varied from very good (0.81-1.00) to fair (0.21-0.40). Statistically significant differences (p < 0.05) between assessments were found for surface lustre, staining, color match and translucency, esthetic anatomical form, fracture of material and retention and marginal adaptation. The classification of the resin composite restorations varied significantly according to clinical or high-quality digital photographic assessments. Overall, clinical assessment detected more demand for repair or replacement.

Clinical applications of intraoral camera to increase patient compliance - current perspectives

Technological advancements in the field of dentistry have reformed the concept of photography as a powerful medium of expression and communication. It also offers a spectrum of perception, interpretation, and execution. One of the widespread clinical applications of computerization in dentistry today is the intraoral camera (IOC). It helps in the revelation of the hidden and overlooked defects in teeth and other parts of the cavity. Dental world constitutes of microstructures that have to be recorded in a detailed manner to perform patient education, documentation of records and treatment, illustration of lectures, publication and web connectivity of complicated cases. This review emphasizes the significant applications of IOC in dentistry and its possible impact on patient compliance for dental care.

Intraoral Camera Use in a Dental School Clinic: Evaluations by Faculty, Students, and Patients

The aims of this study were to assess the perceptions of dental students, faculty members, and patients about the benefits and pitfalls of intraoral camera use and to compare the completion rate of treatment planned posterior crowns with and without intraoral camera use in a predoctoral dental clinic. From July 2016 to June 2017, all 60 fourth-year dental students at one U.S. dental school were encouraged to use the intraoral camera in treatment planning with patients in the school clinic. Perceptions of the students, their patients, and the faculty members supervising the treatment planning were assessed with a survey at the end of the treatment planning appointment. The completion rate of treatment planned posterior crowns was determined by recalling all posterior teeth that were treatment planned for a single unit crown at a specific period of time compared to the number of the same crowns completed for the same patients at a specific period of time, using the electronic health record, with and without camera use. Of the 60 students, 51 completed 198 surveys (85% response rate); 35 faculty members completed 64 surveys, and 202 patients completed one survey each (response rates for those groups could not be calculated). The survey results suggested that the students, faculty, and patients viewed intraoral camera use in a positive way. However, faculty perceptions were a little lower than those of patients and students, and a significant number of faculty members were neutral. The completion rate of posterior planned crowns was significantly higher (p=0.0005) when intraoral cameras were used to present images to patients than when cameras were not used. In this study, intraoral camera use in a predoctoral clinic was perceived positively by students and patients but more neutrally by faculty, and it increased the completion rate of planned posterior crowns.

Decision-making of general practitioners on interventions at restorations based on bitewing radiographs

OBJECTIVE

The aim of this study was to compare decision-making based on bitewing analysis of restored proximal surfaces by general dental practitioners (GDPs) with diagnossis and clinical decisions made by experts in cariology and restorative dentistry.

METHODS

This practice-based study used a database of 7 general dental practices. Posterior bitewing radiographs were selected from the electronic patient files of patients, and 770 cases of proximal restored surfaces were selected. Fifty percent of the cases which lead to the restorative decision, and the other half were cases decided for monitoring by the GDPs. Three experts performed radiographic assessment. The outcome variables were agreement of diagnosis and decision of treatment. Cohen's kappa statistic was used.

RESULTS

For the experts, moderate to substantial intraexaminer agreement was observed for the diagnostic criteria, and kappa values of 0.77, 0.79, and 0.88 were obtained for each expert regarding the treatment assignment. Agreement between GDPs and the majority of experts for secondary caries varied between 67 and 83%. One hundred seventy-three out of 385 cases that were treated by GDPs were decided for monitoring by the experts, while 8 cases that were decided for monitoring by the GDPs were decided for treatment. The agreement between experts and GDPs was moderate for secondary caries detection, and fair for treatment decision.

CONCLUSION

The GDPs tend to have a less conservative approach regarding the decision to intervene or not concerning the reassessment of restorations, showing moderate agreement with the experts for secondary caries detection and fair agreement regarding the treatment decision.

CLINICAL SIGNIFICANCE

This study highlights that GDPs tend to have a less conservative approach to the decision to intervene or not in posterior restorations, compared to experts in cariology and restorative dentistry. Efforts should be made to reduce these differences based on minimally invasive dentistry.