Diagnosis of secondary caries in esthetic restorations: influence of the incidence vertical angle of the X-ray beam

Abstract

The aim of this study was to evaluate the accuracy on the diagnosis of secondary caries-like lesions simulated on esthetic restorations of different materials, changing the incidence vertical angle (IVA) of the x-ray beam. Twenty human teeth received MOD inlay preparations. In the experimental group (n=10), a round cavity was made in the floor of the proximal box to simulate the caries-like lesion. All teeth were restored with 3 composite resins (Charisma, Filtek-Z250 and TPH-Spectrum) at 3 moments. Two radiographic images were acquired with 0º and 10º IVA. Ten observers evaluated the images using a 5-point confidence scale. Intra- and interobserver reliability was analyzed with the Interclass Correlation Coefficient and the diagnostic accuracy was evaluated using the area under the ROC curve (A(z)), Friedman test and Wilcoxon test (α=0.05). Higher accuracy values were obtained with 10º IVA (A(z)=0.66, Filtek-Z250>A(z)=0.56, TPH-Spectrum) compared to 0º (A(z)=0.55, Charisma>A(z)=0.37, TPH-Spectrum), though without statistically significant difference (p>0.05). The detection of secondary caries-like lesions simulated on esthetic restorations of different materials suffered no negative influence by changing the IVA of the x-ray beam.

Influence of Radiopacity of Dental Composites on the Diagnosis of Secondary Caries: The Correlation Between Objective and Subjective Analyses

“…These results corroborate those of a previous study 2 that found that the accuracy was statistically similar and in which the worst accuracy of secondary caries detection was observed with materials of higher radiopacity. On the other hand, these results failed to support the findings of another previous study 7 that showed no difference in the accuracy of secondary caries detection as a result of very similar clinical radiopacities of the tested materials, which were similar to the radiopacity of dental tissues.…”

“…15,17 Clinically, there are more challenges, because in addition to the characteristics of the carious lesion, there are also the inherent troubles associated with the radiographic image 2,3 because caries detection is possible when demineralization has occurred in more than 40% of tooth tissue. 18 The use of secondary caries-like lesions for analysis of observers' performance has been previously applied, 2,12,13,16 and the size of the cavity bears an influence in this performance. 12 In this study, a same-sized bur 12 was used in repeated specimens because the perceptive reliability was an important factor under consideration.…”

“…3,14 Thus, when radiographically diagnosing secondary caries under amalgam, sometimes several different X-rays are needed to detect those lesions. 2,14,17 Furthermore, it must be emphasized that the results of any in vitro study are not directly applicable to a secondary caries diagnosis in the oral environment because challenges are more complex. In the oral cavity, the perception of caries formed under these materials depends on several other factors, among them radiographic and cognitive factors, and these should be taken into account.…”

“…However, despite improvements in these composites, some disadvantages still need to be overcome, including secondary caries, detecting marginal overhangs, or contouring and adaptation failures. [1][2][3] Secondary caries is a common cause of restoration loss. An accurate diagnosis of this condition is key to determining the use of these restorations.…”

In vitro effect of changing the horizontal angulation of X-ray beam on the detection of proximal enamel caries in bitewing radiographs

“…Moreira et al evaluated the effect of vertical angle of X-ray beam on the detection of secondary caries developed under esthetic restorations and showed that 10° vertical angle yielded the highest diagnostic accuracy, although the difference among the tested angles was not statistically significant. 13 In the current study, the sensitivity for detecting carious lesions was higher in group 3 (longer immersion of teeth in demineralizing agent). This finding was in agreement with the results of previous studies reporting that a greater depth of caries results in the easier detection of carious lesions.…”