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

Accuracy of detection methods for secondary caries around direct restorations: A systematic review and meta-analysis

OBJECTIVE

To evaluate and compare the accuracy of detection methods for the diagnosis of secondary caries around direct restorations in posterior teeth.

DATA

Accuracy parameters including sensitivity, specificity, diagnostic odds ratio (DOR), area under curve (AUC), and partial AUC (pAUC) are generated from studies assessing the accuracy of detection methods for secondary caries.

SOURCES

Publications from PubMed, Web of Science, Scopus, Medline, EMBASE and Cochrane Library databases.

STUDY SELECTION/RESULTS

This review included 25 studies evaluating visual examination (V(laboratory); n = 9 & V(clinical); n = 2), tactile examination (T; n = 3), intra-oral radiography (IR; n = 14), cone-beam computed tomography (CBCT; n = 4), quantitative light-induced fluorescence (QLF; n = 4), laser fluorescence (LF; n = 8) and digital imaging fiber-optic transillumination (DIFOTI; n = 1). The pooled sensitivity [95 % Confidence Interval, CI] and specificity [95 % CI] of detection methods for secondary caries were 0.60[0.45-0.73] and 0.67[0.53-0.78] for V(laboratory); 0.82[0.23-0.99] and 0.77[0.15-0.98] for V(clinical); 0.31[0.25-0.39] and 0.95[0.78-0.99] for T; 0.59[0.52-0.66] and 0.82[0.75-0.88] for IR; 0.61[0.48-0.73] and 0.82[0.64-0.92] for CBCT; 0.71[0.64-0.78] and 0.51[0.40-0.62] for QLF; 0.57[0.43-0.71] and 0.81[0.76-0.85] for LF; and 0.63[0.47-0.76] and 0.95[0.90-0.98] for DIFOTI. DOR values [95 % CI] of the secondary caries detection methods were V(laboratory)-2.88[2.18-3.80]; V(clinical)-16.66[3.84-72.28]; T-6.36[1.12-36.28]; IR-6.55[3.44-12.46]; CBCT-6.18[1.42-26.91]; QLF-2.25[1.39-3.63]; LF-4.86[2.40-9.82]; and DIFOTI-30.00[11.94-75.36], respectively. Respective AUC (pAUC) were V-0.645(0.535); T-0.379(0.315); IR-0.767(0.693); CBCT-0.887(0.820); QLF-0.581(0.633) and LF-0.828(0.590). AUC values were not available for DIFOTI and V(clinical).

CONCLUSIONS

Among the seven types of detection method for secondary caries diagnosis, none of the detection methods demonstrate satisfactory accuracy in detecting secondary caries around direct restorations in posterior teeth.

CLINICAL SIGNIFICANCE

This systematic review provides insights for the clinician and researcher in selecting the clinical detection method for secondary caries diagnosis and facilitates clinical decision making.

Incidental findings from cone-beam computed tomography in children and adolescents: a systematic review

PURPOSE

The use of cone-beam computed tomographies (CBCT) in orthodontics and pediatric dentistry is constantly increasing. The aim of this systematic review was to critically appraise and summarize evidence from clinical studies on the prevalence of incidental findings from CBCTs of children and adolescents.

METHODS

Systematic literature searches without restrictions were undertaken in eight databases from inception up to March 2024 for studies reporting on incidental findings from CBCT images of children and adolescents. After duplicate study selection, data extraction, and risk of bias assessment with a custom tool based on the Joanna Briggs institute's tool for prevalence studies, qualitative (narrative) data synthesis was performed.

RESULTS

Ten studies covering a total of 1818 patients (48.5% male; average age 12.3 years) were included. The prevalence of incidental findings ranged from 0.4 to 80.3%, but high heterogeneity was seen between studies (I2 = 99%). Incidental findings were most often related to airways (63.7%), followed by bone (23.6%), teeth (19.2), spine (26.2) and temporomandibular joint (3.8%). However, several methodological issues existed with included studies (incomplete reporting of patient- or CBCT-related details, incomplete categorization and reporting on the severity of findings, small sample sizes, and research transparency issues).

CONCLUSION

Evidence indicates that incidental findings can be often found in the CBCTs of child and adolescent patients. However, when a CBCT image is justified for children or adolescents, it should be adequately assessed for incidental findings by either a specialist oral and maxillofacial radiologist or a dentist with appropriate training and experience.

In vitro accuracy of ultra-low dose cone-beam CT for detection of proximal caries

OBJECTIVES

This study aimed to assess the accuracy of ultra-low dose (ULD) cone-beam CT (CBCT) for detection of proximal caries.

