Risk Factors for a False Positive Test Outcome in Diagnosis of Caries in Approximal Surfaces: Impact of Radiographic Modality and Observer Characteristics

Abstract

The aim of this study was to evaluate the impact of image modality and observer characteristics on radiographic caries diagnosis with particular emphasis on the false positive (FP) test outcome. Eighty human teeth were radiographed by eight digital modalities and film. Eight observers scored caries lesions in each approximal tooth surface. Their use of image enhancement and time spent in assessing an image was recorded. Microscopy served as validation for the presence/absence of a lesion. Of 160 approximal surfaces, 63% were sound and 37% had lesions. Multivariate logistic regression analysis was performed with the FP test outcome as the dependent variable and the radiographic modality and observer’s gender, experience, employment, image enhancement, and time use as the independent variables. The significant risk factors for an FP test outcome were: (1) gender: males scored fewer FP than females (OR 0.26, CI 0.18–0.36); (2) experience: observers with no experience with digital radiography had a six times higher risk for an FP (OR 6.09, CI 4.9–8.1); (3) radiographic modality: two of the digital systems had a significantly lower risk for an FP [a phosphor plate system (OR 0.55, CI 0.37–0.73) and a sensor-based system (OR 0.65, CI 0.46–0.93)] and one phosphor plate system had a higher risk (OR 1.57, CI 1.17–2.13) than film; (4) time use: more time was spent when scoring an FP (OR 1.05, CI 1.03–1.05) than for any other test outcome. Type of employment and the use of image enhancement had no significant impact on the risk for an FP diagnosis.

Diagnostic performance of the visual caries classification system ICDAS II versus radiography and micro-computed tomography for proximal caries detection: An in vitro study

“…Consequently, the ICDAS II criteria were compared to the most widely used diagnostic method for proximal caries detection, namely radiographic examination in both film and digital receptor modalities. 32 Moreover, the diagnostic performance of the aforementioned modalities was validated against the histological ''gold standard'', and we examined the capacity of a new tomographic modality to substitute histological examination in future research. The diagnosis of non-cavitated carious lesions allows the uptake of preventive measures aiming at the inhibition of the carious process at very early stages and the promotion of the remineralization, leading to healing of the lesion.…”

Performance of a photostimulable storage phosphor digital system with or without the sharpen filter and cone beam CT for detecting approximal enamel subsurface demineralization

“…10 Nevertheless, the radiographic diagnosis of caries lesions depends on the contrast and, therefore, demineralization has to encompass at least 30-40% of the enamel layer to be observed, implying an irreversible mineral loss. 8,11 Cone beam CT (CBCT) was developed to address the demand for three-dimensional (3D) information obtained by CT. [12][13][14][15][16][17][18][19][20] The applicability of CBCT images for detecting approximal caries lesions has already been investigated. 4,9,13,18,19,21,22 However, few studies have focused on the diagnostic performance of CBCT for the detection of subtle subsurface enamel demineralization.…”

Accuracy of direct digital radiography for detecting occlusal caries in primary teeth compared with conventional radiography and visual inspection: anin vitrostudy

“…1 There are several studies using different radiographic imaging modalities for detecting carious lesions at the contacting approximal dental surfaces. [2][3][4][5][6] However, the detection of occlusal dental carious lesions is also challenging, and the determination of the extension of such lesions into enamel and dentine is crucial for the determination of the more appropriate treatment. Several studies have tested digital radiography for the detection of occlusal and approximal caries lesions in permanent teeth, 1 and a few researchers have investigated the performance of digital radiography in approximal caries lesions in primary teeth, [7][8][9] but no studies have observed the performance of digital radiography in detecting occlusal caries in primary teeth.…”