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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

Abstract

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.

Keywords

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

Notes

Acknowledgments

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.

References

  1. 1.
    Bader JD, Shugars DA (2004) A systematic review of the performance of a laser fluorescence device for detecting caries. J Am Dent Assoc 135:1414–1426Google Scholar
  2. 2.
    Espelid I, Tveit AB, Fjelltveit A (1994) Variations among dentists in radiographic detection of occlusal caries. Caries Res 28:169–175CrossRefPubMedGoogle Scholar
  3. 3.
    Dove SB (2001) Radiographic diagnosis of dental caries. J Dent Educ 65:985–990PubMedGoogle Scholar
  4. 4.
    Kidd EAM, Naylor MN, Wilson RF (1992) Prevalence of clinically undetected and untreated molar occlusal dentine caries in adolescents on the Isle of Wight. Caries Res 26:397–401CrossRefPubMedGoogle Scholar
  5. 5.
    Weerheijm KL, Groen HJ, Bast AJJ, Kieft JA, Eijkman MAJ, van Amerongen WE (1992) Clinically undetected occlusal dentine caries: a radiographic comparison. Caries Res 26:305–309CrossRefPubMedGoogle Scholar
  6. 6.
    Richardson PS, McIntyre IG (1996) The difference between clinical and bitewing detection of approximal and occlusal caries in Royal Air Force recruits. Community Dent Health 13:65–69PubMedGoogle Scholar
  7. 7.
    Weerheijm KL (1997) Occlusal “hidden caries”. Dent Update 24:182–184PubMedGoogle Scholar
  8. 8.
    Espelid I, Tveit AB (2001) A comparison of radiographic occlusal and approximal caries diagnoses made by 240 dentists. Acta Odontol Scand 59:285–289CrossRefPubMedGoogle Scholar
  9. 9.
    Wenzel A, Fejerskov O (1992) Validity of diagnosis of questionable caries lesions in occlusal surfaces of extracted third molars. Caries Res 26:188–194CrossRefPubMedGoogle Scholar
  10. 10.
    Syriopoulos K, Sanderink GC, Velders XL, van der Stelt PF (2000) Radiographic detection of approximal caries: a comparison of dental films and digital imaging systems. Dentomaxillofac Radiol 29:312–318CrossRefPubMedGoogle Scholar
  11. 11.
    Firestone AR, Lussi A, Weems RA, Heaven TJ (1994) The effect of experience and training on the diagnosis of approximal coronal caries from bitewing radiographs. A Swiss–American comparison. Schweiz Monatsschr Zahnmed 104:719–723PubMedGoogle Scholar
  12. 12.
    Lazarchik DA, Firestone AR, Heaven TJ, Filler SJ, Lussi A (1995) Radiographic evaluation of occlusal caries: effect of training and experience. Caries Res 29:355–358CrossRefPubMedGoogle Scholar
  13. 13.
    Wrbas K-Th, Kielbassa AM, Schulte-Mönting J, Hellwig E (2000) Effects of additional teaching of final-year dental students on their radiographic diagnosis of caries. Eur J Dent Educ 4:138–142CrossRefPubMedGoogle Scholar
  14. 14.
    Lussi A, Reich E (2005) The influence of toothpastes and prophylaxis pastes on fluorescence measurements for caries detection. Eur J Oral Sci 113:141–144CrossRefPubMedGoogle Scholar
  15. 15.
    Hala LA, Mello JB, Carvalho PL (2006) Evaluation of the effectiveness of clinical and radiographic analysis for the diagnosis of proximal caries for different clinical experience levels: comparing lesion depth through histological analysis. Braz J Oral Sci 5:1012–1017Google Scholar
  16. 16.
    Lussi A, Imwinkelried S, Pitts NB, Longbottom C, Reich E (1999) Performance and reproducibility of a laser fluorescence system for detection of occlusal caries in vitro. Caries Res 33:261–266CrossRefPubMedGoogle Scholar
  17. 17.
    Lin LIK (1989) A concordance correlation coefficient to evaluate reproducibility. Biometrics 45:255–268CrossRefPubMedGoogle Scholar
  18. 18.
    Taylor BN, Kuyatt CE (1994) Guidelines for evaluating and expressing the uncertainty of NIST measurement results. NIST Technical 14–15Google Scholar
  19. 19.
    Fleiss IL (1981) Statistical methods for rates and proportions, 2nd edn. Wiley, New YorkGoogle Scholar
  20. 20.
    Mileman PA, van den Hout WB (2002) Comparing the accuracy of Dutch dentists and dental students in the radiographic diagnosis of dentinal caries. Dentomaxillofac Radiol 31:7–14CrossRefPubMedGoogle Scholar
  21. 21.
    Swenson E, Hennessy B (2009) Detection of occlusal carious lesions: an in vitro comparison of clinicians’ diagnostic abilities at varying levels of experience. Gen Dent 57:60–66 quiz 67–68, 95–96PubMedGoogle Scholar
  22. 22.
    Berry HMJ (1983) Cervical burnout and Mach band: two shadows of doubt in radiologic interpretation of carious lesions. J Am Dent Assoc 106:622–625PubMedGoogle Scholar
  23. 23.
