A novel classification system for assessment of approximal caries lesion progression in bitewing radiographs

The Detection of Dental Pathologies on Periapical Radiographs-Results from a Reliability Study

(1) Background: Caries, periapical lesions, periodontal bone loss (PBL), and endo-perio lesions are common dental findings that require an accurate diagnostic assessment to allow appropriate disease management. The purpose of this reliability study was to compare the inter- and intra-rater reliability for the detection of the above-mentioned pathologies on periapical radiographs. (2) Methods: Fourteen dentists (three with more than two years and eleven with less than two years of work experience) participated in a training workshop prior to data acquisition. A total of 150 radiographs were assessed by all raters in two rounds. Cohen's Kappa (CK) values and a binary logistic regression were calculated. (3) Results: The reliability was found in a moderate and substantial range of agreement: caries (mean inter-rater CK value/first round 0.704/mean inter-rater CK value/second round 0.659/mean intra-rater CK value 0.778), periapical lesions (0.643/0.611/0.768), PBL (0.454/0.482/0.739) and endo-perio lesion (0.702/0.689/0.840). The regression model revealed a significant influence of the clinical experience, and furthermore, periapical pathologies and PBL were identified less reliably in comparison to caries and endo-perio lesions. (4) Conclusions: The dentist's ability to detect the chosen pathologies was linked with significant differences. Periapical lesions and PBL were identified less reliably than caries and endo-perio lesions.

Reproducibility and diagnostic value of a new wedge-guided bitewing image receptor-holding device

OBJECTIVE

To assess the reproducibility of a wedge-guided bitewing image receptor-holding device (IRHD-WG) compared to a commercially available bitewing image receptor-holding device (IRHD-XCP).

METHODS AND MATERIALS

Ten operators randomly acquired bitewing radiographs of four posterior regions (Premolar, Molar 1, Molar 2, Molar 3) distributed in two dry bone skulls and mandibles using 2 IRHDs (IRHD-WG and IRHD-XCP). The radiographs corresponding to the same region and IRHD but acquired by different operators were paired for reproducibility comparison. A total of 360 pairs of radiographs were randomized for analysis. Objective analysis consisted of extracting the pixel values from each radiograph and comparing the values between each pair by intraclass correlation coefficient. For subjective analysis, the IRHDs images were digitally removed. Five oral radiologists blinded for the study conditions classified the radiograph pairs according to their similarity and diagnostic value. The answers' relative frequencies were compared by the chi-square test (α = 0.05).

RESULTS

The IRHD-WG presented a higher reproducibility (Mean = 0.850; SD = 0.144) than the IRHD-XCP (Mean = 0.615; SD = 0.287) in the objective analysis. Radiographs acquired with the IRHD-WG were more similar than those acquired with the IRHD-XCP (p < 0.001). The diagnostic value of bitewing radiographs acquired with the IRHD-WG was considered superior to those acquired with the IRHD-XCP (p < 0.001).

CONCLUSION

For the objective and subjective analyses of reproducibility, the IRHD-WG performed better than the commercial IRHD-XCP.

The structure and prevalence of superficial carious and non-carious lesions of permanent and deciduous enamel in children who presented for routine dental care in various districts of St. Petersburg

Relevance. To increase the effectiveness of prevention and treatment protocols, it is above all necessary to consider the activity of caries, especially at the early enamel lesion stage, in the form of a white spot, to make the correct diagnosis based on a clinical examination, which assesses the location, change in surface hardness, symmetry, contour shape, depth, color and opacity of the lesion. Different causes of superficial enamel discoloration, in the form of white spots, are paramount for the restorative treatment as the quality of the enamel preparation affects the marginal fit and the durability of the restoration. However, poor oral hygiene, disturbance in eating behavior affect the course of non-carious hard-tissue diseases, which caries may complicate. Purpose – to optimize the diagnosis of initial dental enamel lesions to improve the caries prevention quality.

Materials and methods. The study examined 460 children living in the Central and Krasnoselsky districts of St. Petersburg. The following indices assessed hard tissue condition: OHI-S, Greene and Vermillion; OHI by O'Leary T., Drake R., Naylor; White spot lesions index, Gorelick L, Geiger A. M, Gwinnett A. J., DMFT and df; caries activity.

Results. The total prevalence of superficial (initial) lesions of hard tissues was 37.82%, i.e. 174 people out of 460 examined patients had superficial enamel lesions according to the criteria of I and II categories. The study found enamel changes in the age groups: 5-6 years (130) – 36 people (27.69%); 12 years old (175) – 62 people (35.42%); 15 years old (155) – 76 people (49.03%).

Conclusions. Focusing on the caries activity signs rather than a precise differential diagnosis of the lesion nature is necessary to provide well-timed treatment and prevention upon detecting initial enamel lesion at a dental check-up.

Threshold values affect predictive accuracy of caries risk assessment

OBJECTIVE

To evaluate effects of thresholds on estimates of predictive accuracy of methods for caries risk assessment.

MATERIAL AND METHODS

Adolescents, aged 12 visiting two dental clinics, were examined by visual/tactile examination and bitewing radiography at baseline and after one year. Three methods for caries risk assessment were applied: previous caries experience, dentists' risk assessment according to set criteria (presence or absence of caries lesion) and acid tolerance of dental biofilm. The measure for validity (the reference standard) comprised caries lesion progression at 1 year. Predictive accuracy estimates were calculated for several thresholds.

