Diagnostic accuracy of different display types in detection of recurrent caries under restorations by using CBCT.
OBJECTIVE
To assess the in vitro diagnostic ability of CBCT images using seven different display types in the detection of recurrent caries.


METHODS
Our study comprised 128 extracted human premolar and molar teeth. 8 groups each containing 16 teeth were obtained as follows: (1) Black Class I (Occlusal) amalgam filling without caries; (2) Black Class I (Occlusal) composite filling without caries; (3) Black Class II (Proximal) amalgam filling without caries; (4) Black Class II (Proximal) composite filling without caries; (5) Black Class I (Occlusal) amalgam filling with caries; (6) Black Class I (Occlusal) composite filling with caries; (7) Black Class II (Proximal) amalgam filling with caries; and (8) Black Class II (Proximal) composite filling with caries. Teeth were imaged using 100 × 90 mm field of view at three different voxel sizes of a CBCT unit (Planmeca ProMax(®) 3D ProFace™; Planmeca, Helsinki, Finland). CBCT TIFF images were opened and viewed using custom-designed software for computers on different display types. Intra- and interobserver agreements were calculated. The highest area under the receiver operating characteristic curve (Az) values for each image type, observer, reading and restoration were compared using z-tests against Az = 0.5. The significance level was set at p = 0.05.


RESULTS
We found poor and moderate agreements. In general, Az values were found when software and medical diagnostic monitor were utilized. For Observer 2, Az values were statistically significantly higher when software was used on medical monitor [p = 0.036, p = 0.015 and p = 0.002, for normal-resolution mode (0.200 mm(3) voxel size), high-resolution mode (0.150 mm(3) voxel size) and low-resolution mode (0.400 mm(3) voxel size), respectively]. No statistically significant differences were found among other display types for all modes (p > 0.05). In general, no difference was found among 3 different voxel sizes (p > 0.05). In general, higher Az values were obtained for composite restorations than for amalgam restorations for all observers. For Observer 1, Az values for composite restorations were statistically significantly higher than those of amalgam restorations for MacBook and iPhone (Apple Inc., Cupertino, CA) assessments (p = 0.002 and p = 0.048, respectively).


CONCLUSIONS
Higher Az values were observed with medical monitors when used with dedicated software compared to other display types which performed similarly in the diagnosis of recurrent caries under restorations. In addition, observers performed better in detection of recurrent caries when assessing composite restorations than amalgams.
1 Ankara University, Faculty of Dentistry, Department of Restorative Dentistry, Ankara, Turkey.
İsmail H
İH
Baltacıoĝlu
2 Ankara University, Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Ankara, Turkey.
Hakan
H
Eren
3 Ankara University, Faculty of Medicine, Department of Biostatistics, Ankara, Turkey.
Yasemin
Y
Yavuz
2 Ankara University, Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Ankara, Turkey.
Kıvanç
K
Kamburoğlu
D019540:Area Under Curve; D001641:Bicuspid / Q000000981:diagnostic imaging; D003188:Composite Resins / Q000737:chemistry; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D003626:Data Display / Q000706:statistics & numerical data; D003723:Dental Amalgam / Q000737:chemistry; D003731:Dental Caries / Q000000981:diagnostic imaging*; D003764:Dental Materials / Q000737:chemistry; D003793:Dental Restoration, Permanent / Q000145:classification; D003937:Diagnosis, Differential; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008963:Molar / Q000000981:diagnostic imaging; D015588:Observer Variation; D011237:Predictive Value of Tests; D012008:Recurrence; D012680:Sensitivity and Specificity; D012984:Software / Q000706:statistics & numerical data
D003188:Composite Resins; D003764:Dental Materials; D003723:Dental Amalgam
CBCT; diagnosis; display type; monitor; recurrent caries