Influence of scan setting selections on root canal visibility with cone beam CT

Objectives

The aim of this study was to assess the influence of scan setting selection, including field of view (FOV) ranging from small to large, number of projections and scan modes on the visibility of the root canal with cone beam CT (CBCT).

Methods

One human mandible cadaver was scanned with CBCT (Accuitomo 170; J Morita MPG Corp., Kyoto, Japan) using six different FOVs (4×4 cm, 6×6 cm, 8×8 cm, 10×10 cm, 14×10 cm and 17×12 cm) with either 360 or 180 projections in standard and high resolution. The right canine was selected for evaluation. Ten observers independently assessed the visibility of the canal space and overall image quality on a five-point scale.

Results

The results indicate that both selections of FOV and number of projections have significant influence on root canal visibility (p = 0.0001), whereas scan mode, whether standard or high resolution, was less relevant (p = 0.34).

Conclusions

The smallest FOV available should always be used for endodontic applications, and it is not recommended to reduce the number of projections to 180. Using the standard scan mode instead of high resolution does not negatively influence the visibility of the root canal space and is therefore recommended.     

Detection accuracy of condylar defects in cone beam CT images scanned with different resolutions and units

Objectives:

To assess the impact of spatial resolution and cone beam CT (CBCT) unit on CBCT images for the detection accuracy of condylar defects.

Methods:

42 temporomandibular joints were scanned, respectively, with the CBCT units ProMax® 3D (Planmeca Oy, Helsinki, Finland) and DCT PRO (Vatech, Co., Ltd., Yongin-Si, Republic of Korea) at normal and high resolutions. Seven dentists evaluated all the test images with respect to the presence or the absence of condylar defects. Receiver operating characteristic curve analysis was employed to define the detection accuracy. Two-way analysis of variance was used to analyse the values under the receiver operating characteristic curves for the differences among imaging groups and observers. Intraobserver variation was analysed using the Wilcoxon test.

Results:

Macroscopic anatomy examination revealed that, of the 42 temporomandibular joint condylar surfaces, 18 were normal and 24 had defects on the surface of condyles. No significant differences were found between the images scanned with normal and high resolutions for both CBCT units ProMax 3D (p = 0.119) and DCT PRO (p = 0.740). Significant differences exist between image groups of DCT PRO and ProMax 3D (p < 0.05). Neither the inter- nor the intraobserver variability were significant.

Conclusions:

The spatial resolution per se did not have an impact on the detection accuracy of condylar defects. The detection accuracy of condylar defects highly depends on the CBCT unit used for examination.     

Assessment of vertical root fractures using three imaging modalities: cone beam CT, intraoral digital radiography and film

Objectives

The aim of this study was to assess the accuracy of cone beam CT (CBCT) in detecting vertical root fractures and to compare the accuracy with images from an intraoral sensor and from conventional intraoral film.

Methods

60 extracted, single-rooted human teeth were divided equally into two groups: a control group of 30 teeth and an induced fracture group of 30 teeth. All teeth were randomly placed into sockets in six dry mandibles. Each tooth was imaged by three modalities: CBCT, intraoral digital radiography and intraoral F-speed film. Three beam angulations (an orthogonal projection and additional projections with ±20° horizontal shifts of the central ray) were used when radiographs were made using film and a digital sensor. Three oral and maxillofacial radiologists evaluated the presence of root fractures twice in each image modality using a five-point confidence rating scale. Areas under receiver operating characteristic curves (A_z) were computed for each observer and modality and were tested for statistical differences using the Kruskal–Wallis test.

Results

There was no statistical difference in the performance of the three modalities (mean of A_z values: CBCT = 0.811, film = 0.797 and sensor = 0.775; p = 0.771).

Conclusions

There was no significant difference between intraoral film, a high-resolution complementary metal oxide semiconductor digital imaging system and CBCT in detecting vertical root fractures in mandibular single-rooted teeth.     

Influence of CBCT enhancement filters on diagnosis of vertical root fractures: a simulation study in endodontically treated teeth with and without intracanal posts

Objectives:

To evaluate the influence of CBCT enhancement filters on the diagnosis of vertical root fractures (VRFs) in teeth with and without metal posts.

