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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) 11125189 | Ratledge/2001 | 32 adult patients with 54 proximal lesions | Clinical trial | Key results | There 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) 22842638 | Wenzel/2013 | 257 non-filled proximal surfaces in permanent premolars and molars | Laboratory | Key results | This 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: |
04/08/2015 |
E-mail |
keshwani@livemail.uthscsa.edu |
Author |
Nikhaar Keshwani |
Co-author(s) |
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Co-author(s) e-mail |
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Faculty mentor/Co-author |
Bennett T. Amaechi, BDS, MSc, PhD |
Faculty mentor/Co-author e-mail |
amaechi@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 and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
None available | |
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