Tuesday, August 8, 2017

Diagnostic Accuracy of Different Imaging Modalities In Detection Of Proximal Caries

Department of Pediatric Dentistry
Lutheran Medical Center
Resident’s Name:     Olga Raptis                                                                              Date: 08/09/2017

Article Title: Diagnostic Accuracy of Different Imaging Modalities In Detection Of Proximal Caries
Author(s): Senel,et al.
Journal: Dentomaxillofacial Radiology
Date: 2009
Major Topic: Diagnosis of caries
Type of Article: Diagnostic Accuracy of Different Imaging Modalities In Detection Of Proximal 
Main Purpose: To assess the in vitro diagnostic ability of visual inspection, film, CCD sensors, PSP sensors and cone beam CT in the detection of proximal caries in posterior teeth in comparison with the histological gold standard.
Key Points: (2 lines Max): Main conclusion or the most interesting
  • Several studies have shown that between 25% and 42% of caries lesions remain undetected by clinical examination performed without radiographic examination.
  •  Radiographic diagnosis of caries is based upon the amount of demineralization needed to create a change in radiographic density, with a minimum of 40% mineral loss needed for radiographic visibility.

The study:
  • Comprised of 230 human premolar and molar teeth with and without caries that had been extracted for periodontal or orthodontic reasons. Teeth were embedded in acrylic blocks in groups of five, with the proximal surfaces in contact.
  •  Detection of proximal caries was performed using visual inspection and film, CCD, PSP and cone beam CT images.
CCD -https://www.photonicsonline.com/doc/

  • Inspection was conducted under daylight using a mirror and probe and surfaces were scored according to the following scale: 0 (no caries lesion), 1 (Opacity or cavitation in enamel); 2 (cavitation in dentine); 3 (cavitation in dentine extending to pulp).
  • All images were viewed at random in a dimly lit room.
  •  Images were evaluated separately by three oral radiologists; intraobserver agreement was assessed by having each observer view all images twice, with a 2 week interval between viewing to eliminate memory bias.
  • Histological validation of caries status was performed by serially sectioning each tooth mesiodistally in parallel to the long axis of the crown.
  •  Teeth were recorded as either sound or as having a caries lesion, which was defined a demineralized white or yellowish-brown discolored area in the enamel or dentine.
  • Histological examination of 276 proximal tooth surfaced revealed no caries in 142 surfaces and caries in 134 surfaces. 
In conclusion:
  • Overall, the study found no differences in the diagnostic ability of visual inspection, film, CCD, PSP and cone beam CT images in the detection of proximal caries.
  • The high intraobserver kappa coefficients found in the present study suggest excellent intraobserver agreement and strong interobserver agreement among experienced observers for all detection methods.
  • The study found that CCD sensors had a higher rate (56.2%) than film (40.2%) and PSP plates (47.9%) but a lower rate than cone beam CT (58.3%) in correctly diagnosing deep dentine caries; the differences between methods, were statistically insignificant. 
  • PSP -https://www.smartpractice.com/
  • The study concludes that none of the modalities tested showed both high sensitivity and high specificity, and none of the modalities significantly outperformed the other in detection of proximal caries. Considering these results, digital intraoral systems can be recommended over film because of their lower levels of radiation exposure.

CBCT - http://www.dentistrytoday.info/content/cbct

1-    In conclusion, visual inspection, Films, CCD, PSP and cone-beam CT chosen for this stufy performed similarly in the detection of proximal caries in vitro
2-    Best diagnostic outcomes are likely to be achieved through a combination of different caries detection modalities.
Assessment of Article:  Level of Evidence/Comments:  Evaluation study 

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