A comparative study of high-resolution cone beam computed tomography and charge-coupled device sensors for detecting caries

Dental Caries Detection and Classification in CBCT Images Using Deep Learning

OBJECTIVES

This study aimed to investigate the accuracy of deep learning algorithms to diagnose tooth caries and classify the extension and location of dental caries in cone beam computed tomography (CBCT) images. To the best of our knowledge, this is the first study to evaluate the application of deep learning for dental caries in CBCT images.

METHODS

The CBCT image dataset comprised 382 molar teeth with caries and 403 noncarious molar cases. The dataset was divided into a development set for training and validation and test set. Three images were obtained for each case, including axial, sagittal, and coronal. The test dataset was provided to a multiple-input convolutional neural network (CNN). The network made predictions regarding the presence or absence of dental decay and classified the lesions according to their depths and types for the provided samples. Accuracy, sensitivity, specificity, and F1 score values were measured for dental caries detection and classification.

RESULTS

The diagnostic accuracy, sensitivity, specificity, and F1 score for caries detection in carious molar teeth were 95.3%, 92.1%, 96.3%, and 93.2%, respectively, and for noncarious molar teeth were 94.8%, 94.3%, 95.8%, and 94.6%. The CNN network showed high sensitivity, specificity, and accuracy in classifying caries extensions and locations.

CONCLUSIONS

This research demonstrates that deep learning models can accurately identify dental caries and classify their depths and types with high accuracy, sensitivity, and specificity. The successful application of deep learning in this field will undoubtedly assist dental practitioners and patients in improving diagnostic and treatment planning in dentistry.

CLINICAL SIGNIFICANCE

This study showed that deep learning can accurately detect and classify dental caries. Deep learning can provide dental caries detection accurately. Considering the shortage of dentists in certain areas, using CNNs can lead to broader geographic coverage in detecting dental caries.

Evaluation of a Decision Support System Developed with Deep Learning Approach for Detecting Dental Caries with Cone-Beam Computed Tomography Imaging

This study aims to investigate the effect of using an artificial intelligence (AI) system (Diagnocat, Inc., San Francisco, CA, USA) for caries detection by comparing cone-beam computed tomography (CBCT) evaluation results with and without the software. 500 CBCT volumes are scored by three dentomaxillofacial radiologists for the presence of caries separately on a five-point confidence scale without and with the aid of the AI system. After visual evaluation, the deep convolutional neural network (CNN) model generated a radiological report and observers scored again using AI interface. The ground truth was determined by a hybrid approach. Intra- and inter-observer agreements are evaluated with sensitivity, specificity, accuracy, and kappa statistics. A total of 6008 surfaces are determined as 'presence of caries' and 13,928 surfaces are determined as 'absence of caries' for ground truth. The area under the ROC curve of observer 1, 2, and 3 are found to be 0.855/0.920, 0.863/0.917, and 0.747/0.903, respectively (unaided/aided). Fleiss Kappa coefficients are changed from 0.325 to 0.468, and the best accuracy (0.939) is achieved with the aided results. The radiographic evaluations performed with aid of the AI system are found to be more compatible and accurate than unaided evaluations in the detection of dental caries with CBCT images.

Comparison of accuracy cone-beam computed tomography and digital bitewing radiography for detection of recurrent caries under various restorative materials: in vitro study

OBJECTIVE

The aim of this study was to compare and evaluate diagnostic accuracy of two different CBCT scan modes and digital bitewing radiography for detection of recurrent caries under five different restorative materials, and determine the relationship between the types of restorative materials.

MATERIALS AND METHODS

In this in vitro study, 200 caries-free upper and lower premolars and molars were selected. A standard deep Class II cavities was created in the middle of the mesial surface of all teeth. In 100 teeth of the experimental and control groups, secondary caries was artificially demineralized. All teeth were filled with five types of restorative material including two types of conventional composite resins, flow composite resin, glass ionomer and amalgam. The teeth were imaged with high resolution (HIRes) and standard CBCT scan modes and digital bitewing. The AUC, sensitivity, specificity and areas under the ROC curve were calculated and verified through SPSS.

RESULTS

CBCT technique was the best option in diagnosing recurrent caries. The diagnostic accuracy and specificity of HIRes CBCT scan mode was significantly higher than standard mode (P = 0.031) and bitewing (P = 0.029) for detection of recurrent caries, especially under composite group. There were no significant differences in accuracy value of bitewing and standard CBCT scan mode.

CONCLUSION

CBCT showed higher accuracy and specificity on the detection of recurrent caries which was more accurate than bitewing radiography. The HIRes CBCT scan mode achieved the highest accuracy and performed the best in recurrent caries detection.

Prevalence of periodontitis based on retrospective radiographic evaluation at dental hospital in Eastern Province of Saudi Arabia: A retrospective study

Objectives

The contemporary information on the prevalence of periodontitis and associated risk factors is deficient in the Kingdom of Saudi Arabia. Our aim was to measure the prevalence of periodontitis and associated risk factors among the Saudi population in the Eastern Province of Saudi Arabia who visited the University Dental Hospital.

Methods

In this retrospective study, the demographic data and medical and dental records of 700 subjects were examined. Bitewing radiographs were analyzed to measure the alveolar bone loss in posterior teeth by measuring the distance between the cementoenamel junction and the crest of the alveolar bone. A chi-square test was performed to compare the severity of periodontitis. A comparison of multivariate mean bone loss was performed using a t-test. Logistic regression analysis was used to evaluate the predictors of periodontitis. A P-value equal to or under 0.05 reflected statistical significance.

Results

Among 700 cases, the patients' mean age was 35.6 ± 12.1; 52.6 % were male and 47.4 % were female. Overall periodontitis prevalence was 52.1 %. The distribution of mild, moderate, and severe periodontitis prevalence was 36.1 %, 14.1 %, and 1.8 %, respectively. The severity of periodontitis was statistically similar between males and females (p = 0.148); however, significantly more Saudi than non-Saudi patients had moderate periodontitis. Higher proportions of severe periodontitis were seen in the age group of over 50-years-old (p < 0.001) and in patients with poor oral hygiene (p < 0.001), diabetes mellitus (p < 0.005), and hypertension (p < 0.002). Six total predictors of periodontitis were depicted, i.e., age > 50 years (OR = 3.73), poor OH status (OR = 2.24), BOP (OR = 3.35), presence of plaque (OR = 2.61), diabetes mellitus (OR = 3.19), and hypertension (OR = 3.62).

Conclusion

The primary factors associated with the prevalence of periodontitis were age, nationality, diabetes, hypertension, BOP, plaque, and OH status. However, no association was observed between gender or cardiovascular disease and the prevalence of periodontitis in the studied population.

