Enhancement filters are potentially supposed to improve the diagnostic performance of digital images. Thus, the aim of this study was to compare the performance of digital radiography with and without enhancement filters for the detection of induced proximal caries lesions. The total sample consisted of 120 sound human teeth (40 premolars, 80 molars). Enamel subsurface demineralization was induced in one of the proximal surfaces of 60 teeth. Standardized radiographs of all teeth were acquired after the demineralization phase using the Digora-Optime  system. Four radiologists examined the digital radiographs and applied the following filters provided by the Digora  for Windows 2.6 package: Negative, Sharpen and both (Negative plus Sharpen). Validation of radiographic diagnosis was carried out by Knoop cross-sectional microhardness profiling on the proximal surfaces. Intraobserver agreement was estimated using Kappa statistics (k). Sensitivity, specificity and overall accuracy were compared using ANOVA/Tukey test (a = 5%). Intraobserver agreement ranged from good to very good/optimal (k: 0.65-0.83). Although not statistically significant, the highest sensitivity (0.68 ± 0.22) and accuracy (0.76 ± 0.16) values were observed using the Sharpen filter as opposed to the Negative filter, which presented the lowest performance indices (0.57 ± 0.13 and 0.70 ± 0.10, respectively). Specificity ranged from 0.84 to 0.85, considering all imaging modalities (p > 0.05). Insofar as the Sharpen filter had the highest performance indices, it may be considered a useful adjunct for detecting subtle proximal caries lesions.

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Objectives: The aim of this study was to assess the performance of photostimulable storage phosphor (PSP) radiographs with or without using the sharpen filter and cone beam CT (CBCT) for detecting enamel subsurface demineralization. Methods: Enamel subsurface demineralization was induced on one of the approximal surfaces of 120 sound human teeth. Standardized images of all teeth were acquired after the demineralization phase using the Digora ® Optime (Orion Corp./Soredex, Helsinki, Finland) (PSP) and the i-CAT™ (Imaging Sciences International, Hatfield, PA) (CBCT) systems. Three calibrated observers interpreted the images using a five-point scale (1, demineralization definitely absent; 2, demineralization probably absent; 3, unsure; 4, demineralization probably present; and 5, demineralization definitely present). Diagnoses were validated by cross-sectional microhardness profiling in the test areas of the approximal surfaces. Interobserver agreement was analysed using kappa statistics. Accuracy was estimated by the areas under the receiver operating characteristic curves (A z ), which were compared using the Kruskal-Wallis test (a 5 5%). Results: Interobserver agreement was higher for CBCT (k 5 0.7-0.8), followed by sharpenfiltered (k 5 0.6-0.7) and original (k 5 0.5-0.6) images. CBCT presented the highest accuracy value (A z 5 0.897) compared with the original (A z 5 0.792) and sharpen-filtered (A z 5 0.712) images. However, no statistical differences were observed between the imaging modalities (p 5 0.0794). Conclusions: It can be concluded that PSP radiographs with or without using the sharpen filter and the CBCT images may be useful adjuncts for detecting subtle approximal enamel demineralization. Dentomaxillofacial Radiology (2013Radiology ( ) 42, 20120313. doi: 10.1259 Cite this article as: Belém MDF, Tabchoury CPM, Ferreira-Santos RI, Groppo FC, HaiterNeto F. Performance of a photostimulable storage phosphor digital system with or without the sharpen filter and cone beam CT for detecting approximal enamel subsurface demineralization.

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