The Real Performance of Bitewing Radiography and Fiber-Optic Transillumination in Approximal Caries Diagnosis

Abstract

For both general practitioners and researchers in caries diagnostics, the true validity of available diagnostic techniques is of considerable interest. Yet, for both bitewing radiography and fiber-optic transillumination, this is still not accurately known, nor is it clear which of the two techniques performs best clinically. This study's purpose was to estimate the clinical performance of the two techniques in diagnosing approximal caries lesions in low-caries-prevalence populations. Clinical studies that compare the two techniques were selected from literature. We determined 2 x 2 contingency tables from these studies and calculated one overall contingency table. The cut-off for decay was at dentinal caries. Assuming that erroneous outcomes from both techniques are mutually independent, we expressed diagnostic sensitivity and specificity of the two techniques as functions of the contingency table cell contents, with caries prevalence as the parameter. Because the caries prevalence was unknown, every sensitivity and specificity value was possible. From the conditions that sensitivity, specificity, and caries prevalence are always between one and zero, a limited range of sensitivity and specificity values was obtained. Three situations were examined: Bitewing radiography specificity is 1, fiber-optic transillumination specificity is 1, and both specificities are equal. Under these conditions, the bitewing radiography sensitivity was between 1.00 and 0.71 +/- 0.01, and the fiber-optic transillumination sensitivity was between 0.70 +/- 0.01 and 0.50 +/- 0.02. Both specificities were between 1.00 and 0.99. We concluded that the two techniques have comparable specificities. but that the fiber-optic transillumination sensitivity is significantly lower than that for bitewing radiography.

Effectiveness of near-infrared transillumination in early caries diagnosis

“…Concerning the application of the visual-tactile method for proximal lesions, it is generally accepted that it could lead to false negative results, especially when the process involves only the enamel [19,20]. In the diagnosis of non-cavitated proximal lesions, our results correspond to other reports: the radiographic method is accurate when the dentin is involved, but often leads to underestimation when only the enamel is affected, although it gives better results than the visual-tactile method [21,22].…”

Methods Used by Dental Practice-based Research Network (DPBRN) Dentists to Diagnose Dental Caries

“…Fiber-optic transillumination (FOTI) has been evaluated in a number of studies for detection of posterior proximal caries lesions reporting low to good sensitivity and good specificity 35, 40-43. One in vitro study suggested that a combination of FOTI and visual examination is valid for determination of occlusal lesion depth 44.…”

An in vitro Comparison of Detection Methods for Approximal Carious Lesions in Primary Molars

“…Several clinical studies have compared conventional bitewing radiographs with transillumination in detecting approximal carious lesions in primary and permanent molars [Sidi and Naylor, 1988;Holt and Azevedo, 1989;Vaarkamp et al, 2000]. In general, while specificity of transillumination was high, the sensitivity was variable, perhaps influenced by the type of fibre-optic light, the dentition (primary or permanent), the caries status, and differing diagnostic criteria.…”