A Two-Year Follow-Up Assessment of Decreasing Crestal Bone Levels Around Dental Implants in Patients Rehabilitated With Mandibular Implant Overdentures

Aim: This two-year follow-up study was aimed to evaluate declining crestal bone levels around dental implants in patients rehabilitated with mandibular implant-supported overdentures. A three-dimensional advanced radiographic tool, cone beam computed tomography (CBCT), was utilized as radiographic aid in this study.

Materials & Methods: A total of 15 patients wearing mandibular implants supported overdentures were studied for two years. Randomization and strict inclusion/exclusion criteria were followed during study execution. Complete dentures were fabricated with standard methods, which were later anchored by a bilateral implant in the mandibular jaw. Bone loss at all four surfaces in all studied implants was estimated by the cone beam computed tomography (CBCT) technique. These assessments were done at postoperative follow-up periods of six, 12, 18, and 24 months. Duly signed and informed consent was obtained from all participating patients.

Statistical Analysis and Results: The statistical analysis was completed by the software IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp. All relevant data was entered into it to be analyzed with suitable statistical tests. Out of all 15 studied patients, 11 were male, and four were female. P-value was very significant for the age range 35-40 years (0.01). In all instances, the lingual surface showed minimum, while the distal surface showed maximum bone loss when seen at all postoperative phases. Grossly, the mean bone loss ranged between 0.14-0.45. P-value was highly significant for the measurements made at the lingual and distal sides of implants (for both B and D positions). A comparison of both study groups by one-way ANOVA confirmed a highly significant p-value for estimations done between the groups (0.001).

Conclusion: Within the limitations of the study, the authors confirmed that crestal bone levels showed a clear decreasing pattern in the postoperative phases. Since these deleterious processes can compromise long-term prosthesis success, operators should consider all these facts while planning to implant an overdenture prosthesis in the lower jaw. 

Effect of Amalgam Restorations and Operation Parameters on Diagnostic Accuracy of Caries Detection Using Cone Beam Computed Tomography: An In Vitro Study

This study was aimed to evaluate the diagnostic accuracy of cone beam computed tomography (CBCT) in detecting noncavitated approximal caries at different exposure parameters and to assess the impact of artifacts generated by amalgam restorations in an in vitro study. Seventy-eight approximal surfaces of extracted teeth were prepared with intentionally created noncavitated approximal caries of different depths; then, thirteen teeth with class 2 amalgam restorations were replaced with one tooth with normal surfaces in each block. CBCT volumes for all teeth were acquired using a Planmeca Promax 3D Mid imaging unit before and after placement of amalgam teeth, with different exposure parameters at low and high definition, both applying and omitting the Metal Artifact Reduction algorithm. The lesions were classified into four groups with regard to lesion extension. All teeth underwent histological analysis as gold standard. The histological examination showed that the distribution of lesions was as follows: 39.8% sound, enamel lesions of less and more than half the enamel thickness each 17.8%, and 24.6% dentin lesions. The detection sensitivity was found to be 0.972%, and specificity was found to be 0.937% for the detection of noncavitated approximal initial enamel and dentin caries. The highest diagnostic accuracy was found when using operating parameters of 90 kV_p, 8 mA, and high resolution (75 μm) with nonamalgam teeth; all modes showed statistically significant higher AUCs than mode 2 (80 kV_p, 7 mA, and 75 μm). However, for teeth with amalgam restorations, the highest accuracy was obtained at low resolution (200 μm) with the other parameters kept the same. It could be concluded that increasing the peak voltage and current improves diagnostic accuracy for the detection of noncavitated approximal caries. Moreover, diagnostic accuracy was found to be higher upon using high spatial resolution when diagnosing caries without adjacent amalgam restorations. There is a statistically significant difference with and without amalgam with respect to all modes.

Radiographic modalities for diagnosis of caries in a historical perspective: from film to machine-intelligence supported systems

Radiographic imaging for the diagnosis of caries lesions has been a supplement to clinical examination for approximately a century. Various methods, and particularly X-ray receptors, have been developed over the years, and computer systems have focused on aiding the dentist in the detection of lesions and in estimating lesion depth. The present historical review has sampled accuracy ex vivo studies and clinical studies on radiographic caries diagnosis that have compared two or more receptors for capturing the image. The epochs of film radiography, xeroradiography, digital intraoral radiography, panoramic radiography and other extraoral methods, TACT analysis, cone-beam CT and artificial intelligence systems aiding in decision-making are reviewed. The author of this review (43 years in academia) has been involved in caries research and contributed to the literature in all the mentioned epochs.

Imaging modalities to inform the detection and diagnosis of early caries

BACKGROUND

The detection and diagnosis of caries at the earliest opportunity is fundamental to the preservation of tooth tissue and maintenance of oral health. Radiographs have traditionally been used to supplement the conventional visual-tactile clinical examination. Accurate, timely detection and diagnosis of early signs of disease could afford patients the opportunity of less invasive treatment with less destruction of tooth tissue, reduce the need for treatment with aerosol-generating procedures, and potentially result in a reduced cost of care to the patient and to healthcare services.

OBJECTIVES

To determine the diagnostic accuracy of different dental imaging methods to inform the detection and diagnosis of non-cavitated enamel only coronal dental caries.

SEARCH METHODS

Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 31 December 2018); Embase Ovid (1980 to 31 December 2018); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 31 December 2018); and the World Health Organization International Clinical Trials Registry Platform (to 31 December 2018). We studied reference lists as well as published systematic review articles.

SELECTION CRITERIA

We included diagnostic accuracy study designs that compared a dental imaging method with a reference standard (histology, excavation, enhanced visual examination), studies that evaluated the diagnostic accuracy of single index tests, and studies that directly compared two or more index tests. Studies reporting at both the patient or tooth surface level were included. In vitro and in vivo studies were eligible for inclusion. Studies that explicitly recruited participants with more advanced lesions that were obviously into dentine or frankly cavitated were excluded. We also excluded studies that artificially created carious lesions and those that used an index test during the excavation of dental caries to ascertain the optimum depth of excavation.

DATA COLLECTION AND ANALYSIS

Two review authors extracted data independently and in duplicate using a standardised data extraction form and quality assessment based on QUADAS-2 specific to the clinical context. Estimates of diagnostic accuracy were determined using the bivariate hierarchical method to produce summary points of sensitivity and specificity with 95% confidence regions. Comparative accuracy of different radiograph methods was conducted based on indirect and direct comparisons between methods. Potential sources of heterogeneity were pre-specified and explored visually and more formally through meta-regression.