Methods:

The crowns of 40 uniradicular human teeth were removed and all roots were prepared. 20 teeth were randomly selected, and VRFs were induced using a universal testing machine. The i-CAT (Imaging Sciences International, Hatfield, PA) CBCT was used to scan teeth with and without intracanal metal posts using the following parameters: 0.2 voxel size, 8 × 8-cm scan size and acquisition time of 26.9 s. Images were evaluated by three observers with and without the use of the following filters: S9, smooth, smooth 3 × 3, sharpen, sharpen-mild and sharpen 3 × 3.

Results:

Intra- and interobserver agreement ranged from poor to moderate. Images with and without CBCT filters did not show significant differences regarding the area under the receiver operating characteristic curve, as well as sensitivity (p > 0.05). As for accuracy, the sharpen-mild filter was superior to the sharpen (p = 0.03), but these filters did not differ from all others. For specificity, S9, smooth and original images were superior to sharpen (p < 0.01). Results for teeth without posts differed from those for teeth with metal posts in all cases (p < 0.05).

Conclusions:

The use of enhancement filters in CBCT images has no influence on the diagnosis of VRFs in teeth with metal posts, and their use is not justified.     

Accuracy of three cone-beam CT devices and two software systems in the detection of vertical root fractures

Objectives :The aim of this study was to compare the accuracy of vertical root fracture (VRF) detection using three tomography devices and two software systems in teeth with different endodontic fillings.Methods:The sample consisted of 45 premolars divided into 3 groups: No filling (NF, n=15); Gutta percha (GP, n=15) and Metallic Post (MP, n=15). Cone-beam computed tomography (CBCT) images were acquired in Kodak 9000 3D, Orthopantomography 300 (OP300) and PreXion 3D devices, before and after induced root fractures. Two oral radiologists analyzed all images using InVivoDental and e-Vol DX software systems. The analysis was repeated after 15 days in 30% of the sample. Data analysis compared receiver operating characteristic (ROC) curves, as well the areas under the ROC curves. Accuracy, sensitivity, specificity, positive and negative predictive value were calculated according to each tomographic device and software. Intra- and interexaminer reliability were tested using the Kappa coefficient.Results:The highest accuracy was seen in the image set from the PreXion 3D, using InVivo (0.96) or e-Vol DX (0.92) in image analysis. The OP300 device presented a similar performance of the PreXion 3D in teeth with different endodontic fillings. When using e-Vol DX, the accuracy of Kodak 9000 3D improved from 0.62 to 0.74.Conclusions:The PreXion 3D device is the most accurate when detecting VRF, with a performance similar to the OP300 in endodontic filled teeth. Kodak 9000 3D is indicated for teeth without fillings, with better accuracy using e-Vol DX software.     

Effect of voxel size on the accuracy of 3D reconstructions with cone beam CT

Objectives

The various types of cone beam CT (CBCT) differ in several technical characteristics, notably their spatial resolution, which is defined by the acquisition voxel size. However, data are still lacking on the effects of voxel size on the metric accuracy of three-dimensional (3D) reconstructions. This study was designed to assess the effect of isotropic voxel size on the 3D reconstruction accuracy and reproducibility of CBCT data.

Methods

The study sample comprised 70 teeth (from the Institut d’Anatomie Normale, Strasbourg, France). The teeth were scanned with a KODAK 9500 3D® CBCT (Carestream Health, Inc., Marne-la-Vallée, France), which has two voxel sizes: 200 µm (CBCT 200 µm group) and 300 µm (CBCT 300 µm group). These teeth had also been scanned with the KODAK 9000 3D® CBCT (Carestream Health, Inc.) (CBCT 76 µm group) and the SCANCO Medical micro-CT XtremeCT (SCANCO Medical, Brüttisellen, Switzerland) (micro-CT 41 µm group) considered as references. After semi-automatic segmentation with AMIRA® software (Visualization Sciences Group, Burlington, MA), tooth volumetric measurements were obtained.

Results

The Bland–Altman method showed no difference in tooth volumes despite a slight underestimation for the CBCT 200 µm and 300 µm groups compared with the two reference groups. The underestimation was statistically significant for the volumetric measurements of the CBCT 300 µm group relative to the two reference groups (Passing–Bablok method).

Conclusions

CBCT is not only a tool that helps in diagnosis and detection but it has the complementary advantage of being a measuring instrument, the accuracy of which appears connected to the size of the voxels. Future applications of such measurements with CBCT are discussed.     

