ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title In a Laboratory Study Using Extracted Teeth, Cone Beam CT (CBCT) Is As Effective As Bite Wings In Detection Of Proximal Decay
Clinical Question Is cone beam CT superior to bite wing radiographs for the detection of proximal decay?
Clinical Bottom Line Based on an in vitro study using extracted teeth, CBCT is an equally effective diagnostic technique as traditional 2D bite wings. Both methods were compared against a histologic report used as the gold standard. (See Comments on the CAT below)
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) 21062944Senel/2010138 human teethIn vitro Clinical Study
Key resultsDifferences between detection methods were not statistically significant (p>0.05). Highest values for (ROC) curves were for CBCT suggesting that it is the best imaging modality, but statistically no real difference between bite wings and CBCT.
#2) 29934291Kayipmaz/201172 extracted teethLab Study: ex vivo
Key resultsNo difference between CBCT and conventional or phosphor plate radiography in the detection of approximal caries using extracted teeth in this laboratory study. CBCT was shown to be superior for the detection of occlusal caries.
Evidence Search “cone beam” AND “decay”
Comments on
The Evidence
This study used receiver operating characteristic (ROC) curves to determine confidence and diagnosis. There is no difference between bite wings and CBCT in detection of proximal decay. Both scored equally and showed results consistently. An in vivo study is needed. The study does, however, try to mimic human conditions as much as possible.
Applicability These studies applies to laboratory studies of CBCT for the diagnosis of proximal caries using extracted teeth and apply to laboratory research of the imaging capability of CBCT. Clinical application of these results would be hampered by the presence of metallic restorations that would cause artifacts across the crowns of teeth. The higher x ray exposure using CBCT for caries detection would be prohibitive compared with that of conventional or phosphor plate imaging. CBCT should be considered an auxiliary method for caries detection when CBCT is indicated for other purposes.
Specialty/Discipline (Oral Medicine/Pathology/Radiology)
Keywords cone beam CT, CBCT, x-ray, radiograph, caries
ID# 2090
Date of submission: 09/15/2011spacer
E-mail hashem@uthscsa.edu
Author Mohannad Hashem
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Marcel Noujeim, DDS, MS
Faculty mentor/Co-author e-mail Noujeim@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by John Ludlow (Chapel Hill, NC) on 10/26/2011
To Dr. White’s comment I would only add that the populations at greatest risk of caries are also the groups that are either at greatest risk from ionizing radiation (kids) or show-stopping artifact (adults with multiple existing restorations). For me this totally changes the bottom line. CBCT is not currently or ever likely to be more cost and risk effective than conventional bite wings.
by Stuart C. White (Los Angeles, CA) on 10/25/2011
It should be noted that CBCT is useful for caries detection only when there are no metallic restorations in the occlusal plane as they cause extensive artifacts. Further, the effective dose of a CBCT examination is typically much greater than for bite wings thus, the CBCT should only be used for this purpose when it is being made for reasons other than to look for interproximal caries.
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