MAIN RESULTS

We included 104 datasets from 77 studies reporting a total of 15,518 tooth sites or surfaces. The most frequently reported imaging methods were analogue radiographs (55 datasets from 51 studies) and digital radiographs (42 datasets from 40 studies) followed by cone beam computed tomography (CBCT) (7 datasets from 7 studies). Only 17 studies were of an in vivo study design, carried out in a clinical setting. No studies were considered to be at low risk of bias across all four domains but 16 studies were judged to have low concern for applicability across all domains. The patient selection domain had the largest number of studies judged to be at high risk of bias (43 studies); the index test, reference standard, and flow and timing domains were judged to be at high risk of bias in 30, 12, and 7 studies respectively. Studies were synthesised using a hierarchical bivariate method for meta-analysis. There was substantial variability in the results of the individual studies, with sensitivities that ranged from 0 to 0.96 and specificities from 0 to 1.00. For all imaging methods the estimated summary sensitivity and specificity point was 0.47 (95% confidence interval (CI) 0.40 to 0.53) and 0.88 (95% CI 0.84 to 0.92), respectively. In a cohort of 1000 tooth surfaces with a prevalence of enamel caries of 63%, this would result in 337 tooth surfaces being classified as disease free when enamel caries was truly present (false negatives), and 43 tooth surfaces being classified as diseased in the absence of enamel caries (false positives). Meta-regression indicated that measures of accuracy differed according to the imaging method (Chi²(4) = 32.44, P < 0.001), with the highest sensitivity observed for CBCT, and the highest specificity observed for analogue radiographs. None of the specified potential sources of heterogeneity were able to explain the variability in results. No studies included restored teeth in their sample or reported the inclusion of sealants. We rated the certainty of the evidence as low for sensitivity and specificity and downgraded two levels in total for risk of bias due to limitations in the design and conduct of the included studies, indirectness arising from the in vitro studies, and the observed inconsistency of the results.

AUTHORS' CONCLUSIONS

The design and conduct of studies to determine the diagnostic accuracy of methods to detect and diagnose caries in situ are particularly challenging. Low-certainty evidence suggests that imaging for the detection or diagnosis of early caries may have poor sensitivity but acceptable specificity, resulting in a relatively high number of false-negative results with the potential for early disease to progress. If left untreated, the opportunity to provide professional or self-care practices to arrest or reverse early caries lesions will be missed. The specificity of lesion detection is however relatively high, and one could argue that initiation of non-invasive management (such as the use of topical fluoride), is probably of low risk. CBCT showed superior sensitivity to analogue or digital radiographs but has very limited applicability to the general dental practitioner. However, given the high-radiation dose, and potential for caries-like artefacts from existing restorations, its use cannot be justified in routine caries detection. Nonetheless, if early incidental carious lesions are detected in CBCT scans taken for other purposes, these should be reported. CBCT has the potential to be used as a reference standard in diagnostic studies of this type. Despite the robust methodology applied in this comprehensive review, the results should be interpreted with some caution due to shortcomings in the design and execution of many of the included studies. Future research should evaluate the comparative accuracy of different methods, be undertaken in a clinical setting, and focus on minimising bias arising from the use of imperfect reference standards in clinical studies.

Tomographic evaluation of direct pulp capping using a novel injectable treated dentin matrix hydrogel: a 2-year randomized controlled clinical trial

OBJECTIVES

To assess clinically and radiographically the success of pulp capping procedure done in traumatically exposed permanent posterior teeth using a novel injectable treated dentin matrix hydrogel (TDMH), Biodentine, and MTA and to evaluate the formed dentin bridge under the capping materials using CBCT imaging.

MATERIALS AND METHODS

45 patients subjected to accidental traumatic pulp exposures by undergraduate dental students are allocated for this study. For each patient, a pulp capping procedure was done. TDMH was formed of TDM powder and sodium alginate to be injected and then hardened in the defect area. Patients were assigned to 3 groups: TDMH, Biodentine, and MTA, respectively, and returned to the clinic after 3, 6, 12, 18, and 24 months for clinical and radiographic examinations. Tomographic data, including thickness and density of formed dentin bridges, were evaluated at the end of the study period compared to the base line. Pulp sensitivity was evaluated throughout the study period using thermal testing and electric pulp tester.

RESULTS

During the follow-up period, all patients were asymptomatic with no clinical signs and symptoms and revealed no radiographic signs of pathosis. However, tomographic evaluation showed the tested materials to have different levels of impact on formed dentin bridges with TDMH group resulted in significantly superior dentin bridges of a higher radiodensity and thickness than Biodentine and MTA.

CONCLUSIONS

TDMH has a greater potential to induce dentin bridge formation than Biodentine and MTA under standardized conditions. Additionally, CBCT imaging was confirmed as a non-invasive and inclusive approach to evaluate the formed dentin bridges after pulp capping procedure.

CLINICAL RELEVANCE

Direct pulp capping can be done successfully with this novel injectable pulp capping material in future clinical applications.

TRIAL REGISTRATION

PACTR201901866476410.

Comparison of photothermal radiometry and modulated luminescence, intraoral radiography, and cone beam computed tomography for detection of natural caries under restorations

OBJECTIVES

The aim of this ex vivo study was to measure the sensitivity, specificity, and receiver operating characteristic (ROC) area under the curve (AUC) of a caries diagnostic system based on photothermal radiometry and modulated luminescence (PTR/LUM) and compare them with the values for digital intraoral radiography (IR) and cone beam computed tomography (CBCT) in detecting recurrent decay.

STUDY DESIGN

Class 2 composite restorations were prepared on 70 proximal surfaces: 35 with caries and 35 without caries. The gingival floor of the restored surfaces was assessed for caries under the restorations using each of the 3 modalities. Statistical calculations and analysis were performed using the R statistical computing environment.

RESULTS

The average scores for sensitivity among the 6 observers were 0.89 for PTR/LUM, 0.38 for IR, and 0.40 for CBCT. Sensitivity for PTR/LUM was significantly greater than sensitivity for IR and CBCT. Average scores for specificity were 0.83, 0.80, and 0.70 for PTR/LUM, IR, and CBCT, respectively. CBCT had significantly lower specificity. The AUC was 0.65 for IR and 0.59 for CBCT, which were significantly different. PTR/LUM had moderate intraobserver agreement.

CONCLUSIONS

PTR/LUM, which involves non-ionizing radiation, can serve as a sensitive adjunct in early caries detection and monitoring.

