Diagnostic performance of cone-beam computed tomography on detection of mechanically-created artificial secondary caries

Abstract

Cone-beam computed tomography (CBCT) has been developed as a new imaging modality for dentists to diagnose various diseases and to determine treatment plan options. It can display the images in axial, sagittal, and coronal planes, as well as permitting three-dimensional (3D) image reconstruction. Therefore, CBCT is widely used in several dental applications.1 Recently, there have been studies on the accuracy in detection of caries using CBCT. 2-9 However, the effectiveness of CBCT in caries detection has been still equivocal. Akdeniz et al 2 found that limited cone beam computed tomography (LCBCT) was better to assess the depth of proximal caries than intra-oral digital imaging systems using storage phosphor plate sensors and film. The 3DX Accuitomo system (Mortita, Kyoto, Japan), one of the CBCT systems, was reported to show significantly higher sensitivity than 2D images in detecting proximal dentin caries. 4,5 For proximal enamel caries, Young et al 5 found that the 3DX Accuitomo was a superior imaging modality to intra-oral digital imaging systems using charge coupled device (CCD) sensors. Kayipmaz et al 7 stated that CBCT images could detect occlusal caries better than conventional films and storage phosphor plates, whereas no signifcant difference was found for proximal caries. Kamburoglu et al 9 found that CBCT images improved the detection of occlusal caries in deep enamel, superficial dentin, and ABSTRACTPurpose : The aim of this study was to compare the diagnostic accuracy of cone-beam computed tomography (CBCT) images and bitewing images in detection of secondary caries. Materials and Methods : One hundred and twenty proximal slots of Class II cavities were randomly prepared on human premolar and molar teeth, and restored with amalgam (n= =60) and composite resin (n= =60). Then, artificial secondary caries lesions were randomly created using round steel No. 4 bur. The teeth were radiographed with a conventional bitewing technique and two CBCT systems; Pax-500ECT and Promax 3D. All images were evaluated by five observers. The area under the receiver operating characteristic (ROC) curve (A z ) was used to evaluate the diagnostic accuracy. Significant difference was tested using the Friedman test (p value⁄0.05).Results : The mean A z values for bitewing, Pax-500ECT, and Promax 3D imaging systems were 0.882, 0.995, and 0.978, respectively. Significant differences were found between the two CBCT systems and film (p= =0.007). For CBCT systems, the axial plane showed the greatest A z value. Conclusion : Based on the design of this study, CBCT images were better than bitewing radiographs in detection of secondary caries. (Imaging Sci Dent 2011; 41 : 143-50)

The effect of different exposure parameters on proximal caries detection using the Kodak 9000 3D CBCT system

“…Studies in the field report that the images obtained using CBCT systems have higher diagnostic accuracy and sharpness 3,11 .…”

“…Authors diverge on the superiority of CBCT images against conventional radiographic images for the detection of caries lesions, especially interproximal images. According to Haiter-Neto et al 17 and Young et al 18 , CBCT and digital radiographic images fail to detect incipient enamel caries lesions, as both methods present low sensibility values Charuakkra et al 3 and Valizadeh et al 11 evaluated the CBCT accuracy on proximal caries detection and compared its results to conventional radiographs. Although those studies had similar aims, their conclusions were different.…”

“…Among those advantages, the elimination of superposition, multiplanar reconstruction, high resolution due to its high image contrast and three-dimensional visualization of the structure of interest stand out from other modalities of radiographic exams [3][4][5][6][7] . The small and isotropic voxels of the CBCT images contribute to the achievement of images with higher details, sharpness, and high definition; although a smaller voxel size can be related to higher exposure time and higher tube current, demanding higher radiation doses than intraoral radiography [13][14] .…”

“…Previous studies suggested that CBCT images could be applied to different areas of dentistry, including caries detection, due to its images possibility of visualizing the dental structure in different image planes [3][4][5][6] . Authors diverge on the superiority of CBCT images against conventional radiographic images for the detection of caries lesions, especially interproximal images.…”

“…Cone Beam Computed Tomography (CBCT) systems were first used in dentistry in the end of last century and, since then; the indications of this threedimensional exam have expanded significantly 3 . One of the advantages of CBCT is its lower radiation dose when compared to Computed Tomography (CT).…”