    Kay EJ, Watts A, Paterson RC, Blinkhorn AS (1988) Preliminary investigation into the validity of dentists’ decisions to restore occlusal surfaces of permanent teeth. Community Dent Oral Epidemiol 16:91–94CrossRefPubMedGoogle Scholar
  24. 24.
    Kay EJ, Knill-Jones R (1992) Variation in restorative treatment decisions: application of receiver operating characteristic curve (ROC) analysis. Community Dent Oral Epidemiol 20:113–117CrossRefPubMedGoogle Scholar
  25. 25.
    Rocha ASPS, Almeida SM, Bóscolo FN, Haiter Neto F (2005) Interexaminer agreement in caries radiographic diagnosis by conventional and digital radiographs. J Appl Oral Sci 13:329–333CrossRefPubMedGoogle Scholar
  26. 26.
    Deep P, Petropoulos D (2003) Effect of illumination on the accuracy of identifying interproximal carious lesions on bitewings radiographs. J Can Dent Assoc 69:444–446PubMedGoogle Scholar
  27. 27.
    Rodrigues JA, Hug I, Diniz MB, Lussi A (2008) Performance of fluorescence methods, radiographic examination and ICDAS II on occlusal surfaces in vitro. Caries Res 42:297–304CrossRefPubMedGoogle Scholar
  28. 28.
    Russell M, Pitts NB (1993) Radiovisiographic diagnosis of dental caries: initial comparison of basic mode video prints with bitewing radiography. Caries Res 27:65–70CrossRefPubMedGoogle Scholar
  29. 29.
    Ricketts DN, Whaites EJ, Kidd EA, Brown JE, Wilson RF (1997) An evaluation of the diagnostic yield from bitewing radiographs of small approximal and occlusal carious lesions in a low prevalence sample in vitro using different film types and speeds. Br Dent J 182:51–58PubMedGoogle Scholar
  30. 30.
    Ashley PF, Blinkhorn AS, Davies RM (1998) Occlusal caries diagnosis: an in vitro histological validation of the electronic caries monitor (ECM) and other methods. J Dent 26:83–88CrossRefPubMedGoogle Scholar
  31. 31.
    Ekstrand KR, Ricketts DN, Kidd EA (1997) Reproducibility and accuracy for assessment of demineralization depth of the occlusal surface: an in vitro examination. Caries Res 31:224–231CrossRefPubMedGoogle Scholar
  32. 32.
    Lussi A, Firestone A, Schoenberg V, Hotz P, Stich H (1995) In vivo diagnosis of fissure caries using a new electrical resistance monitor. Caries Res 29:81–87CrossRefPubMedGoogle Scholar
  33. 33.
    Ricketts D, Kidd E, Smith B, Wilson R (1994) Radiographic detection of occlusal caries: effect of X-ray beam factors on diagnosis. Eur J Prosthodont Restor Dent 2:149–154PubMedGoogle Scholar
  34. 34.
    Wenzel A, Verdonschot EH, Truin GJ, König KG (1992) Accuracy of visual inspection, fiber-optic transillumination, and various radiographic image modalities for the detection of occlusal caries in extracted non-cavitated teeth. J Dent Res 71:1934–1937PubMedGoogle Scholar
  35. 35.
    Pitts NB, Fyffe HE (1991) Scottish dentists’ use and opinions regarding bitewing radiography. Dentomaxillofac Radiol 20:214–218PubMedGoogle Scholar
  36. 36.
    Downer MC (1989) Validation of methods used in dental caries diagnosis. Int Dent J 39:241–246PubMedGoogle Scholar
  37. 37.
    Ricketts DN, Ekstrand KR, Kidd EA, Larsen T (2002) Relating visual and radiographic ranked scoring systems for occlusal caries detection to histological and microbiological evidence. Oper Dent 27:231–237PubMedGoogle Scholar
  38. 38.
    Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36PubMedGoogle Scholar
  39. 39.
    Nytun RB, Raadal M, Espelid I (1992) Diagnosis of dentin involvement in occlusal caries based on visual and radiographic examination of the teeth. Scand J Dent Res 100:144–148PubMedGoogle Scholar
  40. 40.
    Verdonschot EH, Wenzel A, Bronkhorst EM (1993) Assessment of diagnostic accuracy in caries detection: an analysis of two methods. Community Dent Oral Epidemiol 21:203–208CrossRefPubMedGoogle Scholar
  41. 41.
    Angnes V, Angnes G, Batistella M, Grande RHM, Loguercio AD (2005) Clinical effectiveness of laser fluorescence, visual inspection and radiography in the detection of occlusal caries. Caries Res 39:490–495CrossRefPubMedGoogle Scholar
  42. 42.
    Verdonschot EH, Wenzel A, Truin GJ, König KG (1993) Performance of electrical resistance measurements adjunct to visual inspection in the early diagnosis of occlusal caries. J Dent 21:332–337CrossRefPubMedGoogle Scholar
  43. 43.
    Bader JD, Shugars DA (1992) Understanding dentists’ restorative treatment decisions. J Public Health Dent 52:102–110CrossRefPubMedGoogle Scholar
  44. 44.
    Gröndhal HG (1979) Some factors influencing observer performance in radiographic caries diagnosis. Swed Dent J 3:157–172Google Scholar

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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