New evolution of cone-beam computed tomography in dentistry: Combining digital technologies

Panoramic radiographs and computed tomography (CT) play a paramount role in the accurate diagnosis, treatment planning, and prognostic evaluation of various complex dental pathologies. The advent of cone-beam computed tomography (CBCT) has revolutionized the practice of dentistry, and this technique is now considered the gold standard for imaging the oral and maxillofacial area due to its numerous advantages, including reductions in exposure time, radiation dose, and cost in comparison to other imaging modalities. This review highlights the broad use of CBCT in the dentomaxillofacial region, and also focuses on future software advancements that can further optimize CBCT imaging.

Accuracy of extraoral bite-wing radiography in detecting proximal caries and crestal bone loss

BACKGROUND

Extraoral bite-wing (EB) radiography is an imaging technology used in dentistry. The authors conducted an in vivo study comparing the accuracy of intraoral bitewing (IB) radiographs and EB radiographs for proximal caries and bone loss diagnosis.

METHODS

The authors recruited 116 patients who received IB radiographs to receive EB radiographs. The 5 calibrated authors made a consensus radiographic diagnosis of proximal caries and crestal bone loss. For this study, they assumed IB radiographs as the criterion standard. Next, they obtained EB radiographs for the 116 patients and calculated sensitivity, specificity, and false-positive rates against each patient's IB radiograph.

RESULTS

The patients' EB radiographs revealed a significantly greater number of caries and crestal bone loss findings compared with their IB radiographs. The EB radiographs had a high to excellent sensitivity and moderate to low specificity of caries and crestal bone loss findings, respectively. Considering IB radiographs to be the criterion standard, the false-positive rate for EB radiographs was moderate for caries and high for bone loss diagnosis.

CONCLUSIONS

The EB radiographs, which generate fewer images of overlapping proximal surfaces, have the advantage of detecting more carious lesions and bone loss findings than the IB radiographs do, but with the disadvantage of more false-positive diagnoses. Further research is needed to evaluate if the false-positive findings represent true carious lesions and bone loss.

PRACTICAL IMPLICATIONS

EB radiography is a promising technology, which has several advantages over traditional IB radiography. Clinicians should be aware of false-positive diagnosis of caries and bone loss with EB radiography.

Comparison of cone beam computed tomography and digital intraoral radiography performance in the detection of artificially induced recurrent caries-like lesions

OBJECTIVES

The aim of this study was to compare the performance of cone beam computed tomography (CBCT) and digital radiography in the detection of artificial recurrent caries-like lesions under amalgam and composite fillings.

STUDY DESIGN

The study included class II cavities in 30 molars that had been filled with amalgam. Fifteen of those molars had the restoration-enamel interface artificially demineralized. Phantoms were prepared, and CBCT images were acquired with 2 units in 3 voxel sizes (K9000, 0.076 mm; i-CAT, 0.2 mm and 0.4 mm). Intraoral radiographs were obtained with 3 systems (Digora, VistaScan, and RVG-6100). Amalgam fillings were then replaced by composite, and new images were obtained. Three examiners assessed all of the images. Sensitivity, specificity, accuracy, and receiver operating characteristic curve were calculated and verified through analysis of variance and the Tukey test.

RESULTS

There were no significant differences in sensitivity and specificity when the same restorative material was present or when the restorative materials were compared with the imaging technique as a constant. As for accuracy and receiver operating characteristic curve, there were statistically significant differences when the 2 materials were compared, and there were differences in the amalgam group when the imaging modalities were compared.

CONCLUSIONS

CBCT performed similarly to intraoral radiography in detecting demineralization under restorations. However, the voxel size and the type of restorative material influenced its performance.

Alternative methods to visual and radiographic examinations for approximal caries detection

A shift in caries prevalence from occlusal surfaces to approximal surfaces has been demonstrated by epidemiological studies. Two recent meta-analyses evaluated the performance of visual examination and radiography for carious lesion detection, and reported low sensitivity but high specificity for early approximal caries detection. This suggests that the conventional methods have a higher risk of failing to detect approximal lesions. Consequently, in caries susceptible populations, there is a risk of progression of non-cavitated lesions to irreversible tooth destruction before the lesions are detected. This paper aims to review the performance of unconventional and novel methods for approximal caries detection. In vitro and in vivo studies identified through a MEDLINE search using keywords such as caries detection, approximal caries detection, light fluorescence and dental caries, and transillumination and dental caries were reviewed. The unconventional methods known to be used for approximal caries detection and included in this review are: cone beam computed tomography, fiber-optic trans-illumination, digital imaging fiber optic trans-illumination, near-infrared digital imaging transillumination, optical coherence tomography, laser fluorescence, ultrasound, and LED reflection and refraction.

Comparison of Cone-Beam Computed Tomography and Intraoral Radiography in Detection of Recurrent Caries under Composite Restorations

Abstract Secondary caries is the most common cause of dental restoration failures. This study aimed to compare the diagnostic accuracy of conventional and digital intraoral radiography and cone beam computed tomography (CBCT) for detection of recurrent caries around composite restorations. mesio-occluso-distal (MOD) cavities were prepared using bur on 45 extracted sound human molar teeth. The teeth were divided into 3 groups. In the control group, cavities were restored with composite resin after etching and bonding (n=15). In Group 2, 500-μm thick wax was placed over the buccal, lingual and gingival walls and the cavities were restored with composite resin. Group 3 specimens were subjected to pH cycling and artificial caries were created on the buccal, lingual and gingival walls. The cavities were restored with composite. Conventional and digital photo-stimulable phosphor (PSP; Optime) radiographs and two CBCTs images (NewTom 3G and Cranex 3D) were obtained from them. Presence or absence of caries in the cavity walls was assessed on these images. Data were analyzed using Kappa statistic. The diagnostic accuracy of CBCT was significantly higher than that of digital and conventional intraoral radiography (p<0.05). The accuracy was 0.83, 0.78, 0.55 and 0.49 for CBCT Cranex 3D, CBCT NewTom 3G, conventional and digital intraoral radiography, respectively. CBCT has a higher diagnostic accuracy than digital and conventional intraoral radiography for detection of secondary caries around composite restorations.

Diagnostic accuracy of different display types in detection of recurrent caries under restorations by using CBCT

OBJECTIVES

To assess the in vitro diagnostic ability of CBCT images using seven different display types in the detection of recurrent caries.

