Performance of 5 different displays in the detection of artificial incipient and recurrent caries-like lesions.

OBJECTIVES: The aim of this study was to assess whether auto-calibrating medical-grade monitors perform better than off-the-shelf monitors and tablet computers in detecting artificial incipient and recurrent caries-like lesions. STUDY DESIGN: Sixty extracted teeth (30 premolars and 30 molars) were selected. All molars received class II amalgam and composite restorations. A 7-mm2 area on the crowns of half of the teeth was demineralized. Phantoms consisting of 4 teeth were created. Three observers using a 5-point scale evaluated digital periapical radiographs for the presence of caries on 5 displays: 2 autocalibrating medical-grade monitors, 2 tablets, and 1 off-the-shelf monitor. Sensitivity, specificity, accuracy, and receiver operating curve data were calculated and verified through analysis of variance and Tukey tests. Observer agreements were assessed using Cohen's κ test. RESULTS: Intraobserver agreement ranged from 0.347 to 0.612 (molars) and 0.617 to 0.811 (premolars). Interobserver agreement ranged from 0.239 to 0.559 (molars) and 0.657 to 0.858 (premolars). The performances of tablets and the off-the-shelf monitor were similar to medical monitors when the same tooth groups were compared. Medical-grade monitors presented fewer statistically significant differences when different lesions where compared within the same display and restorative material. CONCLUSIONS: Evaluations of similar lesions were not significantly different among the 3 types of displays. However, the autocalibrating medical-grade monitors performed better when incipient and recurrent lesions were compared.

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.

Performance of digital radiography with enhancement filters for the diagnosis of proximal caries.

Enhancement filters are potentially supposed to improve the diagnostic performance of digital images. Thus, the aim of this study was to compare the performance of digital radiography with and without enhancement filters for the detection of induced proximal caries lesions. The total sample consisted of 120 sound human teeth (40 premolars, 80 molars). Enamel subsurface demineralization was induced in one of the proximal surfaces of 60 teeth. Standardized radiographs of all teeth were acquired after the demineralization phase using the Digora-Optime® system. Four radiologists examined the digital radiographs and applied the following filters provided by the Digora® for Windows 2.6 package: Negative, Sharpen and both (Negative plus Sharpen). Validation of radiographic diagnosis was carried out by Knoop cross-sectional micro-hardness profiling on the proximal surfaces. Intraobserver agreement was estimated using Kappa statistics (k). Sensitivity, specificity and over-all accuracy were compared using ANOVA/Tukey test (α = 5%). Intraobserver agreement ranged from good to very good/optimal (k: 0.65-0.83). Although not statistically significant, the highest sensitivity (0.68 ± 0.22) and accuracy (0.76 ± 0.16) values were observed using the Sharpen filter as opposed to the Negative filter, which presented the lowest performance indices (0.57 ± 0.13 and 0.70 ± 0.10, respectively). Specificity ranged from 0.84 to 0.85, considering all imaging modalities (p > 0.05). Insofar as the Sharpen filter had the highest performance indices, it may be considered a useful adjunct for detecting subtle proximal caries lesions.