ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Cavitation of Proximal Caries Lesions Can Be Determined More Accurately on Bitewing Radiographs When the Radiolucent Depth Is > 0.5 mm From the DEJ
Clinical Question How accurately can proximal caries lesion cavitation be predicted from the depth of the radiolucency in bitewing radiograph?
Clinical Bottom Line Cavitation of proximal caries lesions can be determined accurately on bitewing radiographs; the probability of cavitation increases when lesions are 0.5 mm or deeper from the DEJ on the radiograph. However, CBCT has been shown to be more sensitive in detecting proximal cavitation than bitewing radiographs.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 11125189Ratledge/200132 adult patients with 54 proximal lesionsClinical trial
Key resultsThere was a significant correlation between the depth of the lesion as shown on the radiograph and the presence of a cavity recorded on an elastomeric impression. 64% of lesions measuring < 0.5 mm from the DEJ were cavitated (n=14); 93% of lesions > 0.5 mm from the DEJ were cavitated (n=40). There was a significantly greater probability of cavitation (p<0.01) for lesions > 0.5 mm from the DEJ on the bitewing radiograph.
#2) 22842638Wenzel/2013257 non-filled proximal surfaces in permanent premolars and molars Laboratory
Key resultsThis study compared the accuracy of two methods of taking digital bitewing radiographs to cone beam computed tomography (CBCT) in detecting surface cavitation. CBCT was significantly more accurate in detecting surface cavitation (p<0.001) than either bitewing radiographic method.
Evidence Search (“Dental Caries/radiography”[Mesh])OR (“Radiography, Dental, Digital/instrumentation”[Mesh])
Comments on
The Evidence
Validity: In Ratledge’s study, the technique used to establish the true presence of cavitation, tooth separation followed by an elastomeric impression, is very technique-sensitive and could lead to errors. In the Wenzel study, six observers recorded the true absence/presence of proximal cavitation. No competing interests were mentioned in either study. Perspective: Ratledge’s article did not mention whether or not the elastomeric impression technique, which he used as the “gold standard” diagnosis of cavitation, had been validated.
Applicability Ratledge demonstrated that cavitation of the proximal surface can be confirmed if the proximal lesion appears to be >0.5mm in depth from the DEJ on a bitewing radiograph. Therefore, the chances of a radiograph being accurate will increase if the lesions appear to be greater in depth than 0.5mm. Wenzel indicated that cavitation can accurately be confirmed in all lesions using a CBCT image. However, clinicians are likely to continue to rely on bitewing radiograph for caries detection due to their lower cost and lower radiation exposure for the patient.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Restorative Dentistry)
Keywords Dental caries, detection
ID# 2882
Date of submission: 04/08/2015spacer
E-mail keshwani@livemail.uthscsa.edu
Author Nikhaar Keshwani
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Bennett T. Amaechi, BDS, PhD
Faculty mentor/Co-author e-mail amaechi@uthscsa.edu
Basic Science Rationale
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