title: Ex vivo evaluation of new 2D and 3D dental radiographic technology for detecting caries.
abstract: OBJECTIVE
  Proximal dental caries remains a prevalent disease with only modest detection rates by current diagnostic systems. Many new systems are available without controlled validation of diagnostic efficacy. The objective of this study was to evaluate the diagnostic efficacy of three potentially promising new imaging systems.
  
  
  METHODS
  This study evaluated the caries detection efficacy of Schick 33 (Sirona Dental, Salzburg, Austria) intraoral digital detector images employing an advanced sharpening filter, Planmeca ProMax(®) (Planmeca Inc., Helsinki, Finland) extraoral "panoramic bitewing" images and Sirona Orthophos XG3D (Sirona Dental) CBCT images with advanced artefact reduction. Conventional photostimulable phosphor images served as the control modality. An ex vivo study design using extracted human teeth, ten expert observers and micro-CT ground truth was employed.
  
  
  RESULTS
  Receiver operating characteristic analysis indicated similar diagnostic efficacy of all systems (ANOVA p > 0.05). The sensitivity of the Schick 33 images (0.48) was significantly lower than the other modalities (0.53-0.62). The specificity of the Planmeca images (0.86) was significantly lower than Schick 33 (0.96) and XG3D (0.97). The XG3D showed significantly better cavitation detection sensitivity (0.62) than the other modalities (0.48-0.57).
  
  
  CONCLUSIONS
  The Schick 33 images demonstrated reduced caries sensitivity, whereas the Planmeca panoramic bitewing images demonstrated reduced specificity. XG3D with artefact reduction demonstrated elevated sensitivity and specificity for caries detection, improved depth accuracy and substantially improved cavitation detection. Care must be taken to recognize potential false-positive caries lesions with Planmeca panoramic bitewing images. Use of CBCT for caries detection must be carefully balanced with the presence of metal artefacts, time commitment, financial cost and radiation dose.
authors.affiliation: 1 Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Minneapolis, MN, USA.
authors.forename: Laurence
authors.initials: L
authors.lastname: Gaalaas
authors.affiliation: 2 Diagnostic Sciences, School of Dentistry, UNC Chapel Hill, Diagnostic Sciences, Chapel Hill, NC, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Tyndall
authors.affiliation: 2 Diagnostic Sciences, School of Dentistry, UNC Chapel Hill, Diagnostic Sciences, Chapel Hill, NC, USA.
authors.forename: André
authors.initials: A
authors.lastname: Mol
authors.affiliation: 3 Pediatric Dentistry, Dental Research, School of Dentistry, UNC Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Eric T
authors.initials: ET
authors.lastname: Everett
authors.affiliation: 4 Biostatistics, McGavran-Greenberg Hall, Gillings School of Global Public Health, UNC Chapel Hill, Biostatistics, Chapel Hill, NC, USA.
authors.forename: Ananta
authors.initials: A
authors.lastname: Bangdiwala
mesh_terms: D016477:Artifacts; D054893:Cone-Beam Computed Tomography / Q000706:statistics & numerical data; D003731:Dental Caries / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000706:statistics & numerical data*; D008422:Materials Testing; D012372:ROC Curve; D016300:Radiography, Bitewing / Q000706:statistics & numerical data; D011861:Radiography, Dental / Q000706:statistics & numerical data*; D019252:Radiography, Dental, Digital / Q000706:statistics & numerical data; D011862:Radiography, Panoramic / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D013674:Technology, Dental / Q000706:statistics & numerical data; D013679:Technology, Radiologic / Q000706:statistics & numerical data; D014963:X-Ray Intensifying Screens / Q000706:statistics & numerical data; D055114:X-Ray Microtomography / Q000706:statistics & numerical data
keywords: MicroCT; bitewing radiography; cone-beam CT; dental caries; radiography, dental