METHODS

Our study comprised 128 extracted human premolar and molar teeth. 8 groups each containing 16 teeth were obtained as follows: (1) Black Class I (Occlusal) amalgam filling without caries; (2) Black Class I (Occlusal) composite filling without caries; (3) Black Class II (Proximal) amalgam filling without caries; (4) Black Class II (Proximal) composite filling without caries; (5) Black Class I (Occlusal) amalgam filling with caries; (6) Black Class I (Occlusal) composite filling with caries; (7) Black Class II (Proximal) amalgam filling with caries; and (8) Black Class II (Proximal) composite filling with caries. Teeth were imaged using 100 × 90 mm field of view at three different voxel sizes of a CBCT unit (Planmeca ProMax(®) 3D ProFace™; Planmeca, Helsinki, Finland). CBCT TIFF images were opened and viewed using custom-designed software for computers on different display types. Intra- and interobserver agreements were calculated. The highest area under the receiver operating characteristic curve (Az) values for each image type, observer, reading and restoration were compared using z-tests against Az = 0.5. The significance level was set at p = 0.05.

RESULTS

We found poor and moderate agreements. In general, Az values were found when software and medical diagnostic monitor were utilized. For Observer 2, Az values were statistically significantly higher when software was used on medical monitor [p = 0.036, p = 0.015 and p = 0.002, for normal-resolution mode (0.200 mm(3) voxel size), high-resolution mode (0.150 mm(3) voxel size) and low-resolution mode (0.400 mm(3) voxel size), respectively]. No statistically significant differences were found among other display types for all modes (p > 0.05). In general, no difference was found among 3 different voxel sizes (p > 0.05). In general, higher Az values were obtained for composite restorations than for amalgam restorations for all observers. For Observer 1, Az values for composite restorations were statistically significantly higher than those of amalgam restorations for MacBook and iPhone (Apple Inc., Cupertino, CA) assessments (p = 0.002 and p = 0.048, respectively).

CONCLUSIONS

Higher Az values were observed with medical monitors when used with dedicated software compared to other display types which performed similarly in the diagnosis of recurrent caries under restorations. In addition, observers performed better in detection of recurrent caries when assessing composite restorations than amalgams.

Occlusal caries extension in relation to visual and radiographic diagnostic criteria: results from a microcomputed tomography study

OBJECTIVE

This in vitro study aimed to evaluate occlusal caries extension in relation to visual and radiographic diagnostic criteria and their clinical value to indicate operative or preventive dental care.

METHODS

A total of 196 third molars with clinically sound occlusal fissures or noncavitated lesions were collected. Before microcomputed tomography (μCT) investigation, each tooth was examined visually and radiographically. Kühnisch's μCT-based caries-extension index (CE index) was used to determine the caries depth on a numeric scale (0 = sound; 0.01-0.99 = enamel caries; 1.0-1.99 = dentin caries). Sensitivities (SEs), specificities (SPs), and area under the receiver operating characteristic curve (Az value) were also calculated.

RESULTS

Based on μCT data, the following mean CE index values and standard deviations (SDs) were documented according to the visual criteria: sound = 0.6 (0.4); first visible signs = 0.9 (0.4); established lesions = 1.3 (0.3); microcavities = 1.4 (0.2); dentin exposure = 1.5 (0.2); and large cavities = 1.5 (0.3). The radiographic categories according to Marthaler (enamel caries [D0-2], caries in the outer half of dentin [D3], and caries in the inner half of dentin [D4]) were related to CE index values of 0.9 (0.4), 1.4 (0.2) and 1.6 (0.4), respectively. Caries detected visually or radiographically showed an SE of 84% and an SP of 85% (Az = 0.85). When both methods were used to predict dentin involvement simultaneously, SE = 27%, SP = 100%, and Az = 0.63; this combined visual and radiographic approach was associated with a perfect specificity and no false-negative decisions. The proportion of false-positive diagnoses was moderately high, and lesion extension in these cases was mainly limited to the outer 20% of the dentin.

CONCLUSIONS

Our results might be useful for differentiating between preventive and operative dental care for pits and fissures.

A comparative study of different radiographic methods for detecting occlusal caries lesions

OBJECTIVES

The aim of this in vitro study was to compare the diagnostic accuracy of different radiographic imaging modalities in detecting occlusal caries lesions.

MATERIALS AND METHODS

Under standardized conditions, 125 extracted human permanent molar teeth with sound or occlusal caries lesions were radiographed using a conventional film system (F-speed), a direct digital imaging system (complementary metal oxide semiconductor sensor), an indirect digital imaging system (photostimulable phosphor plate) and a cone beam computed tomography system (CBCT). Two observers scored the resultant images for the presence or absence of caries. Then, the teeth were histologically prepared and a definite diagnosis was determined by stereomicroscopic assessment. The area under the receiver operating characteristic curve (Az), sensitivity, specificity and accuracy of each imaging modality were calculated, as well as the intra- and interexaminer reproducibility.

RESULTS

For both thresholds, interexaminer agreement were higher for CBCT. For intraexaminer agreement, observers had different scores for both thresholds, but the scores were generally higher for CBCT. Similar Az values were achieved with all imaging methods at a diagnostic D1 threshold. The Az values of the CBCT system were found to be statistically higher than those of the other imaging modalities at a diagnostic D3 threshold (p > 0.05); no significant differences were found among the other imaging modalities. All radiographic methods showed similar sensitivities, specificities and accuracy in detecting D1 threshold. The CBCT system showed higher sensitivity and accuracy in detecting dentine lesions.

CONCLUSIONS

Within the limitations of this study, CBCT exhibited better performance in detecting deep occlusal caries lesions than the other radiographic systems.

A comparative study of the diagnostic accuracy of cone beam computed tomography and intraoral radiographic modalities for the detection of noncavitated caries

OBJECTIVES

The aim of this study was to determine the diagnostic accuracy of cone beam computed tomography (CBCT) in the detection of approximal and occlusal noncavitated carious lesions.

METHODS

A total of 135 extracted human posterior teeth were used. They were radiographed using the following: conventional film (Kodak Insight), a digital system (PSP plates Digora Optime, Soredex), and a CBCT system (NewTom 3G, Quantitative Radiology). All the images were assessed by two independent observers twice. Receiver operating characteristic analysis (Az) was used.

RESULTS

NewTom 3G 9″ CBCT was statistically inferior to conventional film and a digital system for the detection of approximal caries. NewTom 3G 9″ had significantly higher Az values than PSP plate (p < 0.05), but there were no statistically significant differences between the Az values for CBCT and film (p > 0.33) for occlusal surface caries.

CONCLUSION

The diagnostic accuracy of all three tested radiographic systems is low, and it is necessary to use other methods to improve early caries detection.

CLINICAL RELEVANCE

CBCT has found a wide application in different fields of dentistry. The report from a CBCT examination performed for any of these reasons should include all abnormal findings, and the detection of noncavitated caries lesions is especially important because it facilitates the use of noninvasive treatment.