Detection of dental root fractures by using cone-beam computed tomography

OBJECTIVES: The purpose of this study was to compare the diagnostic accuracy of cone beam CT (CBCT) with that of conventional dental radiography in the detection of root fractures and to evaluate the influence of root canal fillings on root fracture detection. METHODS: We investigated 128 patients with clinically suspected root fractures in 135 teeth. These patients underwent conventional dental radiography, CBCT and eventually surgical exploration. Among the 135 teeth, 86 were non-endodontically treated teeth and 49 were endodontically treated teeth. Two oral radiologists independently analysed the dental radiographs and CBCT images of each patient and reached a consensus. The CBCT findings of root fractures were set as the detection of a separation of the adjacent root segments on at least two contiguous sections and on at least two of the three-dimensional (3D) planes. Results: Root fracture was intraoperatively detected in 95 of the 135 teeth. The sensitivity and specificity of root fractures diagnosed on the basis of the consensus between the 2 evaluators were 26.3% and 100%, respectively, for dental radiography and 89.5% and 97.5%, respectively, for CBCT. CBCT was significantly more accurate than dental radiography in detecting root fractures (P < 0.001). The sensitivity of CBCT was reduced in the presence of root canal fillings but its specificity remained unaffected. Both the sensitivity and specificity of dental radiography were not influenced by the presence of root canal fillings. Conclusions: CBCT appears to be more accurate than conventional dental radiography in the detection of root fractures.     

Effect of electric potential and current on mandibular linear measurements in cone beam CT

Objectives

The purpose of this study was to compare mandibular linear distances measured from cone beam CT (CBCT) images produced by different radiographic parameter settings (peak kilovoltage and milliampere value).

Methods

20 cadaver hemimandibles with edentulous ridges posterior to the mental foramen were embedded in clear resin blocks and scanned by a CBCT machine (CB MercuRay^TM; Hitachi Medico Technology Corp., Chiba-ken, Japan). The radiographic parameters comprised four peak kilovoltage settings (60 kVp, 80 kVp, 100 kVp and 120 kVp) and two milliampere settings (10 mA and 15 mA). A 102.4 mm field of view was chosen. Each hemimandible was scanned 8 times with 8 different parameter combinations resulting in 160 CBCT data sets. On the cross-sectional images, six linear distances were measured. To assess the intraobserver variation, the 160 data sets were remeasured after 2 weeks. The measurement precision was calculated using Dahlberg''s formula. With the same peak kilovoltage, the measurements yielded by different milliampere values were compared using the paired t-test. With the same milliampere value, the measurements yielded by different peak kilovoltage were compared using analysis of variance. A significant difference was considered when p < 0.05.

Results

Measurement precision varied from 0.03 mm to 0.28 mm. No significant differences in the distances were found among the different radiographic parameter combinations.

Conclusions

Based upon the specific machine in the present study, low peak kilovoltage and milliampere value might be used for linear measurements in the posterior mandible.     

Evaluation of juxta-apical radiolucency in cone beam CT images

Objectives:

The aim of this study was to analyse the position and relationship of juxta-apical radiolucency (JAR) to the mandibular canal and buccal and/or lingual cortical plates using cone beam CT (CBCT).

Methods:

A retrospective study was carried out to analyse the JAR on CBCT for 27 patients. These findings were compared with 27 age- and sex-matched patients without the presence of JAR, which acted as the control group. The CBCT images were analysed according to a checklist, to evaluate the position of the JAR and its relationship to the mandibular canal. Then, any thinning or perforation of either the buccal or lingual cortical plate due to JAR was noted, and a classification to quantify the thinning of cortical plates was proposed. The findings in the two groups were analysed using a paired comparison by McNemar test.

Results:

A statistical increased thinning of cortical plates was seen in the JAR group compared with the control group, and most of the cases were in the J3 group. None of the patients in either the JAR or the control group showed perforation of the buccal and/or lingual cortical plate on CBCT images.

Conclusions:

A classification to quantify the thinning of cortical plates was proposed, which may be used for objective evaluation of the thinning of the cortical plates in future studies. The present study gives an insight into the relationship of the juxta-apical area with the mandibular canal and cortical plates in the mandible using CBCT.     

Comparison of linear and angular measurements using two-dimensional conventional methods and three-dimensional cone beam CT images reconstructed from a volumetric rendering program in vivo

Objective

The aim of this study was to compare the linear and angular measurements made on two-dimensional (2D) conventional cephalometric images and three-dimensional (3D) cone beam CT (CBCT) generated cephalograms derived from a 3D volumetric rendering program.

