title: Diagnostic accuracy of proximal enamel subsurface demineralization and its relationship with calcium loss and lesion depth.
abstract: OBJECTIVE
  The aim of this study was to determine the relationship between the amount of calcium loss, lesion depth, and the accuracy of storage phosphor plate (SPP) and film radiographs for the detection of artificial proximal demineralization.
  
  
  METHODS
  Standard enamel windows of extracted premolars were exposed to a demineralizing solution for 60 h, 80 h, 100 h and 120 h. Solutions were analysed for calcium concentration by atomic absorption spectrometer and the lesion depths were calculated by a specific formula. All teeth were radiographed with SPPs and F-speed films before and after acid application. Images were evaluated by five observers. Stereomicroscopic and scanning electron microscopic (SEM) observations were carried out to visualize enamel surfaces after acid exposure. Receiver operating characteristic analysis was used for diagnostic accuracy (A(z)). A(z)s were compared with factorial analysis of variance and t-tests. The relationship between A(z)s and lesion depths was determined with Pearson's correlation test.
  
  
  RESULTS
  Strong positive correlation was found between A(z)s of both radiographic methods and lesion depths. No difference was found between the A(z)s of two radiographic systems for any of the demineralization durations (p > 0.05). Pair-wise comparisons revealed no significant difference in A(z)s of SPPs (p > 0.05), while significant differences were obtained for the A(z)s of films for different demineralization periods (p < 0.05). Stereomicroscopic and SEM observations confirmed demineralizations from superficial to deeper layers of enamel.
  
  
  CONCLUSIONS
  Subsurface enamel demineralization was not accurately detectable with either storage phosphor plates or F-speed films. The amount of calcium loss and the depth of demineralization have a strong relationship with diagnostic accuracy with a significant effect particularly on F-speed films.
authors.affiliation: Ege Universitesi, Dishekimligi Fakultesi, Oral Diagnoz and Rad AD, Bornova, Izmir, Turkey.
authors.forename: E
authors.initials: E
authors.lastname: Onem
authors.forename: B G
authors.initials: BG
authors.lastname: Baksi
authors.forename: B H
authors.initials: BH
authors.lastname: Sen
authors.forename: O
authors.initials: O
authors.lastname: Sögüt
authors.forename: A
authors.initials: A
authors.lastname: Mert
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001641:Bicuspid / Q000000981:diagnostic imaging; D002118:Calcium / Q000032:analysis; D003743:Dental Enamel / Q000737:chemistry / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D012372:ROC Curve; D011861:Radiography, Dental / Q000379:methods*; D019252:Radiography, Dental, Digital; D015203:Reproducibility of Results; D013054:Spectrophotometry, Atomic; D018709:Statistics, Nonparametric; D017001:Tooth Demineralization / Q000000981:diagnostic imaging*; D014962:X-Ray Film; D014963:X-Ray Intensifying Screens
chemical_list: D002118:Calcium
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