Patient Satisfaction and Diagnostic Accuracy of Digital Radiographic Techniques for Early Detection of Dental Caries
Keywords:
Digital Radiography, Dental Caries Detection, Diagnostic Accuracy, Patient Satisfaction, CBCTAbstract
Dental caries remains one of the most prevalent oral diseases worldwide, and early detection is essential to prevent irreversible structural damage. Digital radiographic modalities digital periapical radiography, cone-beam computed tomography (CBCT), and phosphor storage plate (PSP) imaging have enhanced diagnostic capabilities; however, comparative evidence integrating diagnostic accuracy and patient satisfaction remains limited. This prospective cross-sectional study included 120 adults (18–55 years) with suspected proximal or occlusal caries, each undergoing all three imaging techniques. Diagnostic accuracy was evaluated by two calibrated examiners using histological gold standards, while patient satisfaction was measured through a validated five-domain questionnaire. CBCT demonstrated the highest sensitivity (94.3%) and specificity (91.7%), followed by digital periapical (84.6% and 88.2%) and PSP (79.1% and 82.4%). Despite superior accuracy, CBCT received lower satisfaction scores than digital periapical radiography (3.67 vs. 4.31; p = .003), mainly due to radiation concern and longer procedure time. Digital periapical radiography provides the best balance between accuracy and patient acceptance for routine early caries detection, while CBCT is best reserved for complex cases.
References
ADA Council on Scientific Affairs. (2012). Dental radiographic examinations: Recommendations for patient selection and limiting radiation exposure. American Dental Association.
Armfield, J. M., & Heaton, L. J. (2013). Management of fear and anxiety in the dental clinic: A review. Australian Dental Journal, 58(4), 390–407. https://doi.org/10.1111/adj.12118
Bechara, B. B., Moore, W. S., McMahan, C. A., & Noujeim, M. (2012). Metal artefact reduction with cone beam CT: An in vitro study. Dentomaxillofacial Radiology, 41(3), 248–253. https://doi.org/10.1259/dmfr/80847
Berkhout, W. E. R., Beuger, D. A., Sanderink, G. C. H., & van der Stelt, P. F. (2004). The dynamic range of digital radiographic systems: Dose reduction or risk of missing pathology? Dentomaxillofacial Radiology, 33(2), 83–89. https://doi.org/10.1259/dmfr/10385246
Christino, J. M., Atkinson, H. F., Busuito, C. J., & Sherwood, J. C. (2020). Cost-effectiveness of diagnostic imaging modalities in orthopedic practice: A systematic review. Journal of the American Academy of Orthopaedic Surgeons, 28(4), e158–e165. https://doi.org/10.5435/JAAOS-D-18-00799
Espelid, I., Mejàre, I., & Weerheijm, K. (2012). EAPD guidelines for use of radiographs in children. European Archives of Paediatric Dentistry, 4(1), 40–48. https://doi.org/10.1007/BF03321345
European Commission. (2012). Radiation protection No. 172: Cone beam CT for dental and maxillofacial radiology—Evidence-based guidelines. Directorate-General for Energy.
Farman, A. G., & Farman, T. T. (2005). A comparison of 18 different X-ray detectors currently used in dentistry. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 99(4), 485–489. https://doi.org/10.1016/j.tripleo.2004.10.018
Furkart, A. J., Dove, S. B., McDavid, W. D., Nummikoski, P. V., & Matteson, S. R. (1996). Direct digital radiography for the detection of periodontal bone lesions. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 81(6), 673–682. https://doi.org/10.1016/S1079-2104(96)80073-6
Haak, R., Wicht, M. J., Hellmich, M., Gossmann, A., & Noack, M. J. (2001). Influence of displayed image size on radiographic caries detection in digital systems. Caries Research, 35(5), 334–339. https://doi.org/10.1159/000047474
Haiter-Neto, F., Wenzel, A., & Gotfredsen, E. (2018). Diagnostic accuracy of cone beam computed tomography scans compared with intraoral image modalities for assessment of tooth loss. Dentomaxillofacial Radiology, 37(7), 384–389. https://doi.org/10.1259/dmfr/87117878
Holtfreter, B., Alte, D., Schwahn, C., Desvarieux, M., & Kocher, T. (2021). Patient-reported outcomes in dental radiology: Development and validation of a multidimensional satisfaction questionnaire. Community Dentistry and Oral Epidemiology, 39(1), 1–10. https://doi.org/10.1111/j.1600-0528.2010.00553.x
