Clinical Oral Investigations

, Volume 14, Issue 5, pp 515–523 | Cite as

Influence of examiner’s clinical experience on the reproducibility and accuracy of radiographic examination in detecting occlusal caries

  • Michele Baffi Diniz
  • Jonas Almeida Rodrigues
  • Klaus W. Neuhaus
  • Rita C. L. Cordeiro
  • Adrian Lussi
Original Article


The aim of this in vitro study was to assess the influence of varying examiner’s clinical experience on the reproducibility and accuracy of radiographic examination for occlusal caries detection. Standardized bitewing radiographs were obtained from 166 permanent molars. Radiographic examination was performed by final-year dental students from two universities (A, n = 5; B, n = 5) and by dentists with 5 to 7 years of experience who work in two different countries (C, n = 5; D, n = 5). All examinations were repeated after 1-week interval. The teeth were histologically prepared and assessed for caries extension. For intraexaminer reproducibility, the unweighted kappa values were: A (0.11–0.40), B (0.12–0.33), C (0.47–0.58), and D (0.42–0.71). Interexaminer reproducibility statistics were computed based on means ± SD of unweighted kappa values: A (0.07 ± 0.05), B (0.12 ± 0.09), C (0.24 ± 0.08), and D (0.33 ± 0.10). Sensitivity, specificity, and accuracy were calculated at D1 and D3 thresholds and compared by performing McNemar test (p = 0.05). D1 sensitivity ranged between 0.29 and 0.75 and specificity between 0.24 and 0.85. D3 specificity was moderate to high (between 0.62 and 0.95) for all groups, with statistically significant difference between the dentists groups (C and D). Sensitivity was low to moderate (between 0.21 and 0.57) with statistically significant difference for groups B and D. Accuracy was similar for all groups (0.55). Spearman’s correlations were: A (0.12), B (0.24), C (0.30), and D (0.38). In conclusion, the reproducibility of radiographic examination was influenced by the examiner’s clinical experience, training, and dental education as well as the accuracy in detecting occlusal caries.


Dental caries Occlusal caries detection Radiographic caries diagnosis Clinical experience Bitewing radiographs 



The authors wish to thank the examiners of this research and the Department of Preventive, Restorative, and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland and the Department of Pediatric Dentistry, School of Dentistry of Araraquara, São Paulo State University (UNESP), Araraquara, SP, Brazil for technical support.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Michele Baffi Diniz
    • 1
    • 2
    • 3
  • Jonas Almeida Rodrigues
    • 2
  • Klaus W. Neuhaus
    • 2
  • Rita C. L. Cordeiro
    • 1
  • Adrian Lussi
    • 2
  1. 1.Department of Pediatric Dentistry, Araraquara School of DentistrySão Paulo State University (UNESP)AraraquaraBrazil
  2. 2.Department of Preventive, Restorative, and Pediatric Dentistry, School of Dental MedicineUniversity of BernBernSwitzerland
  3. 3.Departamento de Clínica InfantilFaculdade de Odontologia de AraraquaraAraraquaraBrazil

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