METHODS

This in vitro study evaluated 104 molar and premolar teeth. The teeth were mounted in dry skulls and underwent CBCT with 4 protocols of high-resolution (HR), normal (NORM), ULD-HR, and ULD-NORM; 78 CBCT images were scored by 3 observers for the presence and penetration depth of caries twice with a 2-week interval using a 5-point Likert scale. The teeth were then sectioned and observed under a stereomicroscope (gold standard). The 4 protocols were compared with each other and with the gold standard. The receiver operating characteristic curve was drawn, and the area under the curve (AUC) was calculated and compared by the Chi-square test (alpha = .05).

RESULTS

The interobserver agreement ranged from 0.5233 to 0.6034 for ULD-NORM, 0.5380 to 0.6279 for NORM, 0.5856 to 0.6300 for ULD-HR, and 0.6614 to 0.7707 for HR images. The intra-observer agreement ranged from 0.6027 to 0.8812 for ULD-HR, 0.7083 to 0.7556 for HR, 0.6076 to 0.9452 for ULD-NORM, and 0.7012 to 0.9221 for NORM images. Comparison of AUC revealed no significant difference between NORM and ULD-NORM (P > .05), or HR and ULD-HR (P > .05). The highest AUC belonged to HR (0.8529) and the lowest to NORM (0.7774).

CONCLUSIONS

Considering the significant reduction in radiation dose in ULD CBCT and its acceptable diagnostic accuracy for detection of proximal caries, this protocol may be used for detection of proximal carious lesions and assessment of their depth.

Comparison of near-infrared imaging with cone-beam computed tomography for proximal caries detection in permanent dentition: An in vivo study

OBJECTIVES

This study aimed to evaluate the diagnostic performance of near-infrared imaging (NIRI) and unaided visual examination (UVE) in detecting proximal caries in permanent dentition in comparison with cone-beam computed tomography (CBCT).

METHODS

Patients who underwent NIRI, UVE, and CBCT imaging within 1 week were enrolled. Using CBCT as the reference test, the positive percent agreement (PPA), negative percent agreement (NPA), and overall percent agreement (OPA) of NIRI, UVE, and a combination of the two for detecting proximal caries at different depths and in different tooth locations were assessed. Additionally, the consistency of these diagnostic methods with CBCT was evaluated.

RESULTS

We evaluated 6,084 proximal surfaces and identified 177 CBCT-positive sites. NIRI had a PPA, NPA, and OPA of 68.93 %, 99.09 %, and 98.21 %, respectively, with a substantial agreement with CBCT. When combined with UVE, the PPA increased by approximately 50 % compared with that of UVE alone. Regarding caries at different depths, NIRI outperformed UVE in detecting initial caries (ICDAS 1-2) over moderate-to-advanced caries (ICDAS 3-6). However, the combined use of NIRI and UVE improved the detection of moderate-to-advanced caries. In the anterior teeth region, NIRI exhibited excellent agreement with CBCT, surpassing its performance in the posterior region.

CONCLUSIONS

Although NIRI cannot fully replace radiographic methods, the substantial agreement of NIRI with CBCT in detecting proximal caries highlights its potential as a complementary tool in routine caries screening, especially when combined with UVE.

CLINICAL SIGNIFICANCE

This study highlights the potential of NIRI as a radiation-free method for detecting proximal caries in permanent teeth. Early detection through regular NIRI scanning can lead to timely intervention, improved patient outcomes, and reduced overall disease burden.

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.

Technical Performance Assessment and Quality Control of Ultrasound Device Monitors

The purpose of this study was to investigate and evaluate the current technical performance of ultrasound imaging device displays. Altogether 53 ultrasound device displays were evaluated in two hospital districts of Finland. The performance of the displays was evaluated with tests and test patterns developed by American Association of Physicists in Medicine (AAPM). Minimum, maximum and ambient luminances (L_min,L_max,L_amb) were measured. Ambient ratio (AR), luminance ratio (LR), [Formula: see text] and [Formula: see text] were calculated, and luminance uniformity, defined as deviation from the median (MLD), was evaluated. The results indicate that none of the measured displays fulfill the AAPM Task Group (TG) 270 maximum luminance recommendation for diagnostic displays. A majority (32/53, 60%) of the displays fail the AAPM TG270 acceptable level for secondary displays as well. Only 3 of 53 (6%) displays were at the acceptable level for diagnostic displays. Also, for most of the displays (41/53, 77%), [Formula: see text] was under the diagnostic acceptable level. Ambient ratios exceeded the acceptable limit in 31 of 53 (58%) displays. Luminance ratios, on the other hand, were within acceptable levels for the majority of displays (38/53, 72%). All devices passed the AAPM requirement for luminance uniformity (MLD). The results indicate that the maximum luminance and minimum luminance of most displays are not sufficient. AAPM, the Society for Imaging Informatics in Medicine and the American College of Radiology introduced the updated luminance [Formula: see text] and [Formula: see text] criteria in 2012. All ultrasound displays should at least fulfill the AAPM TG18 secondary display minimum criteria. Even so, 6 of 53 (11%) fail. The newest displays should be expected to fulfill the revised AAPM TG270 criteria as well. Display technology has developed, and therefore, monitor testing needs to be updated.