Methods

Pre-treatment cephalometric digital radiographs of 11 patients and their corresponding CBCT images were randomly selected. The digital cephalometric radiographs were traced using Vista Dent OC (GAC International, Inc Bohemia, NY) and by hand. CBCT and Maxilim® (Medicim, Sint-Niklass, Belgium) software were used to generate cephalograms from the CBCT data set that were then linked to the 3D hard-tissue surface representations. In total, 16 cephalometric landmarks were identified and 18 widely used measurements (11 linear and 7 angular) were performed by 2 independent observers. Intraobserver reliability was assessed by calculating intraclass correlation coefficients (ICC), interobserver reliability was assessed with Student t-test and analysis of variance (ANOVA). Mann–Whitney U-tests and Kruskal–Wallis H tests were also used to compare the three methods (P < 0.05).

Results

The results demonstrated no statistically significant difference between interobserver analyses for CBCT-generated cephalograms (P < 0.05), except for Gonion-Menton (Go-Me) and Condylion-Gnathion (Co-Gn). Intraobserver examinations showed low ICCs, which was an indication of poor reproducibility for Go-Me and Sella-Nasion (S-N) in CBCT-generated cephalograms and poor reproducibility for Articulare-Gonion (Ar-Go) in the 2D hand tracing method (P < 0.05). No statistical significance was found for Vista Dent OC measurements (P > 0.05).

Conclusions

Measurements from in vivo CBCT-generated cephalograms from Maxilim® software were found to be similar to conventional images. Thus, owing to higher radiation exposure, CBCT examinations should only be used when the inherent 3D information could improve the outcome of treatment.     

Influence of cone beam CT enhancement filters on diagnosis ability of longitudinal root fractures

Objectives:

To determine whether cone beam CT (CBCT) enhancement filters influence the diagnosis of longitudinal root fractures.

Methods:

40 extracted human posterior teeth were endodontically prepared, and fractures with no separation of fragments were made in 20 teeth of this sample. The teeth were placed in a dry mandible and scanned using a Classic i-CAT® CBCT device (Imaging Sciences International, Inc., Hatfield, PA). Evaluations were performed with and without CBCT filters (Sharpen Mild, Sharpen Super Mild, S9, Sharpen, Sharpen 3 × 3, Angio Sharpen Medium 5 × 5, Angio Sharpen High 5 × 5 and Shadow 3 × 3) by three oral radiologists. Inter- and intraobserver agreement was calculated by the kappa test. Accuracy, sensitivity, specificity and positive and negative predictive values were determined. McNemar test was applied for agreement between all images vs the gold standard and original images vs images with filters (p < 0.05).

Results:

Means of intraobserver agreement ranged from good to excellent. Angio Sharpen Medium 5 × 5 filter obtained the highest positive predictive value (80.0%) and specificity value (76.5%). Angio Sharpen High 5 × 5 filter obtained the highest sensitivity (78.9%) and accuracy (77.5%) value. Negative predictive value was the highest (82.9%) for S9 filter. The McNemar test showed no statistically significant differences between images with and without CBCT filters (p > 0.05).

Conclusions:

Although no statistical differences was observed in the diagnosis of root fractures when using filters, these filters seem to improve diagnostic capacity for longitudinal root fractures. Further in vitro studies with endodontic-treated teeth and research in vivo should be considered.     

The effect of cone beam CT (CBCT) on therapeutic decision-making in endodontics

Objectives:

The aim was to assess to what extent cone beam CT (CBCT) used in accordance with current European Commission guidelines in a normal clinical setting has an impact on therapeutic decisions in a population referred for endodontic problems.

Methods:

The study includes data of consecutively examined patients collected from October 2011 to December 2012. From 2 different endodontic specialist clinics, 57 patients were referred for a CBCT examination using criteria in accordance with current European guidelines. The CBCT examinations were performed using similar equipment and standardized among clinics. After a thorough clinical examination, but before CBCT, the examiner made a preliminary therapy plan which was recorded. After the CBCT examination, the same examiner made a new therapy plan. Therapy plans both before and after the CBCT examination were plotted for 53 patients and 81 teeth. As four patients had incomplete protocols, they were not included in the final analysis.

Results:

4% of the patients referred to endodontic clinics during the study period were examined with CBCT. The most frequent reason for referral to CBCT examination was to differentiate pathology from normal anatomy, this was the case in 24 patients (45% of the cases). The primary outcome was therapy plan changes that could be attributed to CBCT examination. There were changes in 28 patients (53%).