RESULTS

Accuracy estimates changed with threshold values of the methods and the reference standard. Patient spectrum differed between the clinics, which resulted in different accuracy estimates for the two samples. Generally, negative predictive values were high while positive ones were low indicating that these methods were more efficient in finding individuals who are at low risk of developing caries lesions than those with increased risk.

CONCLUSIONS

As thresholds and patient spectrum affected predictive accuracy, it may be difficult to design a universal model with set thresholds for caries risk assessment. Foremost, a model should consider the level of aspiration for prediction and clinical decisions that will be made based on the risk assessment in the actual clinical setting.

Measurability and reliability of assessments of root length and marginal bone level in cone beam CT and intraoral radiography: a study of adolescents

OBJECTIVES

To evaluate measurability and reliability of measurements of root length and marginal bone level in CBCT, periapical (PA) and bitewing (BW) radiographs.

METHODS

CBCT of both jaws, PA of maxillary incisors and posterior BW radiographs of 10 adolescents (mean age 13.4) were selected. The radiographs comprised part of the baseline examinations of a trial of orthodontic treatment. Six raters assessed measurability and measured root length and marginal bone level. Three raters repeated their assessments. Measurability was expressed as frequency of interpretable sites and reliability as intraclass correlation coefficient (ICC).

RESULTS

Measurability was 100 % in CBCT and 95 % in PA of maxillary incisors for root length measurements. For marginal bone level, measurability was 100 % in CBCT, 76 % in PA and 86 % in posterior BW. Mean ICC for interrater reliability for root length measurements in CBCT was 0.88 (range 0.27-0.96 among different teeth) and 0.69 in PA of maxillary incisors. For marginal bone level measurements, mean ICC was 0.4 in CBCT, 0.38 in PA of maxillary incisors and 0.4 in posterior BW. Intrarater reliability varied among methods, root length or marginal bone level and among raters, except for root length measurements in CBCT, which presented high reliability (above 0.8) for all raters.

CONCLUSIONS

As measurability and reliability were high for root length measurements in CBCT, this may be the method of choice for scientific analyses in orthodontics. For clinical praxis, we recommend PA following the "as low as diagnostically acceptable" principle, as clinical decisions seem to be influenced only when severe root resorption occurs.

A comparison of diagnosis of early stage interproximal caries with bitewing radiographs and periapical images using consensus reference

OBJECTIVES:

The purpose of this study was to assess the diagnostic property of intraoral bitewing radiographs (BTW) for early stage interproximal caries, and to compare them with periapical radiographs (PA) at different levels of caries progression.

METHODS:

A total of 241 interproximal surfaces of BTW and corresponding PAs were used. Seven teaching faculty consisting of three oral and maxillofacial radiologists, two operative faculty, and two prosthodontists evaluated the images. The observers graded images as either "intact", "enamel caries <1/2 width", "enamel caries >1/2 width", or "caries into dentin". The gold-standard was established by consensus of two experienced faculty with 35 years and 27 years of experience. Specificity, sensitivity, positive-predictive value, and negative-predictive value were calculated for the different level of caries progression. Furthermore, receiver operating curves) of BTW and PAs of each evaluator were made and the area under the curve of BTW and PAs were compared.

RESULTS:

There was no significant difference in the specificity of BTW and PAs. BTW showed significantly higher sensitivity than PAs in all levels of caries progression (p<0.01). Positive-predictive value and negative-predictive value of BTWs were also significantly higher than PAs. One-way ANOVA and Tukey HSD test showed a significant difference in sensitivity with different levels of caries progression. The average area under the curve was significantly higher for BTWs than PAs (p<0.01).

CONCLUSIONS:

BTWs offer a significant advantage over PAs in the diagnoses of early stages of interproximal carious lesions.

Inter- and intraexaminer reliability of bitewing radiography and near-infrared light transillumination for proximal caries detection and assessment

OBJECTIVES

The purpose of this in vitro study was to evaluate the inter- and intraexaminer reliability of digital bitewing (DBW) radiography and near-infrared light transillumination (NIRT) for proximal caries detection and assessment in posterior teeth.

METHODS

From a pool of 85 patients, 100 corresponding pairs of DBW and NIRT images (~1/3 healthy, ~1/3 with enamel caries and ~1/3 with dentin caries) were chosen. 12 dentists with different professional status and clinical experience repeated the evaluation in two blinded cycles. Two experienced dentists provided a reference diagnosis after analysing all images independently. Statistical analysis included the calculation of simple (κ) and weighted Kappa (wκ) values as a measure of reliability. Logistic regression with a backward elimination model was used to investigate the influence of the diagnostic method, evaluation cycle, type of tooth, and clinical experience on reliability.

RESULTS

Altogether, inter- and intraexaminer reliability exhibited good to excellent κ and wκ values for DBW radiography (Inter: κ = 0.60/ 0.63; wκ = 0.74/0.76; Intra: κ = 0.64; wκ = 0.77) and NIRT (Inter: κ = 0.74/0.64; wκ = 0.86/0.82; Intra: κ = 0.68; wκ = 0.84). The backward elimination model revealed NIRT to be significantly more reliable than DBW radiography.

CONCLUSIONS

This study revealed a good to excellent inter- and intraexaminer reliability for proximal caries detection using DBW and NIRT images. The logistic regression analysis revealed significantly better reliability for NIRT. Additionally, the first evaluation cycle was more reliable according to the reference diagnoses.