Current Strategies to Control Recurrent and Residual Caries with Resin Composite Restorations: Operator- and Material-Related Factors

This review addresses the rationale of recurrent and/or residual caries associated with resin composite restorations alongside current strategies and evidence-based recommendations to arrest residual caries and restrain recurrent caries. The PubMed and MEDLINE databases were searched for composite-associated recurrent/residual caries focusing on predisposing factors related to materials and operator’s skills; patient-related factors were out of scope. Recurrent caries and fractures are the main reasons for the failure of resin composites. Recurrent and residual caries are evaluated differently with no exact distinguishment, especially for wall lesions. Recurrent caries correlates to patient factors, the operator’s skills of cavity preparation, and material selection and insertion. Material-related factors are significant. Strong evidence validates the minimally invasive management of deep caries, with concerns regarding residual infected dentin. Promising technologies promote resin composites with antibacterial and remineralizing potentials. Insertion techniques influence adaptation, marginal seal, and proximal contact tightness. A reliable diagnostic method for recurrent or residual caries is urgently required. Ongoing endeavors cannot eliminate recurrent caries or precisely validate residual caries. The operator’s responsibility to precisely diagnose original caries and remaining tooth structure, consider oral environmental conditions, accurately prepare cavities, and select and apply restorative materials are integral aspects. Recurrent caries around composites requires a triad of attention where the operator’s skills are cornerstones.

The impact of different dental restorations on detection of proximal caries by cone beam computed tomography

OBJECTIVES

To evaluate the effects of different types of restorations on observer ability to detect proximal caries in CBCT images.

MATERIALS AND METHODS

Forty human premolars and molars with artificial proximal caries were placed proximal and distal to 5 molars having different restorations (amalgam, composite, resin-modified glass ionomer cement (RMGIC) fillings, zirconia, and lithium disilicate crowns) and a non-restored molar. CBCT scans were obtained using i-CAT^® Next Generation. Images were rated twice by 2 observers. The exact depth of artificial caries was histologically established. Sensitivity, specificity, and area under the receiver operating characteristic curve (Az) values were calculated.

RESULTS

Caries detection in teeth surfaces mesial and distal to amalgam showed compromised specificity and accuracy. Moreover, caries detection in teeth surfaces mesial to zirconia crown showed low sensitivity, specificity, and accuracy. Capability of CBCT in detection of proximal caries in teeth adjacent to composite, RMGIC, and lithium disilicate was comparable to those adjacent to non-restored molar.

CONCLUSIONS

CBCT scans performed for tasks other than caries detection should be assessed for proximal caries in absence of any restorations as well as in presence of composite, RMGIC fillings, and lithium disilicate crowns. However, CBCT should not be used for proximal caries detection in teeth adjacent to amalgam and teeth surfaces mesial to zirconia crowns.

CLINICAL SIGNIFICANCE

It is important to investigate the influence of artifacts produced by various restorations on CBCT-based caries detection to optimize CBCT benefits, caries diagnosis and avoid unnecessary treatment of sound surfaces.

In vitro comparison of high-definition US, CBCT and periapical radiography in the diagnosis of proximal and recurrent caries

OBJECTIVE

To assess the in vitro performance of high-definition (HD) US, CBCT and periapical radiography for the visibility of proximal and recurrent caries in teeth with and without restoration.

METHODS

A total of 240 molar teeth were divided into eight groups each comprised of 30 teeth. Control groups consisted of teeth without caries (Group 1-4; N = 120), whereas diseased groups consisted of teeth with proximal caries (Group 5-8; N = 120 teeth). Finally, a total of four image sets were obtained as follows: i) PSP periapical radiography, ii) CBCT 0.075 mm voxel size, iii) CBCT 0.2 mm voxel size and iv) HD US images. The image sets were viewed separately by four observers by using a 5-point confidence scale. Intraclass correlation coefficients were calculated. The areas under the ROC curves were compared using chi-square tests. Significance level was set at α = 0.05.

