A novel classification system for assessment of approximal caries lesion progression in bitewing radiographs

Abstract

Objectives: To design and pilot a novel classification system for the assessment of caries lesion progression in bitewing radiography and to report rater agreement of the system. Methods: A classification system with drawings and text was designed to assess caries lesion progression. Guidelines for Reporting Reliability and Agreement Studies were used to study and report rater agreement. Pairs of posterior bitewing radiographs (baseline and 1-year follow-up) with different status concerning caries lesion progression were selected from files from public dental health clinics. 10 raters, 5 general dental practitioners and 5 specialists in oral and maxillofacial radiology were asked to assess the radiographs with the aid of the classification system. Seven raters repeated their assessments. Rater agreement was expressed as percentage of agreement and kappa. Results: Kappa for the interrater agreement of 10 raters assessing progression was 0.61, indicating substantial agreement. Agreement was moderate for progression in the outer half of the dentine (kappa 0.55) and within enamel (kappa 0.44). Pairwise interrater agreement varied (range 69-92%; kappa 0.42-0.84). For about half of the pairs of raters, kappa was substantial ($0.61). Intrarater agreement assessing progression was substantial (kappa 0.66-0.82). Conclusions: We demonstrated the applicability of the proposed classification system on caries lesion progression with respect to rater agreement. This system can provide a common framework for clinical decision-making on caries interventional methods and patient visiting intervals. Scientifically, this system allows for a comparative analysis of different methods of prevention and treatment of caries as well as of different caries risk assessment methods. Dentomaxillofacial Radiology (2016Radiology ( ) 45, 20160039. doi: 10.1259 Cite this article as: Senneby A, Elfvin M, Stebring-Franzon C, Rohlin M. A novel classification system for assessment of approximal caries lesion progression in bitewing radiographs. Dentomaxillofac Radiol 2016; 45: 20160039.

Threshold values affect predictive accuracy of caries risk assessment

“…In the same session, one bitewing radiograph was exposed at each side of the mouth. The radiographic equipment, storage, export of images, and the quality control of the equipment and images have previously been described [25]. Two oral and maxillofacial radiologists performed in consensus the radiographic assessment of the approximal surfaces of the posterior teeth (all visible mesial and distal surfaces) using SynedraV R view personal (Planmeca, Finland) and a computer (HP Compaq Elite 8100 SFF, US).…”

“…without access to results of the clinical examinations. Figure 3 displays the system used for assessment of caries lesion progression of each approximal surface, a system based on the classification system designed to visualize sound, arrested, and progressed caries lesions [25].…”

“…Bitewing radiography: mesial and distal surfaces of premolars and molars assessed as sound, lesion in outer-or inner enamel or dentin (outer third of dentin). For caries increment criteria according to Senneby et al [25].…”

“…Classification used for assessment of caries lesion progression in approximal surfaces of posterior teeth in bitewing radiographs from baseline and follow-up displayed side-by-side. The classification is based on the system presented by Senneby et al[25].…”

A comparison of diagnosis of early stage interproximal caries with bitewing radiographs and periapical images using consensus reference

“…[10][11][12][13] However, no investigation has been conducted of their use for different levels of caries progression, specifically including carious lesions that are less than half of outer enamel. 14 Radiographic images usually underestimate the actual size or depth of a carious lesion. 15 By the time a lesion has visibly reached the dentino-enamel junction (DEJ) on a radiograph, the only effective therapy is a Class II restoration, that may potentially subject the tooth to a lifetime of treatment.…”