Intraoral vs. extraoral bitewing radiography for approximal caries detection: A multi-observer ex vivo ROC study...

Area of Science:

• Dental radiology
• Diagnostic imaging
• Caries detection

Background:

• Accurate detection of interproximal caries is crucial for timely dental treatment.
• Comparing intraoral bitewing radiography (iBWR) and extraoral bitewing radiography (eBWR) for caries detection is important for clinical practice.

Purpose of the Study:

• To compare the diagnostic accuracy of iBWR and eBWR in detecting natural interproximal carious lesions.
• To evaluate the performance of both radiographic techniques using a multi-observer design and a histological gold standard.

Main Methods:

• Eighty extracted teeth were mounted in a simulated jaw, with approximately 50% having caries.
• Images were acquired using iBWR with a CMOS sensor and eBWR with a digital panoramic device.
• Twenty-seven dentists assessed caries presence and depth, with results compared to histological analysis.

Main Results:

• Overall diagnostic accuracy was higher for iBWR (Az=0.58) than for eBWR (Az=0.54).
• Both intra-rater and inter-rater reliability were low for both methods.
• iBWR demonstrated higher specificity and positive predictive values for enamel caries, while eBWR showed higher initial sensitivity.

Conclusions:

• Intraoral bitewing radiography (iBWR) demonstrated superior diagnostic accuracy compared to extraoral bitewing radiography (eBWR) for interproximal caries detection.
• Despite higher accuracy, both methods showed limited diagnostic capability for early enamel lesions, performing just above random guessing.