Extraoral imaging for proximal caries detection: Bitewings vs scanogram.

Area of Science:

• Dentistry
• Radiology
• Diagnostic Imaging

Background:

• Accurate detection of proximal caries is crucial for timely dental treatment.
• Intraoral bitewing radiography is the current standard for proximal caries detection.
• Extraoral imaging modalities offer potential advantages in patient comfort and workflow.

Purpose of the Study:

• To compare the diagnostic accuracy of three extraoral imaging modalities against intraoral bitewing radiographs for detecting proximal caries.
• To evaluate the impact of digital enhancement on the diagnostic performance of scanograms.

Main Methods:

• Three Cranex TOME scanogram techniques (screen/film, unenhanced digital, enhanced digital) were compared with Insight intraoral radiographs.
• Nine observers assessed proximal surfaces of 45 extracted posterior teeth for caries using a 5-point confidence scale.
• Histological sections served as the ground truth; data were analyzed using repeated measures ANOVA and ROC curves (Az).

Main Results:

• Significant differences in diagnostic accuracy were found among the imaging modalities (P = .041).
• Insight intraoral radiographs showed superior accuracy only compared to unenhanced digital scanograms (P = .003).
• Mean Az scores were 0.73 for Insight, 0.65 for screen/film scanograms, 0.64 for unenhanced digital scanograms, and 0.66 for enhanced digital scanograms.

Conclusions:

• Film-based and enhanced digital scanograms demonstrated comparable diagnostic accuracy to Insight intraoral radiographs for proximal caries detection.
• Unenhanced digital scanograms exhibited statistically significantly lower diagnostic accuracy compared to Insight intraoral radiographs.