The influence of amalgam fillings on the detection of approximal caries by cone beam CT: in vitro study

OBJECTIVES

The aim of this CBCT investigation on the detection of caries was to assess the influence of artefacts produced by the presence of amalgam fillings located in the vicinity.

METHODS

102 non-cavitated pre-molar and molar teeth were placed in blocks of silicone with approximal contacts consisting of 3 sound or carious teeth and 1 mesial-occlusal-distal amalgam-filled tooth in-between. Radiographs of all the teeth were recorded using the CBCT system (NewTom™ 3G; QR Srl, Verona, Italy; field of view, 9 inches). Data from the CBCT unit were reconstructed and sectioned in the mesiodistal tooth plane. Images were evaluated twice by two observers, using a five-step confidence scale. After the CBCT examination, the teeth were individually sectioned in the mesiodistal direction with a diamond saw. Using a light microscope at ×40 magnification, the true morphological status of all approximal surfaces was established.

RESULTS

Sensitivity of the CBCT for the detection of caries on surfaces located proximally and distally to an amalgam filing ranged from 0.27 to 0.30 for enamel and from 0.47 to 0.56 for dentin. Specificity values for enamel proximal and distal lesions were 0.48 and 0.53, respectively, for enamel and 0.33 to 0.38, respectively, for proximal and distal dentin cases. Intra-observer reliability was 0.84, and interobserver reliability was 0.49.

CONCLUSIONS

Owing to its low specificity, scans from a CBCT examination should not be used to determine the presence of demineralization of the tooth surface when amalgam fillings are present in the region of interest.

Diagnostic accuracy of cone beam computed tomography compared with intraoral radiography for the detection of noncavitated occlusal carious lesions

The aim of this study was to evaluate the accuracy of cone beam computed tomography (CBCT) in the detection of noncavitated occlusal caries lesions and to compare this accuracy with that observed with conventional radiographs. 135 human teeth, 67 premolars and 68 molars with macroscopically intact occlusal surfaces, were examined by two independent observers using the CBCT system: NewTom 3G (Quantitative Radiology) and intraoral conventional film (Kodak Insight). The true lesion diagnosis was established by histological examination. The detection methods were compared by means of sensitivity, specificity, predictive values and accuracy. To assess intra- and interobserver agreement, weighted kappa coefficients were computed. Analyses were performed separately for caries reaching into dentin and for all noncavitated lesions. For the detection of occlusal lesions extending into dentin, sensitivity values were lower for film (0.45) when compared with CBCT (0.51), but the differences were not statistically significant (p > 0.19). For all occlusal lesions sensitivity values were 0.32 and 0.22, respectively, for CBCT and film. The specificity scores were high for both modalities. Interobserver agreement amounted to 0.93 for the CBCT system and to 0.87 for film. It was concluded that the use of the 9-inch field of view NewTom CBCT unit for the diagnosis of noncavitated occlusal caries cannot be recommended.

Radiographic display of carious lesions and cavitation in approximal surfaces: Advantages and drawbacks of conventional and advanced modalities

BACKGROUND

Treatment strategies have changed with efforts on arresting carious lesions suspected to have an intact surface sparing operative treatment for cavitated lesions. Radiography is still the most recommended adjunct method in the diagnosis of clinically inaccessible approximal surfaces. BITEWING RADIOGRAPHY: The major drawback of bitewing radiography for caries diagnosis is that the clinical state of the surface cannot be determined; i.e. if cavitation has developed or the demineralized surface is still intact. Based on studies of the relationship between radiographic lesion depth and clinical cavitation in approximal surfaces, a threshold for operative treatment decision has been suggested when a lesion is observed radiographically more than one-third into dentine. However, the results from previous studies are contradictory and the majority of studies are ~25 years old. In addition, there are few longitudinal observational studies on the behaviour of dentinal carious lesions, particularly in adults. CONE BEAM COMPUTED TOMOGRAPHY: Cone beam CT is an advanced 3-dimensional radiographic modality, which seems much more accurate than intra-oral modalities for displaying cavitation in approximal surfaces. Nonetheless, there are several drawbacks with CBCT, such as radiation dose, costs and imaging artefacts. Therefore, CBCT cannot be advocated at current as a primary radiographic examination with the aim of diagnosing cavitated carious lesions.

CONCLUSIONS

Bitewing radiography is, thus, still state-of-the-art as an adjunct in diagnosing carious lesions in clinically inaccessible approximal surfaces. The risk for cavitation is related to lesion depth, but new studies are needed in both child and adult populations to validate current thresholds for the operative treatment decision based on the radiographic lesion depth.

Cone-beam computed tomography: time for an evidence-based approach

Cone-beam computed tomography (CBCT) is an imaging technology that has revolutionised dental imaging in the last decade. Although of particular value to specialists performing implant treatment, it is increasingly being adopted by general dental practitioners. As the radiation dose is higher than that of conventional radiography, it is important to consider its diagnostic efficacy for the common tasks performed in general dental practice, such as caries diagnosis, endodontics and the detection of periapical pathosis. Any new imaging technique needs to have proven advantages over existing techniques before it is adopted, yet the evidence remains quite limited. Furthermore, image quality and radiation doses vary enormously between different manufacturers' equipment, so that extrapolating results of one piece of research from one CBCT machine to another is fraught with pitfalls. Radiation doses with CBCT are typically an order of magnitude higher than conventional radiography. There is scope, however, for reducing these doses by judicious adjustment of exposure factors and limiting the field of view to the smallest dimensions consistent with the clinical situation. There is still a long way to go before we understand the value of CBCT in dentistry. High quality research evidence is needed, particularly with regard to assessing whether using BCT improves patient outcomes.

Performance of a photostimulable storage phosphor digital system with or without the sharpen filter and cone beam CT for detecting approximal enamel subsurface demineralization

OBJECTIVES

The aim of this study was to assess the performance of photostimulable storage phosphor (PSP) radiographs with or without using the sharpen filter and cone beam CT (CBCT) for detecting enamel subsurface demineralization.

METHODS

Enamel subsurface demineralization was induced on one of the approximal surfaces of 120 sound human teeth. Standardized images of all teeth were acquired after the demineralization phase using the Digora(®) Optime (Orion Corp./Soredex, Helsinki, Finland) (PSP) and the i-CAT™ (Imaging Sciences International, Hatfield, PA) (CBCT) systems. Three calibrated observers interpreted the images using a five-point scale (1, demineralization definitely absent; 2, demineralization probably absent; 3, unsure; 4, demineralization probably present; and 5, demineralization definitely present). Diagnoses were validated by cross-sectional microhardness profiling in the test areas of the approximal surfaces. Interobserver agreement was analysed using kappa statistics. Accuracy was estimated by the areas under the receiver operating characteristic curves (Az), which were compared using the Kruskal-Wallis test (α = 5%).

