Impact of using bitewing radiographs alone or in combination with clinical information on treatment decisions

The combination of different methods has been advocated to increase sensitivity in detecting secondary caries lesions. This cross-sectional study compared the detection of caries lesions around posterior restorations and treatment decisions using bitewing radiographs alone or in combination with clinical information from patient records. The radiographs (n = 212) were randomly distributed into two sequences for assessment across two phases, with a wash-out period of two weeks. In the first phase (X-ray group), the radiographic images were evaluated without clinical information; in the second phase (X-ray/CARS group), the radiographic images were assessed in conjunction with the CARS score (Caries Associated with Restorations or Sealants) and lesion activity. A radiographic classification system for carious lesions around restorations was adapted to classify the bitewing radiographs included in this study. Evaluations were conducted in consensus by a panel of specialists, focusing on the detection of caries around restorations and subsequent treatment decisions. A chi-squared test was used to compare treatment decisions between the groups, and Cohen's kappa coefficient was employed to assess the agreement of scores. The results showed a significant difference in the distribution of decisions regarding the need for restorative intervention between the groups (p < 0.001), with the X-ray/CARS group leading to more decisions favoring restorative intervention. There was a moderate to good agreement of scores (κ = 0.749). The combination of clinical and radiographic information was found to influence the treatment decision-making process by increasing the likelihood of opting for restorative intervention.