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Title CBCT Appears To Be More Accurate than Intraoral Radiographs in Detecting Artificially Created Recurrent Caries
Clinical Question How accurately can recurrent caries in teeth with amalgam be detected using CBCT as compared to intraoral radiograph?
Clinical Bottom Line CBCT appears to be more accurate than intraoral radiographs in detecting artificially created recurrent caries. This is based on in vitro studies that showed that CBCT assisted in diagnosing recurrent dental caries amongst the observers. However, more in vivo studies with natural recurrent caries should be conducted to overcome the limitations of artificially created recurrent caries and observers’ bias. In addition, when using CBCT scans, limitations such as the increased radiation dose to the patient and artifacts from metal and beam hardening should be considered.
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) 22232722Charuakkra/2011120 extracted teeth, restored with amalgam and compositeIn Vitro Study
Key resultsAmong the intra-observers, kappa values ranged from 0.659 – 0.848 for bitewings, and it was equal to 1.000 for both CBCT units; for inter-observers, kappa coefficients ranged from 0.400-0.780 for bitewings, and it was also equal to 1.000 for both CBCT systems; sensitivity was approximately 0.800 and 1.000 for bitewings and both CBCT, respectively; the mean Az values for bitewings and both CBCT systems were 0.882, 0.995, and 0.978, respectively. Significant differences were found between film and the two CBCT systems (P = 0.007).
#2) 22917443Murat/2013120 extracted teeth, restored with composite, amalgam, thermoplastic polymer, or Ni-Cr crownsEx Vivo Study
Key resultsAmong the inter-observers, Kappa coefficients ranged from 0.337-0.522 for intraoral film and 0.458-0.617 for CBCT; sensitivity ranged from 0.206-0.912; specificity ranged from 0.209-0.953; PPV ranged from 0.458-0.807; NPV ranged from 0.388-0.886; and FPR ranged from 0.047-0.791. The Az values of both readings of all three observers were highest for the Veraviewepocs 3D followed by Kodak 9000, except for the second reading of the third observer. No significant differences were found between the Az values (p > 0.05) of the intraoral film and digital systems. Also, there was no significant difference (p > 0.05) between the two CBCT systems. However, there were significant differences among the Az values (p < 0.05) of the intraoral films and one of the CBCT systems (Veraviewepocs), as well as between the digital system and Veraviewepocs CBCT. Kodak 9000 CBCT system was not significantly different from intraoral film or digital systems, except for the second reading of the second observer. Overall, CBCT outperformed intraoral radiography in detecting artificial buccal recurrent caries under restorations.
Evidence Search recurrent[All Fields] AND "dental caries"[MeSH Terms] OR proximal[All Fields] AND ("dental caries"[MeSH Terms] OR ("dental"[All Fields] AND "caries"[All Fields]) OR "dental caries"[All Fields] OR "caries"[All Fields]) AND amalgam[All Fields] AND CBCT[All Fields]
Comments on
The Evidence
Validity and perspective: In Charuakkra, the 'gold standard' to which the results of bitewing and CBCT interpretation were compared was the preparation of artificial caries at 2mm coronal to the CEJ on mesial and distal surfaces of the teeth. Carious lesions were simulated using a bur. Images were interpreted by five experienced dentists who were trained on using the CBCT software viewers. Teeth were arranged in an anatomical arch shape in a plastic block and mounted in plaster. Radiographic techniques utilized film-based bitewings and 2 CBCT units, Pax-500 ECT and ProMax 3D. One limitation of this study was the use of artificially created caries as opposed to natural caries, as the artificially created caries provided a higher contrast than that of natural caries, obscuring the interpretation of “true” caries. Another limitation was the instructions given to the observers to evaluate caries with specific shape, size, and location, which may have influenced them and led to biased interpretations resulting in very high Az values for both CBCT units; this may also have removed the confounding factor of artifacts from amalgam restorations. In Murat, the 'gold standard' was the researcher’s knowledge of the tooth status. Lesions were simulated using a bur. Images were interpreted by three calibrated and experienced observers; sensitivity, specificity, and ROC analyses were used to compare the results. Teeth with artificial buccal caries were placed in alveolar sockets of a dry human mandible. Radiographic technology used included intraoral film, intraoral digital, Veraviewepocs 3D, and Kodak 9000. Limitations to the study comprise the use of only two CBCT systems and the use of buccal lesions only.
Applicability According to Charuakkra, no studies prior 2011 have been conducted to evaluate the accuracy between intraoral radiographs and CBCT in detecting recurrent caries. On the other hand, even though both studies, Charuakkra and Murat, showed that CBCT images outperformed intraoral radiographs in detecting recurrent caries, it is important to consider the significant limitations in study methodologies, as described above.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Restorative Dentistry)
Keywords Dental Caries; Cone Beam CT; Radiography, Bitewing; Diagnosis
ID# 3112
Date of submission: 11/21/2016spacer
E-mail KordabN@uthscsa.edu
Author Nada Kordab, DDS
Co-author(s) e-mail
Faculty mentor/Co-author Rujuta Katkar, MS, BDS
Faculty mentor/Co-author e-mail KatkarR@uthscsa.edu
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