RESULTS

Interobserver agreement was higher for CBCT (κ = 0.7-0.8), followed by sharpen-filtered (κ = 0.6-0.7) and original (κ = 0.5-0.6) images. CBCT presented the highest accuracy value (Az = 0.897) compared with the original (Az = 0.792) and sharpen-filtered (Az = 0.712) images. However, no statistical differences were observed between the imaging modalities (p = 0.0794).

CONCLUSIONS

It can be concluded that PSP radiographs with or without using the sharpen filter and the CBCT images may be useful adjuncts for detecting subtle approximal enamel demineralization.

Proximal caries detection accuracy using intraoral bitewing radiography, extraoral bitewing radiography and panoramic radiography

OBJECTIVE

To compare proximal caries detection using intraoral bitewing, extraoral bitewing and panoramic radiography.

METHODS

80 extracted human premolar and molar teeth with and without proximal caries were used. Intraoral radiographs were taken with Kodak Insight film (Eastman Kodak Co., Rochester, NY) using the bitewing technique. Extraoral bitewing and panoramic images were obtained using a Planmeca Promax Digital Panoramic X-ray unit (Planmeca Inc., Helsinki, Finland). Images were evaluated by three observers twice. In total, 160 proximal surfaces were assessed. Intra- and interobserver kappa coefficients were calculated. Scores obtained from the three techniques were compared with the histological gold standard using receiver operating characteristic analysis. Az values for each image type, observer and reading were compared using z-tests, with a significance level of α = 0.05.

RESULTS

Kappa coefficients ranged from 0.883 to 0.963 for the intraoral bitewing, from 0.715 to 0.893 for the extraoral bitewing, and from 0.659 to 0.884 for the panoramic radiography. Interobserver agreements for the first and second readings for the intraoral bitewing images were between 0.717 and 0.780, the extraoral bitewing readings were between 0.569 and 0.707, and the panoramic images were between 0.477 and 0.740. The Az values for both readings of all three observers were highest for the intraoral bitewing. Az values for the extraoral bitewing images were higher than those of the panoramic images without statistical significance (p > 0.05).

CONCLUSION

Intraoral bitewing radiography was superior to extraoral bitewing and panoramic radiography in diagnosing proximal caries of premolar and molar teeth ex vivo. Similar intra- and interobserver coefficients were calculated for extraoral bitewing and panoramic radiography.

Validity of wax and acrylic as soft-tissue simulation materials used in in vitro radiographic studies

OBJECTIVE

To determine the thickness of wax and acrylic that provides a radiographic density similar to that of the human cheek.

METHODS

An intraoral film radiograph of the human cheek including a 40×30×3 mm reference aluminium block was recorded under standardized conditions in 61 subjects. Radiographic density was measured by a densitometer in ten randomly selected sites of the film to serve as the gold standard for density values of the cheek soft tissues. Thereafter, the density of series of radiographs of two tissue-simulating materials-wax and acrylic-in systematically increasing thicknesses (wax, 1.5-30 mm; acrylic, 2-40 mm) plus the reference block were measured and compared with the gold-standard values.

RESULTS

The radiographic density of wax with a thickness of 13-17 mm or acrylic with a thickness of 14.5 mm corresponded to the average density of the human cheek.

CONCLUSION

The soft tissues of the average human cheek can be simulated with 13-17 mm wax or 14.5 mm acrylic in in vitro radiographic studies.

Detection of cavitated approximal surfaces using cone beam CT and intraoral receptors

OBJECTIVES

The aim of this study was to compare cone beam CT (CBCT) in a small field of view (FOV) with a solid-state sensor and a photostimulable phosphor plate system for detection of cavitated approximal surfaces.

METHODS

257 non-filled approximal surfaces from human permanent premolars and molars were recorded by two intraoral digital receptors, a storage phosphor plate (Digora Optime, Soredex) and a solid-state CMOS sensor (Digora Toto, Soredex), and scanned in a cone beam CT unit (3D Accuitomo FPD80, Morita) with a FOV of 4 cm and a voxel size of 0.08 mm. Image sections were carried out in the axial and mesiodistal tooth planes. Six observers recorded surface cavitation in all images. Validation of the true absence or presence of surface cavitation was performed by inspecting the surfaces under strong light with the naked eye. Differences in sensitivity, specificity and agreement were estimated by analysing the binary data in a generalized linear model using an identity link function.

RESULTS

A significantly higher sensitivity was obtained by all observers with CBCT (p < 0.001), which was not compromised by a lower specificity. Therefore, a significantly higher overall agreement was obtained with CBCT (p < 0.001). There were no significant differences between the Digora Optime phosphor plate system and the Digora Toto CMOS sensor for any parameter.

CONCLUSIONS

CBCT was much more accurate in the detection of surface cavitation in approximal surfaces than intraoral receptors. The differences are interpreted as clinically significant. A CBCT examination performed for other reasons should also be assessed for approximal surface cavities in teeth without restorations.

Occlusal caries depth measurements obtained by five different imaging modalities

The study aimed to assess the accuracy and reproducibility of occlusal caries depth measurements obtained from different imaging modalities. The study comprised 21 human mandibular molar teeth with occlusal caries. Teeth were imaged using film, CCD, two different cone-beam computerized tomography (CBCT) units and a microcomputer tomography (micro-CT). Thereafter, each tooth was serially sectioned, and the section with the deepest carious lesion was scanned using a high-resolution scanner. Each image set was separately viewed by three oral radiologists. Images were viewed randomly, and each set was viewed twice. Lesion depth was measured on film images using a digital caliper, on CCD and CBCT images using built-in measurement tools, on micro-CT images using the Mimics software program, and on histological images using AxioVision Rel. 4.7. Intra- and inter-rater reliabilities were assessed according to the Bland/Altman method by calculating Intraclass Correlation Coefficients (ICCs). Mean/median values obtained with intraoral systems were lower than those obtained with 3-D and histological images for all observers and both readings. Intra-observer ICC values for all observers were highest for histology and micro-CT. In addition, intra-observer ICC values were higher for histology and CBCT than for histology and intra-oral methods. Inter-observer ICC values for first and second readings were high for all observers. No differences in repeatability were found between Accuitomo and Iluma CBCT images or between intra-oral film and CCD images. Micro-CT was found to be the best imaging method for the ex vivo measurement of occlusal caries depth. In addition, both CBCT units performed similarly and better than intra-oral modalities.