Conclusions:

CBCT has a significant impact on therapeutic decision efficacy in endodontics when used in concordance with the current European Commission guidelines.     

Reproducibility of mandibular third molar assessment comparing two cone beam CT units in a matched pairs design

The aim of this study was to evaluate the reproducibility of the third molar assessment, comparing five observers and two cone beam CT (CBCT) units. 28 patients, each with two impacted mandibular third molars, were included. Each patient was randomly examined with a Scanora^® 3D (Soredex, Helsinki, Finland) CBCT unit in one mandibular third molar region and with a Cranex^® 3D (Soredex) CBCT unit in the other region. Five observers with varying CBCT experience assessed all third molars and recorded the following variables: number and morphology of the roots, relation to the mandibular canal in two directions, shape of the canal and whether there was a direct contact between the roots of the molar and the mandibular canal. The radiographic assessments were compared pairwise among all observers for all variables. Wilcoxon''s signed-rank test was used to test the differences in observer accordance percentages among the recorded variables in the images from the two units, and kappa statistics expressed interobserver reproducibility. The mean percentages for observer accordance ranged from 65.4 to 92.9 for Scanora 3D and 60.3 to 94.8 for Cranex 3D. There was no significant difference between the observer accordance in the two CBCT units (p > 0.05), except for assessing root flex in the mesiodistal direction, for which the observer accordance was higher for Scanora 3D (p < 0.05). Kappa values ranged from 0.1 to 1.0 for Scanora 3D and from 0.2 to 0.9 for Cranex 3D. For the variable “direct contact”, the interobserver reproducibility was excellent for the two trained radiologists. The two units had almost similar interobserver reproducibility for mandibular third molar assessment. Observer variation existed, and experienced radiologists demonstrated the highest interobserver reproducibility for canal-related variables.     

Influence of size of field of view (FOV), position within the FOV,and scanning mode on the detection of root fracture and observer’s perception of artifacts in CBCT images

Objective:To assess the influence of field of view (FOV) size, scanning position within the FOV and scanning mode on the detection of root fracture and artifact perception.Methods:Forty single-rooted premolars restored with NiCr and AgPd posts were divided into two groups: fractured and sound. All teeth were scanned using four CBCT scanning protocols varying FOV sizes (80 × 80 mm and 50 × 55 mm) and scanning modes (Standard and High Definition). The sample was positioned within the FOV in two pre-set positions (central and lateral) and in four positions established by the operator (quadrants). Detection of root fracture and artifact perception were assessed by two observers using 5-point and 4-point scales. Sensitivity, specificity, accuracy, and AUC values were calculated and compared by ANOVA two-way and Tukey’s test. Chi-square and Fisher’s exact test were used to assess artifact perception. The level of significance was set at p < 0.05.Results :The central position within the FOV presented higher sensitivity, specificity, accuracy, and AUC values and differed from the lateral position within the FOV for the studied metal posts (p<0.05). Quadrant 2 presented the best sensitivity, accuracy, and AUC values (p<0.05). The lateral position within the FOV, AgPd posts, quadrants 1 and 3 and protocols 1 (SM, 80 × 80) and 2 (HD, 80× 80) presented higher frequency of artifacts classified as “severe”.Conclusion:Positioning the object in the center or closer to the anterior periphery of the FOV while using a small FOV improved the detection of root fracture and decreased artifact perception.     

The importance of cone beam CT in the radiological detection of osteomalacia

Although osteomalacia is one of the most common osteometabolic diseases among the elderly, there is no case in the literature that presents the effects of osteomalacia in detail using cone beam CT (CBCT). While thin and porous bones are the most common radiographic sign of the disease, the radiological hallmarks are pseudofractures (Looser's zone). We coincidentally detected osteomalacia in a 23-year-old female and we showed the pseudofracture on CBCT images. In the present case, we aim to present the images of osteomalacia that were detected by CBCT in detail. CBCT has an important value in screening for osteomalacia.     

Accuracy of linear measurement in the Galileos cone beam computed tomography under simulated clinical conditions

Objectives

The aim of this study was to determine the geometric accuracy of cone beam CT (CBCT)-based linear measurements of bone height obtained with the Galileos CBCT (Sirona Dental Systems Inc., Bensheim, Hessen, Germany) in the presence of soft tissues.

