Extraoral radiographic imaging of primary caries

Abstract

OBJECTIVE: To evaluate three extra-oral radiographic imaging modalities as alternatives to conventional intra-oral film for the detection of primary caries. METHODS: Sixty-four extracted primary molar teeth with eighty-five carious lesions were radiographed using D-speed film (N = 8), panoramic imaging (N = 8), multidirectional tomography (N = 8), and linear tomography (N = 8). Eight trained observers were asked to identify the presence or absence of caries on each surface using a five point scale. Ground sections were viewed microscopically to determine truth. ROC curve areas (Az) were generated from observer responses and assessed with ANOVA. RESULTS: Average of Az for the detection of combined results for proximal and occlusal lesions were 0.70 for D-speed, film, 0.58 for linear tomography, 0.64 for both multidirectional tomography, and panoramic film. Turkey's pairwise comparisons of Az revealed that D-speed film was significantly better than linear tomography (P = 0.0039). When data were divided into proximal and occlusal surfaces the variability due to modality remained significant (P = 0.0003 and P = 0.0024 respectively). Turkey's comparisons for proximal surfaces revealed that D-speed film was significantly better than linear tomography (P = 0.0007), multidirectional tomography (P = 0.0010) and panoramic radiography (P = 0.0100). For detection of occlusal lesions, multidirectional tomography was significantly better than linear tomography (P = 0.0075) and panoramic radiography (P = 0.0034), but not significantly different from D-speed film (P = 0.2337). CONCLUSIONS: Multidirectional tomography and panoramic radiography performed as well as intra-oral D-speed film for the combined assessment of proximal and occlusal caries in the model used. when proximal surfaces were evaluated alone, D-speed film was significantly better. For occlusal caries there was no statistically significant difference between multidirectional tomography and D-speed film.