Diagnostic performance of cone-beam computed tomography on detection of mechanically-created artificial secondary caries

Purpose

The aim of this study was to compare the diagnostic accuracy of cone-beam computed tomography (CBCT) images and bitewing images in detection of secondary caries.

Materials and Methods

One hundred and twenty proximal slots of Class II cavities were randomly prepared on human premolar and molar teeth, and restored with amalgam (n=60) and composite resin (n=60). Then, artificial secondary caries lesions were randomly created using round steel No. 4 bur. The teeth were radiographed with a conventional bitewing technique and two CBCT systems; Pax-500ECT and Promax 3D. All images were evaluated by five observers. The area under the receiver operating characteristic (ROC) curve (A_z) was used to evaluate the diagnostic accuracy. Significant difference was tested using the Friedman test (p value<0.05).

Results

The mean A_z values for bitewing, Pax-500ECT, and Promax 3D imaging systems were 0.882, 0.995, and 0.978, respectively. Significant differences were found between the two CBCT systems and film (p=0.007). For CBCT systems, the axial plane showed the greatest A_z value.

Conclusion

Based on the design of this study, CBCT images were better than bitewing radiographs in detection of secondary caries.

Detection accuracy of proximal caries by phosphor plate and cone-beam computerized tomography images scanned with different resolutions

This study was carried out to assess whether the spatial resolution has an impact on the detection accuracy of proximal caries in flat panel CBCT (cone beam computerized tomography) images and if the detection accuracy can be improved by flat panel CBCT images scanned with high spatial resolution when compared to digital intraoral images. The CBCT test images of 45 non-restored human permanent teeth were respectively scanned with the ProMax 3D and the DCT Pro scanners at different resolutions. Digital images were obtained with a phosphor plate imaging system Digora Optime. Eight observers evaluated all the test images for carious lesion within the 90 proximal surfaces. With the histological examination serving as the reference standard, observer performances were evaluated by receiver operating characteristic (ROC) curves. The areas under the ROC curves were analyzed with two-way analysis of variance. No significant differences were found among the CBCT images and between CBCT and digital images when only proximal enamel caries was detected (p = 0.989). With respect to the detection of proximal dentinal caries, significant difference was found between CBCT and digital images (p < 0.001) but not among CBCT images. The spatial resolution did not have an impact on the detection accuracy of proximal caries in flat panel CBCT images. The flat panel CBCT images scanned with high spatial resolution did not improve the detection accuracy of proximal enamel caries compared to digital intraoral images. CBCT images scanned with high spatial resolutions could not be used for proximal caries detection.

Current status of dental caries diagnosis using cone beam computed tomography

Purpose

The purpose of this article is to review the current status of dental caries diagnosis using cone beam computed tomography (CBCT).

Materials and Methods

An online PubMed search was performed to identify studies on caries research using CBCT.

Results

Despite its usefulness, there were inherent limitations in the detection of caries lesions through conventional radiograph mainly due to the two-dimensional (2D) representation of caries lesions. Several efforts were made to investigate the three-dimensional (3D) image of lesion, only to gain little popularity. Recently, CBCT was introduced and has been used for diagnosis of caries in several reports. Some of them maintained the superiority of CBCT systems, however it is still under controversies.

Conclusion

The CBCT systems are promising, however they should not be considered as a primary choice of caries diagnosis in everyday practice yet. Further studies under more standardized condition should be performed in the near future.

Diagnostic accuracy studies needed for cone beam computed tomography

DATA SOURCES

Medline, Embase, CENTRAL and the reference lists of identified studies.

STUDY SELECTION

Studies had to describe diagnostic accuracy efficacy, diagnostic thinking efficacy, therapeutic efficacy or any combination for CBCT in the diagnosis of impacted teeth or of important features associated with impactions. Criteria for the diagnosis had to be described in detail or referenced. For studies elucidating only observer performance, the analysis had to be based on a minimum of two observers.

DATA EXTRACTION AND SYNTHESIS

Data were extracted with the aid of protocol based on critical appraisal of diagnostic studies. Two authors independently assessed the quality and internal validity of studies using the QUADAS tool,(1) with disagreements being resolved by discussion. The results were described narratively as meta-analyses could not be conducted.

RESULTS

The search yielded 96 titles, of which seven were included. There was only limited evidence for diagnostic efficacy expressed as sensitivity, specificity and predictive values. Only two studies compared CBCT and panoramic radiographs with a valid reference method and presented the results in terms of percentage of correct diagnoses.

CONCLUSIONS

There is a need for diagnostic accuracy studies on CBCT where accepted methodological criteria for diagnostic thinking, efficacy and therapeutic efficacy are incorporated.

Diagnostic performance of the visual caries classification system ICDAS II versus radiography and micro-computed tomography for proximal caries detection: an in vitro study

OBJECTIVES

The purpose of this study was: (a) to compare the visual caries classification system ICDAS II with conventional (CR) and digital radiography (DR) for diagnosis of non-cavitated caries on free proximal surfaces, (b) to examine the potential of micro-computed tomography (MCT) to substitute histological examination for the in vitro caries assessment.

METHODS

Both proximal surfaces of 20 teeth received classification separately by two examiners by means of the diagnostic modalities examined. The teeth were sectioned and assessed for depth of the lesion. The modalities were compared in terms of degree of inter-examiner agreement, sensitivity, specificity, accuracy, positive and negative predictive value and validity. Two diagnostic thresholds were applied: no caries versus all caries scores (D1), and no dentin caries versus dentin caries (D3).

RESULTS

The weighted kappa values for inter-examiner reproducibility for all diagnostic modalities were 0.51-0.81. Visual examination (ICDAS II) reached significant higher sensitivity (0.92-0.96) and negative predictive value (0.9-1) than radiography. Likewise, the radiographic modalities presented significantly higher specificity (0.93-1) and positive predictive values (0.92-1) than the ICDAS II criteria. The overall accuracy performance of radiographic modalities was related to the diagnostic threshold. MCT did not agree with histological validation at each disease severity scale.

CONCLUSIONS

The ICDAS II criteria are a promising tool for caries diagnosis on free proximal surfaces. DR and CR radiography present comparable performance. Furthermore, MCT is not capable of constituting a reliable alternative to histological examination for caries research.

Modern dental imaging: a review of the current technology and clinical applications in dental practice

A review of modern imaging techniques commonly used in dental practice and their clinical applications is presented. The current dental examinations consist of intraoral imaging with digital indirect and direct receptors, while extraoral imaging is divided into traditional tomographic/panoramic imaging and the more recently introduced cone beam computed tomography. Applications, limitations and current trends of these dental "in-office" radiographic techniques are discussed.