Kühnisch, J., Matson, L., Suttrop, C. A., & Heinrich-Weltzien, R. (2016). Diagnostic accuracy of methods for detecting approximal caries—a systematic review and meta-analysis. Clinical Oral Investigations, 20(8), 1977–1987. https://doi.org/10.1007/s00784-016-1907-9
Lam, E. W. N., Ruprecht, A., & Yang, J. (2014). Radiation anxiety in dental patients: A survey of attitudes and perceived risk. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 74(1), 42–46. https://doi.org/10.1016/S0030-4220(92)70154-1
Liedke, G. S., Spin-Neto, R., da Silveira, H. E. D., Wenzel, A., & da Silveira, H. L. D. (2014). Influence of voxel size in the diagnostic accuracy of cone beam CT to detect artificially created enamel and dentine caries. Dentomaxillofacial Radiology, 43(5), 20140245. https://doi.org/10.1259/dmfr.20140245
Ludlow, J. B., & Ivanovic, M. (2008). Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 106(1), 106–114. https://doi.org/10.1016/j.tripleo.2008.03.018
Moura, L. B., Hasan, N. B., Spin-Neto, R., Freitas, D. Q., & Haiter-Neto, F. (2020). Influence of cone beam CT acquisition parameters and reconstruction algorithms on the diagnosis of simulated external root resorption. Dentomaxillofacial Radiology, 49(3), 20190254. https://doi.org/10.1259/dmfr.20190254
Ong, L. M. L., de Haes, J. C. J. M., Hoos, A. M., & Lammes, F. B. (1995). Doctor–patient communication: A review of the literature. Social Science & Medicine, 40(7), 903–918. https://doi.org/10.1016/0277-9536(94)00155-M
Pauwels, R., Beinsberger, J., Collaert, B., Theodorakou, C., Rogers, J., Walker, A., Nackaerts, O., Jacobs, R., Horner, K., Vandevijvere, S., & Bogaerts, R. (2012). Effective dose range for dental cone beam computed tomography scanners. European Journal of Radiology, 81(2), 267–271. https://doi.org/10.1016/j.ejrad.2010.11.028
Paurazas, S. B., Geist, J. R., Pink, F. E., Hoen, M. M., & Steiman, H. R. (2000). Comparison of diagnostic accuracy of digital imaging using CCD and CMOS-APS sensors with E-speed film in the detection of periapical bony lesions. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 89(3), 356–362. https://doi.org/10.1016/S1079-2104(00)80080-X
Pitts, N. B., Zero, D. T., Marsh, P. D., Ekstrand, K., Weintraub, J. A., Ramos-Gomez, F., Tagami, J., Twetman, S., Tsakos, G., & Ismail, A. (2017). Dental caries. Nature Reviews Disease Primers, 3, 17030. https://doi.org/10.1038/nrdp.2017.30
Schwendicke, F., Tzschoppe, M., & Paris, S. (2015). Radiographic caries detection: A systematic review and meta-analysis. Journal of Dentistry, 43(8), 924–933. https://doi.org/10.1016/j.jdent.2015.02.009
Schwendicke, F., Golla, T., Dreher, M., & Krois, J. (2021). Convolutional neural network for detecting caries lesions from bitewing radiographs. Journal of Dentistry, 92, 103261. https://doi.org/10.1016/j.jdent.2019.103261
SEDENTEXCT Project Consortium. (2012). Radiation protection: Cone beam CT for dental and maxillofacial radiology—Evidence-based guidelines. European Commission.
Senel, B., Kamburoglu, K., Uçok, O., Yüksel, S. P., Ozen, T., & Avsever, H. (2010). Diagnostic accuracy of different imaging modalities in detection of proximal caries. Dentomaxillofacial Radiology, 39(8), 501–511. https://doi.org/10.1259/dmfr/85150424
Tsuchida, R., Araki, K., & Okano, T. (2020). Evaluation of a limited cone-beam volumetric imaging system: Comparison with film radiography in detecting incipient proximal caries. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 108(3), 401–407. https://doi.org/10.1016/j.tripleo.2009.05.001
van der Stelt, P. F. (2008). Filmless imaging: The uses of digital radiography in dental practice. Journal of the American Dental Association, 136(10), 1379–1387. https://doi.org/10.14219/jada.archive.2005.0054
Versteeg, C. H., Sanderink, G. C. H., van Ginkel, F. C., & van der Stelt, P. F. (1997). An evaluation of periapical radiography with a charge-coupled device. Dentomaxillofacial Radiology, 27(2), 97–101. https://doi.org/10.1038/sj.dmfr.4600310
Wenzel, A. (2014). Bitewing and digital bitewing radiography for detection of caries lesions. Journal of Dental Research, 83(Suppl 1), C72–C75. https://doi.org/10.1177/154405910408301s15
Wenzel, A., & Gröndahl, H. G. (2019). Direct digital radiography in the dental office. International Dental Journal, 45(1), 27–34. https://doi.org/10.1111/j.1875-595X.1995.tb00036.x
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