Ex vivo evaluation of new 2D and 3D dental radiographic technology for detecting caries.
OBJECTIVES
Proximal dental caries remains a prevalent disease with only modest detection rates by current diagnostic systems. Many new systems are available without controlled validation of diagnostic efficacy. The objective of this study was to evaluate the diagnostic efficacy of three potentially promising new imaging systems.


METHODS
This study evaluated the caries detection efficacy of Schick 33 (Sirona Dental, Salzburg, Austria) intraoral digital detector images employing an advanced sharpening filter, Planmeca ProMax(®) (Planmeca Inc., Helsinki, Finland) extraoral "panoramic bitewing" images and Sirona Orthophos XG3D (Sirona Dental) CBCT images with advanced artefact reduction. Conventional photostimulable phosphor images served as the control modality. An ex vivo study design using extracted human teeth, ten expert observers and micro-CT ground truth was employed.


RESULTS
Receiver operating characteristic analysis indicated similar diagnostic efficacy of all systems (ANOVA p > 0.05). The sensitivity of the Schick 33 images (0.48) was significantly lower than the other modalities (0.53-0.62). The specificity of the Planmeca images (0.86) was significantly lower than Schick 33 (0.96) and XG3D (0.97). The XG3D showed significantly better cavitation detection sensitivity (0.62) than the other modalities (0.48-0.57).


CONCLUSIONS
The Schick 33 images demonstrated reduced caries sensitivity, whereas the Planmeca panoramic bitewing images demonstrated reduced specificity. XG3D with artefact reduction demonstrated elevated sensitivity and specificity for caries detection, improved depth accuracy and substantially improved cavitation detection. Care must be taken to recognize potential false-positive caries lesions with Planmeca panoramic bitewing images. Use of CBCT for caries detection must be carefully balanced with the presence of metal artefacts, time commitment, financial cost and radiation dose.
['Gaalaas|Laurence|L|', 'Tyndall|Donald|D|', 'Mol|André|A|', 'Everett|Eric T|ET|', 'Bangdiwala|Ananta|A|']
D016477:Artifacts D054893:Cone-Beam Computed Tomography D003731:Dental Caries D006801:Humans D021621:Imaging, Three-Dimensional D008422:Materials Testing D012372:ROC Curve D016300:Radiography, Bitewing D011861:Radiography, Dental D019252:Radiography, Dental, Digital D011862:Radiography, Panoramic D012680:Sensitivity and Specificity D013674:Technology, Dental D013679:Technology, Radiologic D014963:X-Ray Intensifying Screens D055114:X-Ray Microtomography
dental caries MicroCT bitewing radiography cone-beam CT radiography, dental