title: Diagnostic accuracy of conventional and digital radiography for detecting misfit between the tooth and restoration in metal-restored teeth.
abstract: BACKGROUND
  Although the postprocessing of digital images with enhancement filters could lead to the presence of artifacts and result in false-positive diagnoses, no study has analyzed whether the use of digital radiographs and/or postprocessing of digital images interferes with the diagnosis of marginal adaptation in metal-restored teeth.
  
  
  OBJECTIVE
  The purpose of this study was to compare the diagnostic accuracy of conventional and digital radiographic images with and without filters for detecting a misfit between the tooth and restoration in metal-restored teeth.
  
  
  METHODS
  Forty teeth with mesial-occlusal-distal inlays and 40 with complete crowns (each with a perfect fit, 20 with a 0.2-mm gap and 20 with a 0.4-mm gap) were imaged with conventional film and digital phosphor plate systems. Digital radiographs were exported as original images and with edge enhancement (high and low), inversion, and pseudo-3-dimensional filters. Four examiners assessed the presence of gaps by using a categorical scale (fit, misfit, cannot decide). Sensitivity, specificity, and overall accuracy were calculated for each variable. In addition, time spent scoring the images was recorded. A multivariate logistic regression was performed with accuracy as the dependent variable.
  
  
  RESULTS
  Of the images, 6.2% received the score "cannot decide," most of them with a high edge enhancement filter and in the crown group. A tendency for higher sensitivity (range 0.67-0.83), specificity (range 0.81-0.92), and accuracy (range 0.73-0.86) values was found in conventional and digital original images. Results of a logistic regression found that restoration type, gap size, and high enhancement and inversion filters had a statistically significant impact on accuracy (P<.05).
  
  
  CONCLUSIONS
  Original nonfiltered images should be used to assess teeth with metal restorations. High enhancement filters and image inversion should be avoided, especially when metal crowns are present.
authors.affiliation: Doctoral student, Oral Radiology, Department of Surgery and Orthopedics, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil and Section of Oral Radiology, Department of Dentistry, Aarhus University, Aarhus, Denmark. Electronic address: gabiliedke@yahoo.com.br.
authors.forename: Gabriela Salatino
authors.initials: GS
authors.lastname: Liedke
authors.affiliation: Doctoral student, Oral Radiology, Section of Oral Radiology, Department of Dentistry, Aarhus University, Aarhus, Denmark.
authors.forename: Rubens
authors.initials: R
authors.lastname: Spin-Neto
authors.affiliation: Adjunct Professor, Department of Surgery and Orthopedics, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
authors.forename: Mariana Boessio
authors.initials: MB
authors.lastname: Vizzotto
authors.affiliation: Doctoral student, Oral Radiology, Department of Surgery and Orthopedics, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
authors.forename: Priscila Fernanda
authors.initials: PF
authors.lastname: Da Silveira
authors.affiliation: Professor, Department of Surgery and Orthopedics, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
authors.forename: Heloisa Emilia Dias
authors.initials: HE
authors.lastname: Silveira
authors.affiliation: Professor, Section of Oral Radiology, Department of Dentistry, Aarhus University, Aarhus, Denmark and Institute of Odontology, Copenhagen University, Copenhagen, Denmark.
authors.forename: Ann
authors.initials: A
authors.lastname: Wenzel
mesh_terms: D003442:Crowns; D003722:Dental Alloys / Q000737:chemistry*; D018772:Dental Marginal Adaptation; D005374:Filtration / Q000295:instrumentation; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000706:statistics & numerical data; D021621:Imaging, Three-Dimensional / Q000295:instrumentation / Q000706:statistics & numerical data; D007284:Inlays; D011856:Radiographic Image Enhancement; D019252:Radiography, Dental, Digital / Q000295:instrumentation / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013997:Time Factors; D014070:Tooth / Q000000981:diagnostic imaging*; D014962:X-Ray Film / Q000706:statistics & numerical data; D014963:X-Ray Intensifying Screens / Q000706:statistics & numerical data
chemical_list: D003722:Dental Alloys