The effects of orthodontic materials on the accuracy of periapical radiography-based caries detection



To investigate the influence of orthodontic materials on the assessment of proximal caries using periapical radiography.


Forty non-cavitated and restoration-free human premolars and molars ranging from sound teeth to teeth containing various grades of lesions were embedded with approximal contacts into silicon blocks. Periapical radiographs were obtained using combinations of two orthodontic materials (three bracket and two archwires). Images were obtained using a Planmeca ProX (Planmeca®, Helsinki, Finland). Two observers assessed the images. Intraobserver and interobserver agreement was computed using an intraclass correlation coefficient. Receiver operating characteristic (ROC) analysis was used to calculate the true positive value, true negative value, and the area under the ROC curve (AUC).


Intraobserver agreement ranged from 0.483 to 0.768. Interobserver agreement ranged from 0.383 to 0.718. The AUC, sensitivity and specificity were 0.792, 71.23% and 87.10% in the control group (without bracketing), respectively. The highest area under the curve (AUC) value (0.792) was obtained from the without bracket group. The lowest AUC value (0.659) belonged to the stainless steel bracket and steel wire group. A decrease in the AUC values was observed for the control group (without bracketing) compared to the stainless steel bracket and steel wire group (P = 0.040).


The addition of a stainless steel bracket with stainless steel wire combination makes it difficult to the diagnose the interproximal tooth caries by periapical radiography.

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Correspondence to Ozlem Isman.

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Ozlem Isman and Seda Kayar declare that they have no conflict of interest.

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All procedures followed were in accordance with the ethical standards of the responsible committee (institutional and national) and with the Helsinki Declaration of 1964 and later versions. The study protocol was approved by the Local Research Ethics Committee of Gaziantep University Faculty of Medicine Ethic Committee. This article does not contain any studies with animal subjects performed by any of the authors.

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Isman, O., Kayar, S. The effects of orthodontic materials on the accuracy of periapical radiography-based caries detection. Oral Radiol 36, 349–355 (2020).

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  • Caries
  • Periapical radiography
  • Oral diagnosis
  • Orthodontic brackets