RESULTS

Intraobserver agreement for both readings for the four observers ranged between 0.848 and 0.988 for CBCT (0.075 mm) images; 0.658 and 0.952 for CBCT (0.2 mm) images; 0.555 and 0.810 for periapical images; 0.427 and 0.676 for US images. Highest AUC values were found for CBCT (0.075 mm) images and lowest for US images. Statistically significant differences were found among CBCT (0.075 mm) images and US images (p < 0.001), CBCT (0.2 mm) images and US images (p < 0.001) and periapical images and US images (p < 0.001) for the detection of proximal caries.

CONCLUSION

Periapical and CBCT images outperformed HD US imaging in the detection of proximal dental caries.

Guidelines for oral and maxillofacial imaging: COVID-19 considerations

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing the current coronavirus disease 2019 (COVID-19) pandemic, is not only highly infectious but can induce serious outcomes in vulnerable individuals including dental patients and dental health care personnel (DHCPs). Responses to COVID-19 have been published by the Centers for Disease Control and Prevention and the American Dental Association, but a more specific response is required for the safe practice of oral and maxillofacial radiology. We aim to review the current knowledge of how the disease threatens patients and DHCPs and how to determine which patients are likely to be SARS-CoV-2 infected; consider how the use of personal protective equipment and infection control measures based on current best practices and science can reduce the risk of disease transmission during radiologic procedures; and examine how intraoral radiography, with its potentially greater risk of spreading the disease, might be replaced by extraoral radiographic techniques for certain diagnostic tasks. This is complemented by a flowchart that can be displayed in all dental offices.

The influence of image display systems on observers' preference for visualizing subtle dental radiographic abnormalities

OBJECTIVE

The objectives of this study were to assess observers' preference for standard screens (SSs) or medical displays (MDs) in visualizing difficult-to-diagnose radiographic dental abnormalities and their preference for dental filter tools when utilized with MD systems.

STUDY DESIGN

A retrospective data set of 60 in vivo radiographs consisting of intraoral (n = 20), panoramic (n = 20), and cone beam computed tomography (n = 20) images was created. Three image display monitors, including an SS, an MD, and an MD with 3 dental filter configurations (bone-low density enhancement filter, tooth-high density enhancement filter, and a combined filter representing regular MD), were utilized to assess 4 observers' monitor preferences in detecting radiographically subtle dental abnormalities. The data were analyzed by using binomial distribution. A P value ≤.05 was considered statistically significant.

RESULTS

Although observers expressed preference for MD for visualizing some abnormalities when examining intraoral and panoramic radiographs, MD was not preferred for detection of any abnormalities with cone beam computed tomography. There were no significant differences in preference for SS or MD overall (P ≥ .2024). Observers expressed significant preference for the filters in visualizing all but 2 abnormalities (P ≤ .0252).

CONCLUSIONS

The use of MD monitors enabled with dental filter tools may be preferred for visualizing certain subtle abnormalities.

Comparison of the different voxel sizes in the estimation of peri-implant fenestration defects using cone beam computed tomography: an ex vivo study

Background

To examine the influence of voxel sizes to detect of peri-implant fenestration defects on cone beam computed tomography (CBCT) images.

Materials and methods

This study performed with three sheep heads both maxilla and mandible and two types of dental implant type 1 zirconium implant (Zr⁴⁰) (n = 6) and type 2 titanium implant (Ti²²) (n = 10). A total of 14 peri-implant fenestrations (8 buccal surfaces, 6 palatal/lingual surface) were created while 18 surfaces (8 buccal, 10 palatal/lingual) were free of fenestrations. Three observers have evaluated the images of fenestration at each site. Images obtained with 0.75 mm³, 0.100 mm³, 0.150 mm³, 0.200 mm³, and 0.400 mm³ voxel sizes. For intra- and inter-observer agreements for each voxel size, Kappa coefficients were calculated.

Results

Intra- and inter-observer kappa values were the highest for 0.150 mm³, and the lowest in 0.75 mm³ and 0.400 mm³ voxel sizes for all types of implants. The highest area under the curve (AUC) values were found higher for the scan mode of 0.150 mm³, whereas lower AUC values were found for the voxel size for 0.400 mm³. Titanium implants had higher AUC values than zirconium with the statistical significance for all voxel sizes (p ≤ 0.05).

Conclusion

A voxel size of 0.150 mm³ can be used to detect peri-implant fenestration bone defects. CBCT is the most reliable diagnostic tool for peri-implant fenestration bone defects.

