Sensitivity of various radiographic methods for detection of oral cancellous bone lesions

The purpose of this study was to determine the effectiveness in diagnosing cancellous bone defects of the following radiographic methods: conventional film, digitized film, enhanced digitized film, direct digital imaging, enhanced direct digital imaging, digital subtraction, and enhanced digital subtraction.

Mechanical lesions of varying depths were generated beneath cadaver molar and premolar mandibular tooth roots. A portfolio of radiographic images of random types and lesion sizes was presented to 20 clinicians, and their diagnoses were evaluated.

Positive identification of lesions was significantly improved by enhanced subtraction radiography over all other forms of radiography for the 4-mm lesions and was better than all forms except enhanced digital radiography and film for the 6-mm lesions. Subtraction radiography and enhanced subtraction radiography significantly reduced false positive diagnoses at all lesion sizes in comparison with the other radiographic methods except enhanced digital radiography at the 6-mm lesion size.

For the methods evaluated, only subtraction radiography and enhanced subtraction radiography can significantly improve the clinician's diagnostic abilities for detection of oral cancellous bone lesions through increased rates for detection of existing defects and, even more importantly, through decreased rates of defect misdiagnosis.