Influence of examiner’s clinical experience on the reproducibility and accuracy of radiographic examination in detecting occlusal caries

Abstract

The aim of this in vitro study was to assess the influence of varying examiner's clinical experience on the reproducibility and accuracy of radiographic examination for occlusal caries detection. Standardized bitewing radiographs were obtained from 166 permanent molars. Radiographic examination was performed by final-year dental students from two universities (A, n = 5; B, n = 5) and by dentists with 5 to 7 years of experience who work in two different countries (C, n = 5; D, n = 5). All examinations were repeated after 1-week interval. The teeth were histologically prepared and assessed for caries extension. For intraexaminer reproducibility, the unweighted kappa values were: A (0.11-0.40), B (0.12-0.33), C (0.47-0.58), and D (0.42-0.71). Interexaminer reproducibility statistics were computed based on means ± SD of unweighted kappa values: A (0.07 ± 0.05), B (0.12 ± 0.09), C (0.24 ± 0.08), and D (0.33 ± 0.10). Sensitivity, specificity, and accuracy were calculated at D(1) and D(3) thresholds and compared by performing McNemar test (p = 0.05). D(1) sensitivity ranged between 0.29 and 0.75 and specificity between 0.24 and 0.85. D(3) specificity was moderate to high (between 0.62 and 0.95) for all groups, with statistically significant difference between the dentists groups (C and D). Sensitivity was low to moderate (between 0.21 and 0.57) with statistically significant difference for groups B and D. Accuracy was similar for all groups (0.55). Spearman's correlations were: A (0.12), B (0.24), C (0.30), and D (0.38). In conclusion, the reproducibility of radiographic examination was influenced by the examiner's clinical experience, training, and dental education as well as the accuracy in detecting occlusal caries.

Diagnostic agreement between radiologist, dentist and dental students for radiographic detection of approximal caries.

“…There is consensus that there should be an emphasis on education and training in the diagnosis of caries in undergraduate dental students 26 in order to reduce the lack of reproducibility of caries diagnosis reported both in the present Chilean study as in the one carried out in Brazil and Switzerland by Diniz et al 22 . The lack of reproducibility of diagnosis negatively affects treatment costs 26 , so it would be advisable, on the one hand, to strengthen the undergraduate curriculum regarding the diagnosis of caries, and, on the other, to propose regular training on diagnostic agreement among dentists in order to detect, verify and correct this lack of reproducibility in the diagnosis.…”

“…In the study most similar to this investigation, researchers used a sample of 20 participants, divided into groups of 5 senior students from Brazil and Switzerland, and a similar number of dentists from the same countries 22 . They used a 5-point scale, and the level of agreement was calculated using unweighted Kappa.…”

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

“…19 Another important factor to be considered is the experience of the observers who are diagnosing the secondary caries. 20 The results of a previous study 20 showed that there is a lack of instruction in how to accurately diagnose secondary carious lesions in everyday clinical practice. Only an accurate diagnosis can provide a good basis for dental treatment planning.…”

“…However, even with minimal experience in caries diagnosis, because the observer sample consisted of dental students during their last phase prior to receiving their academic degree, intra-and inter-observer reliability values found in the current study were similar to those observed in previous studies. 3,20 Diagnostic challenges can occur in a clinical situation as the result of a low perception of differences in radiopacity values that are very similar between materials, making it difficult for observers to distinguish these minor variations on a radiographic image. 23 Others studies [3][4][5][6][7] showed that restorative materials with a radiopacity closer to that of enamel supported greater accuracy in diagnosing secondary caries.…”

Traditional and Novel Caries Detection Methods

“…This effect is an optical illusion phenomenon, due to the tissue density and the variable penetration of X-ray at the cervical region of the tooth and the regions above and below it, which produces a dark shadow on the radiograph due to lower absorption of photons in the neck of the tooth (Berry, 1983). For these reasons, radiographs should be interpreted with caution and requires constant retraining, updating, experience and information of the human observer (Diniz et al, 2010).…”