Evaluation of a metal artifact reduction algorithm and an optimization filter in the estimation of peri-implant dehiscence defects by using cone beam computed tomography: an in-vitro study

OBJECTIVES

The aim of this study was to assess the effect of a metal artifact reduction (MAR) algorithm and the adaptive image noise optimizer (AINO) optimization filter in the detection of peri-implant dehiscences with cone beam computed tomography (CBCT).

STUDY DESIGN

Nine implants (3 zirconium, 3 titanium, and 3 zirconium-titanium) were placed in 3 sheep heads. Dehiscences were created on the buccal and lingual/palatal surfaces. A total of 9 defects and 9 controls with no defects were evaluated by 3 observers. Each sheep head was scanned 5 times with 4 scan modes; (1) without MAR/without AINO; (2) with MAR/without AINO; (3) without MAR/with AINO; and (4) with MAR/with AINO. Receiver operating characteristic analysis and weighted kappa coefficients were used to calculate diagnostic efficacy and intra- and interobserver agreements for each implant type and scan mode.

RESULTS

For all implant types, dehiscences were most accurately detected when both MAR and AINO were applied (P ≤ .045). Detection of dehiscences was more accurate with titanium implants (P ≤ .040). There were no significant differences in agreement among and between the observers.

CONCLUSIONS

The use of both MAR and AINO enhanced the detection accuracy of artificially created dehiscences in proximity to implants. Their combined use is recommended for detecting peri-implant dehiscences.

An ex vivo comparative study of occlusal and proximal caries using terahertz and X-ray imaging

OBJECTIVES:

To examine the effectiveness of terahertz (THz) pulsed imaging (TPI) in comparison to intraoral photostimulable phosphor late (PSP) and cone beam CT (CBCT) for the detection of dental caries ex vivo.

METHODS:

Newly extracted 32 human permanent teeth surfaces (16 with caries and 16 without caries) were serially sectioned mesiodistally and imaged by using four image sets as follows: (1) CBCT; (2) PSP; (3) THz movie video; and (4) THz static images. All images were evaluated twice separately by two calibrated observers for the presence/absence of caries using a 5-grade rating/confidence scale. Weighted κ coefficients were calculated. Different image sets were compared with the histological gold-standard using the receiver operating characteristic and area under curves for each image set were compared using χ² tests, with a significance level of α = 0.05.

RESULTS:

Intra- and interobserverκ-values for all image sets were almost excellent ranging between 0.777 and 0.988. Mean Az values of observers and readings were 0.898 for CBCT, 0.888 for PSP images, 0.853 for THz static images and 0.781 for THz video movie. No statistically significant differences (p > 0.05) were found between Az values for the different image sets. When observer scores were evaluated according to caries location again no statistically significant differences (p > 0.05) were found between Az values for the occlusal and proximal caries for the four image sets.

CONCLUSIONS:

Terahertz pulsed imaging was found to be successful for the detection of dental caries ex vivo.

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.

Effects of various cone-beam computed tomography settings on the detection of recurrent caries under restorations in extracted primary teeth

Purpose

The aim of this study was to assess the ex vivo diagnostic ability of 9 different cone-beam computed tomography (CBCT) settings in the detection of recurrent caries under amalgam restorations in primary teeth.

Materials and Methods

Fifty-two primary teeth were used. Twenty-six teeth had dentine caries and 26 teeth did not have dentine caries. Black class II cavities were prepared and restored with amalgam. In the 26 carious teeth, recurrent caries were left under restorations. The other 26 intact teeth that did not have caries served as controls. Teeth were imaged using a 100×90-mm field of view and a 0.2-mm voxel size with 9 different CBCT settings. Four observers assessed the images using a 5-point scale. Kappa values were calculated to assess observer agreement. CBCT settings were compared with the gold standard using a receiver operating characteristic analysis. The area under the curve (AUC) values for each setting were compared using the chi-square test, with a significance level of α=.05.

Results

Intraobserver kappa values ranged from 0.366 to 0.664 for observer 1, from 0.311 to 0.447 for observer 2, from 0.597 to 1.000 for observer 3, and from 0.869 to 1 for observer 4. Furthermore, interobserver kappa values among the observers ranged from 0.133 to 0.814 for the first reading and from 0.197 to 0.805 for the second reading. The highest AUC values were found for setting 5 (0.5916) and setting 3 (0.5886), and were not found to be statistically significant (P>.05).

Conclusion

Variations in tube voltage and tube current did not affect the detection of recurrent caries under amalgam restorations in primary teeth.