title: Secondary caries in crowned teeth: correlation of clinical and radiographic findings.
abstract: BACKGROUND
  The diagnostic value of radiographs for interproximal caries detection on nonrestored teeth is well investigated. However, little is known about the use of radiographs in the diagnosis of secondary caries localized at crown margins.
  
  
  OBJECTIVE
  The aim of this study was to correlate clinical findings with regard to secondary caries with the findings of a radiographic evaluation.
  
  
  METHODS
  One hundred randomly selected patients who underwent restorations with fixed prostheses and were exhibiting at least one secondary carious lesion were included in the study. A total of 820 restorations (test group, 730 interproximal surfaces of 365 single crowns and 910 interproximal surfaces of 455 fixed partial denture retainer crowns) and 1024 interproximal surfaces of 512 nonrestored teeth (control group) were investigated clinically, with the use of modified California Dental Association criteria, and radiographically for interproximal carious lesions. The extension of the lesions was rated to be initial (with no cavitation), early (with cavitation limited to orthodentin), or deep (with cavitation). The data were statistically analyzed for normal distribution, and the frequency of the findings was calculated in absolute numbers and as a percentage. Statistically significant differences were determined by use of the chi(2) test (P<.05). A linear regression model was applied for the correlation between the percentage of secondary caries and the duration of the crowns in situ.
  
  
  RESULTS
  Secondary caries was diagnosed clinically in 11.2% of 1640 interproximal surfaces but only in 8.3% radiographically. In contrast, the frequency of interproximal carious lesions diagnosed clinically in nonrestored teeth increased with the use of radiographs from 3.3% to 4.1%.
  
  
  CONCLUSIONS
  Within the limits of this study, the results confirm that radiographs improve the diagnostic sensitivity for interproximal caries in nonrestored teeth. However, for the diagnosis of secondary caries in crowned teeth, the clinical examination is more reliable than the radiographic evaluation.
authors.affiliation: Department of Prosthodontics, University of Witten/Herdecke, Witten, Germany. axel.zoellner@uni-wh.de
authors.forename: Axel
authors.initials: A
authors.lastname: Zoellner
authors.forename: Max
authors.initials: M
authors.lastname: Heuermann
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Weber
authors.forename: Peter
authors.initials: P
authors.lastname: Gaengler
mesh_terms: D016009:Chi-Square Distribution; D003442:Crowns / Q000009:adverse effects*; D000044:Dental Abutments; D003731:Dental Caries / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D006801:Humans; D016014:Linear Models; D011861:Radiography, Dental; D012008:Recurrence; D012680:Sensitivity and Specificity