title: Validity of diagnosis of questionable caries lesions in occlusal surfaces of extracted third molars.
abstract: This study was to evaluate the accuracy of visual inspection, conventional radiography, and digital radiographic methods for the detection of occlusal carious lesions in third molars from a present-day adolescent population. Seventy-eight third molars, considered clinically to be without occlusal cavities, were extracted from young soldiers. Before extraction, an intra-oral radiograph was obtained. After extraction, the teeth were examined visually as per the criteria: 0 = no caries, 1 = chalky/stained fissure indicative of enamel caries, 2 = chalky and dark-stained fissure considered indicative of a dentinal lesion, and 3 = as per criterion 2, but with small surface defects (microcavities). The radiographs were digitised, and image enhancement with contrast stretch and a filtering procedure was performed, respectively. The three types of radiographic image were assessed as per the criteria: 1 = no caries/caries confined to enamel, 2 = caries involving the outermost dentine, and 3 = deep dentinal caries extending half-way or more to the pulp. Ground sections (500-600 microns in thickness) served as validation for lesion depth. The digital radiographic method with contrast stretch performed overall best of the four methods (greater than 70% detection rate) while visual inspection (53% detection rate) performed better than conventional radiography (48% detection rate). When results from visual inspection and conventional radiography were combined, an increase in the detection rate of 11% was obtained with a 7% increase in false-positive scorings. When digitally contrast-manipulated radiographs were combined with visual inspection, a gain of 33% was obtained with an 11% increase in false positives.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Oral Radiology, Royal Dental College, Aarhus, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Wenzel
authors.forename: O
authors.initials: O
authors.lastname: Fejerskov
mesh_terms: D000293:Adolescent; D000328:Adult; D003731:Dental Caries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D003743:Dental Enamel / Q000000981:diagnostic imaging / Q000473:pathology; D003750:Dental Fissures / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D003804:Dentin / Q000000981:diagnostic imaging / Q000473:pathology; D005189:False Positive Reactions; D006801:Humans; D008964:Molar, Third / Q000000981:diagnostic imaging / Q000473:pathology*; D011856:Radiographic Image Enhancement; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity