Journal of Digital Imaging

, Volume 24, Issue 5, pp 804–813 | Cite as

Occlusal Caries Depth Measurements Obtained by Five Different Imaging Modalities

  • Kıvanç Kamburoğlu
  • Hakan Kurt
  • Eray Kolsuz
  • Bengi Öztaş
  • İlkan Tatar
  • Hakan Hamdi Çelik


The study aimed to assess the accuracy and reproducibility of occlusal caries depth measurements obtained from different imaging modalities. The study comprised 21 human mandibular molar teeth with occlusal caries. Teeth were imaged using film, CCD, two different cone-beam computerized tomography (CBCT) units and a microcomputer tomography (micro-CT). Thereafter, each tooth was serially sectioned, and the section with the deepest carious lesion was scanned using a high-resolution scanner. Each image set was separately viewed by three oral radiologists. Images were viewed randomly, and each set was viewed twice. Lesion depth was measured on film images using a digital caliper, on CCD and CBCT images using built-in measurement tools, on micro-CT images using the Mimics software program, and on histological images using AxioVision Rel. 4.7. Intra- and inter-rater reliabilities were assessed according to the Bland/Altman method by calculating Intraclass Correlation Coefficients (ICCs). Mean/median values obtained with intraoral systems were lower than those obtained with 3-D and histological images for all observers and both readings. Intra-observer ICC values for all observers were highest for histology and micro-CT. In addition, intra-observer ICC values were higher for histology and CBCT than for histology and intra-oral methods. Inter-observer ICC values for first and second readings were high for all observers. No differences in repeatability were found between Accuitomo and Iluma CBCT images or between intra-oral film and CCD images. Micro-CT was found to be the best imaging method for the ex vivo measurement of occlusal caries depth. In addition, both CBCT units performed similarly and better than intra-oral modalities.