Methods

Six embalmed cadaver heads were imaged with the Galileos CBCT unit subsequent to placement of radiopaque fiduciary markers over the buccal and lingual cortical plates. Electronic linear measurements of bone height were obtained using the Sirona software. Physical measurements were obtained with digital calipers at the same location. This distance was compared on all six specimens bilaterally to determine accuracy of the image measurements.

Results

The findings showed no statistically significant difference between the imaging and physical measurements (P > 0.05) as determined by a paired sample t-test. The intraclass correlation was used to measure the intrarater reliability of repeated measures and there was no statistically significant difference between measurements performed at the same location (P > 0.05).

Conclusions

The Galileos CBCT image-based linear measurement between anatomical structures within the mandible in the presence of soft tissues is sufficiently accurate for clinical use.     

Prevalence of apical periodontitis detected in cone beam CT images of a Brazilian subpopulation

Objectives

The aim of this study was to determine the prevalence of apical periodontitis (AP) detected in cone beam CT (CBCT) images from a database.

Methods

CBCT images of 300 Brazilian patients were assessed. AP images were measured in three dimensions. Age, gender, number and location of total teeth in each patient were considered. AP location was considered according to tooth groups. The extent of AP was determined by the largest diameter in any of the three dimensions. Percentages and the χ² test were used for statistical analysis.

Results

AP was found in 51.4% of the patients and in 3.4% of the teeth. Higher prevalence of AP was found in 60- to 69-year-olds (73.1%) and in mandibular molars (5.9%) (p < 0.05). Inadequate endodontic treatment presented higher prevalence of AP (78.1%).

Conclusions

AP can be frequently found in CBCT examinations. The presence of AP has a significant association with patients'' age, and tooth type and condition. CBCT databases are useful for cross-sectional studies about AP prevalence in a population.     

A comparative study of accuracy of detection of surface osseous changes in the temporomandibular joint using multidetector CT and cone beam CT

Objective

The aim of this study was to assess the accuracy and reliability of cone beam CT (CBCT) images compared with multidetector CT (MDCT) images for the detection of surface osseous changes in temporomandibular joints (TMJs).

Methods

Naked-eye inspection of 110 sites in 10 TMJs from 5 dry human skulls provided the gold standard. Two radiologists interpreted the images. Sensitivity, specificity and kappa statistics were used for analysis.

Results

The sensitivities of both modalities were low and comparable whereas the specificities were high and comparable. Intraobserver reliabilities for CBCT (p=0.0005) and for MDCT (p=0.0001) showed significant agreement. Interobserver reliability was higher for CBCT than for MDCT.

Conclusion

CBCT and MDCT accuracy was comparable in detecting surface osseous changes with comparable intraobserver reliabilities. However, since CBCT requires less radiation exposure, it should be encouraged for imaging TMJ with suspected surface osseous changes.     

Detection of cavitated approximal surfaces using cone beam CT and intraoral receptors

Objectives

The aim of this study was to compare cone beam CT (CBCT) in a small field of view (FOV) with a solid-state sensor and a photostimulable phosphor plate system for detection of cavitated approximal surfaces.

Methods

257 non-filled approximal surfaces from human permanent premolars and molars were recorded by two intraoral digital receptors, a storage phosphor plate (Digora Optime, Soredex) and a solid-state CMOS sensor (Digora Toto, Soredex), and scanned in a cone beam CT unit (3D Accuitomo FPD80, Morita) with a FOV of 4 cm and a voxel size of 0.08 mm. Image sections were carried out in the axial and mesiodistal tooth planes. Six observers recorded surface cavitation in all images. Validation of the true absence or presence of surface cavitation was performed by inspecting the surfaces under strong light with the naked eye. Differences in sensitivity, specificity and agreement were estimated by analysing the binary data in a generalized linear model using an identity link function.

Results

: A significantly higher sensitivity was obtained by all observers with CBCT (p < 0.001), which was not compromised by a lower specificity. Therefore, a significantly higher overall agreement was obtained with CBCT (p < 0.001). There were no significant differences between the Digora Optime phosphor plate system and the Digora Toto CMOS sensor for any parameter.

Conclusions

CBCT was much more accurate in the detection of surface cavitation in approximal surfaces than intraoral receptors. The differences are interpreted as clinically significant. A CBCT examination performed for other reasons should also be assessed for approximal surface cavities in teeth without restorations.