Occlusal caries Depth measurement CBCT Micro-CT Radiography 


  1. 1.
    Poorterman JHG, Weerheijm KL, Groen HJ, Kalsbeek H: Clinical and radiographic judgment of occlusal caries in adolescents. Eur J Oral Sci 108:93–98, 2000PubMedCrossRefGoogle Scholar
  2. 2.
    Dowker SEP, Elliott JC, Davis GR, Wilson RM, Cloetens P: Three-dimensional study of human dental fissure enamel by synchrotron X-ray microtomography. Eur J Oral Sci 114(Suppl. 1):353–359, 2006PubMedCrossRefGoogle Scholar
  3. 3.
    Shi XQ, Welander U, Angmar-Mansson B: Occlusal caries detection with KaVo DIAGNOdent and radiography: an in vitro comparison. Caries Res 34:151–158, 2000PubMedCrossRefGoogle Scholar
  4. 4.
    Kühnisch J, Dietz W, Stösser L, Hickel R, Heinrich-Weltzien R: Effects of dental probing on occlusal surfaces—a scanning electron microscopy evaluation. Caries Res 41:43–48, 2007PubMedCrossRefGoogle Scholar
  5. 5.
    Souza-Zaroni WC, Ciccone JC, Souza-Gabriel AE, Ramos RP, Corona SAM, Palma-Dibb RG: Validity and reproducibility of different combinations of methods for occlusal caries detection: an in vitro comparison. Caries Res 40:194–201, 2006PubMedCrossRefGoogle Scholar
  6. 6.
    Hamilton JC, Gregory WA, Valentine JB: DIAGNOdent measurements and correlation with the depth and volume of minimally invasive cavity preparations. Oper Dent 31:291–296, 2006PubMedCrossRefGoogle Scholar
  7. 7.
    Jablonski-Momeni A, Stachniss V, Ricketts DN, Heinzel-Gutenbrunner M, Pieper K: Reproducibility and accuracy of the ICDAS-II for detection of occlusal caries in vitro. Caries Res 42:79–87, 2008PubMedCrossRefGoogle Scholar
  8. 8.
    Rodrigues JA, Hug I, Diniz MB, Lussi A: Performance of fluorescence methods, radiographic examination and ICDAS II on occlusal surfaces in vitro. Caries Res 42:297–304, 2008PubMedCrossRefGoogle Scholar
  9. 9.
    Abalos C, Herrera M, Jimenez-Planas A, Llamas R: Performance of laser fluorescence for detection of occlusal dentinal caries lesions in permanent molars: an in vivo study with total validation of the sample. Caries Res 43:137–141, 2009PubMedCrossRefGoogle Scholar
  10. 10.
    Hintze H, Wenzel A: Clinical and laboratory radiographic caries diagnosis. A study same teeth. Dentomaxillofac Radiol 25:115–118, 1996PubMedGoogle Scholar
  11. 11.
    Kositbowornchai S, Basiw M, Promwang Y, Moragorn H, Sooksuntisakoonchai N: Accuracy of diagnosing occlusal caries using enhanced digital images. Dentomaxillofac Radiol 33:236–240, 2004PubMedCrossRefGoogle Scholar
  12. 12.
    Ricketts DNJ, Ekstrand KR, Martignon S, Ellwood R, Alatsaris M, Nugent Z: Accuracy and reproducibility of conventional radiographic assessment and subtraction radiography in detecting demineralization in occlusal surfaces. Caries Res 41:121–128, 2007PubMedCrossRefGoogle Scholar
  13. 13.
    Pereira AC, Eggertsson H, Martinez-Mier EA, Mialhe FL, Eckert GJ, Zero DT: Validity of caries detection on occlusal surfaces and treatment decisions based on results from multiple caries-detection methods. Eur J Oral Sci 117:51–57, 2009PubMedCrossRefGoogle Scholar
  14. 14.
    Kühnisch J, Ifland S, Tranaeus S, Heinrich-Weltzien R: Comparison of visual inspection and different radiographic methods for dentin caries detection on occlusal surfaces. Dentomaxillofac Radiol 38:452–457, 2009PubMedCrossRefGoogle Scholar
  15. 15.
    Kamburoğlu K, Şenel B, Yüksel SP, Özen T: A comparison of the diagnostic accuracy of in vivo and in vitro photostimulable phosphor digital images in the detection of occlusal caries lesions. Dentomaxillofac Radiol 39:17–22, 2010PubMedCrossRefGoogle Scholar
  16. 16.
    Scarfe WC, Farman AG: What is cone-beam CT and how does it work? Dent Clin North Am 52:707–730, 2008PubMedCrossRefGoogle Scholar
  17. 17.
    Tyndall DA, Rathore S: Cone-beam CT diagnostic applications: caries, periodontal bone assessment, and endodontic applications. Dent Clin North Am 52:825–841, 2008PubMedCrossRefGoogle Scholar
  18. 18.
    Akdeniz BG, Gröndahl HG, Magnusson B: Accuracy of proximal caries depth measurements: comparison between limited cone beam computed tomography, storage phosphor and film radiography. Caries Res 40:202–207, 2006PubMedCrossRefGoogle Scholar
  19. 19.
    Kamburoğlu K, Murat S, Yüksel SP, Cebeci ARİ, Paksoy CS: Occlusal caries detection by using a cone-beam CT with different voxel resolutions and a digital intraoral sensor. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:e63–e69, 2010PubMedCrossRefGoogle Scholar
  20. 20.
    Haiter-Neto F, Wenzel A, Gotfredsen E: Diagnostic accuracy of cone beam computed tomography scans compared with intraoral image modalities for detection of caries lesions. Dentomaxillofac Radiol 37:18–22, 2008PubMedCrossRefGoogle Scholar
  21. 21.
    Young SM, Lee JT, Hodges RJ, Chang TL, Elashoff DA, White SC: A comparative study of high-resolution cone beam computed tomography and charge-coupled device sensors for detecting caries. Dentomaxillofac Radiol 38:445–451, 2009PubMedCrossRefGoogle Scholar
  22. 22.
    Jablonski-Momeni A, Ricketts DNJ, Stachniss V, Maschka R, Heinzel-Gutenbrunner M, Pieper K: Occlusal caries: evaluation of direct microscopy versus digital imaging used for two histological classification systems. J Dent 37:204–211, 2009PubMedCrossRefGoogle Scholar
  23. 23.
    Schwass DR, Swain MV, Purton DG, Leichter JW: A system of calibrating microtomography for use in caries research. Caries Res 43:314–321, 2009PubMedCrossRefGoogle Scholar
  24. 24.
    Kamburoğlu K, Barenboim SF, Arıtürk T, Kaffe I: Quantitative measurements obtained by micro-computed tomography and confocal laser scanning microscopy. Dentomaxillofac Radiol 37:385–391, 2008PubMedCrossRefGoogle Scholar
  25. 25.
    Neves Ade A, Coutinho E, Cardoso MV, Jaecques SV, Van Meerbeek B: Micro- CT based quantitative evaluation of caries excavation. Dent Mater 26:579–588, 2010PubMedCrossRefGoogle Scholar
  26. 26.
    Spiguel MH, Tovo MF, Kramer PF, Franco KS, Alves KMPR, Delbem ACB: Evaluation of laser fluorescence in the monitoring of the initial stage of the de-/remineralization process: an in vitro and in situ study. Caries Res 43:302–307, 2009PubMedCrossRefGoogle Scholar
  27. 27.
    Kühnisch J, Heinrich-Weltzien R, Tabatabaie M, Stösser L, Huysmans MCDNJM: An in vitro comparison between two methods of electrical resistance measurement for occlusal caries detection. Caries Res 40:104–111, 2006PubMedCrossRefGoogle Scholar
  28. 28.
    Verdonschot EH, Wenzel A, Truin GJ, König KG: Performance of electrical resistance measurements adjunct visual inspection in the early diagnosis of occlusal caries. J Dent 21:332–337, 1993PubMedCrossRefGoogle Scholar
  29. 29.
    Zakian CM, Taylor AM, Ellwood RP, Pretty IA: Occlusal caries detection by using thermal imaging. J Dent 38:788–795, 2010PubMedCrossRefGoogle Scholar
  30. 30.
    Lofthag-Hansen S, Thilander-Klang A, Ekestubbe A, Helmrot E, Gröndahl K: Calculating effective dose on a cone beam computed tomography device: 3D Accuitomo and 3D Accuitomo FPD. Dentomaxillofac Radiol 37:72–79, 2008PubMedCrossRefGoogle Scholar
  31. 31.
    Ludlow JB, Ivanovic M: Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 106:106–114, 2008PubMedCrossRefGoogle Scholar

Copyright information

© Society for Imaging Informatics in Medicine 2010

Authors and Affiliations

  • Kıvanç Kamburoğlu
    • 1
  • Hakan Kurt
    • 1
  • Eray Kolsuz
    • 1
  • Bengi Öztaş
    • 1
  • İlkan Tatar
    • 2
  • Hakan Hamdi Çelik
    • 2
  1. 1.Department of Oral and Maxillofacial Radiology, Faculty of DentistryAnkara UniversityAnkaraTurkey
  2. 2.Department of Anatomy, Faculty of MedicineHacettepe UniversityAnkaraTurkey

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