The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 21 , ISSUE 12 ( December, 2020 ) > List of Articles


Accuracy of Cone-beam Computed Tomography and Extraoral Bitewings Compared to Intraoral Bitewings in Detection of Interproximal Caries

Cheen Y Loo, Aruna Ramesh

Citation Information : Loo CY, Ramesh A. Accuracy of Cone-beam Computed Tomography and Extraoral Bitewings Compared to Intraoral Bitewings in Detection of Interproximal Caries. J Contemp Dent Pract 2020; 21 (12):1361-1367.

DOI: 10.5005/jp-journals-10024-2979

License: CC BY-NC 4.0

Published Online: 13-04-2021

Copyright Statement:  Copyright © 2020; The Author(s).


Aim and objective: The purpose of this study is to evaluate the diagnostic accuracy of cone-beam computed tomography (CBCT) and extraoral bitewings in the detection of interproximal caries compared to intraoral bitewings. Materials and methods: Seven preserved cadaver heads with 106 teeth (molars, premolars, and canines) including 183 proximal surfaces were used. Five radiographic modalities were studied: intraoral bitewings, extraoral bitewings, iCAT 3D, ProMax 3D high resolution, and ProMax 3D low resolution. Seven pediatric dental residents were recruited and calibrated as observers and asked to evaluate each proximal surface. Teeth were extracted, mounted, drilled, caries detection dye was applied, and the surfaces were examined under the light microscope. Interexaminer reliability, sensitivity, specificity, and area under the curve values were compared. Results: No significant differences were found in sensitivity, specificity, and area under the curve values between the five radiographic modalities. Restorations may influence the accuracy of caries diagnosis. Conclusion: Cone-beam computed tomography radiographs and extraoral bitewings showed similar accuracies in detecting interproximal caries compared to intraoral bitewings. This suggests that with proper training and experience, CBCT and extraoral bitewings could be comparable to intraoral bitewings in detecting interproximal caries. Clinical significance: Cone-beam computed tomography and extraoral bitewings could potentially serve as alternatives to intraoral bitewings to diagnose proximal caries, especially when the CBCT study is needed for a specific diagnostic purpose.

  1. Development of a compact computed tomographic apparatus for dental use. Dentomaxillofac Radiol 1999;28(4):245–248. DOI: 10.1038/sj.dmfr.4600448.
  2. A new volumetric CT machine for dental imaging based on the cone-beam technique: preliminary results. Eur Radiol 1998;8(9):1558–1564. DOI: 10.1007/s003300050586.
  3. CBCT dosimetry: orthodontic considerations. Semin Orthod 2009;15(1):14–18. DOI: 10.1053/j.sodo.2008.09.002.
  4. Cone-beam computerized tomography (CBCT) imaging of the oral and maxillofacial region: a systematic review of the literature. Int J Oral Maxillofac Surg 2009;38(6):609–625. DOI: 10.1016/j.ijom.2009.02.028.
  5. Detection of vertical root fractures in endodontically treated teeth by a cone beam computed tomography scan. J Endod 2009;35(5):719–722. DOI: 10.1016/j.joen.2009.01.022.
  6. What is cone-beam CT and how does it work? Dent Clin North Am 2008;52(4):707–730. DOI: 10.1016/j.cden.2008.05.005, v.
  7. Effective dose of dental CBCT—a meta analysis of published data and additional data for nine CBCT units. Dentomaxillofac Radiol 2015;44(1):20140197. DOI: 10.1259/dmfr.20140197.
  8. Cone-beam CT diagnostic applications: caries, periodontal bone assessment, and endodontic applications. Dent Clin North Am 2008;52(4):825–841. DOI: 10.1016/j.cden.2008.05.002., vii
  9. Current status of dental caries diagnosis using cone beam computed tomography. Imaging Sci Dent 2011;41(2):43–51. DOI: 10.5624/isd.2011.41.2.43.
  10. Extraoral imaging for proximal caries detection: bitewings vs scanogram. Oral Surg, Oral Med, Oral Pathol, Oral Radiol, Endod 2004;98(6):730–737. DOI: 10.1016/j.tripleo.2004.08.006.
  11. Proximal caries detection accuracy using intraoral bitewing radiography, extraoral bitewing radiography and panoramic radiography. Dentomaxillofac Radiol 2012;41(6):450–459. DOI: 10.1259/dmfr/30526171.
  12. Accuracy of digital bitewing radiography versus different views of digital panoramic radiography for detection of proximal caries. J Dent 2015;12(4):290.
  13. Diagnostic accuracy of cone beam computed tomography scans compared with intraoral image modalities for detection of caries lesions. Dentomaxillofac Radiol 2008;37(1):18–22. DOI: 10.1259/dmfr/87103878.
  14. A comparative study of high-resolution cone beam computed tomography and charge-coupled device sensors for detecting caries. Dentomaxillofac Radiol 2009;38(7):445–451. DOI: 10.1259/dmfr/88765582.
  15. Detection accuracy of proximal caries by phosphor plate and cone-beam computerized tomography images scanned with different resolutions. Clin Oral Investig 2012;16(4):1015–1021. DOI: 10.1007/s00784-011-0599-7.
  16. An in vitro comparison of diagnostic abilities of conventional radiography, storage phosphor, and cone beam computed tomography to determine occlusal and approximal caries. Eur J Radiol 2011;80(2):478–482. DOI: 10.1016/j.ejrad.2010.09.011.
  17. The detection accuracies for proximal caries by cone-beam computerized tomography, film, and phosphor plates. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111(1):103–108. DOI: 10.1016/j.tripleo.2010.06.025.
  18. Accuracy of proximal caries depth measurements: comparison between limited cone beam computed tomography, storage phosphor and film radiography. Caries Res 2006;40(3):202–207. DOI: 10.1159/000092226.
  19. Detection accuracy of in vitro approximal caries by cone beam computed tomography images. Eur J Radiol 2011;79(2):e24–e27. DOI: 10.1016/j.ejrad.2009.05.063.
  20. Diagnostic accuracy of different imaging modalities in detection of proximal caries. Dentomaxillofac Radiol 2010;39(8):501–511. DOI: 10.1259/dmfr/28628723.
  21. Evaluation of a limited cone-beam volumetric imaging system: comparison with film radiography in detecting incipient proximal caries. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104(3):412–416. DOI: 10.1016/j.tripleo.2007.02.028.
  22. Evaluation of cone beam computed tomography (CBCT) system: comparison with intraoral periapical radiography in proximal caries detection. J Dent Res Dent Clin Dent Prospects 2012;6(1):1–5.
  23. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess 1994;6(4):284–290. DOI: 10.1037/1040-3590.6.4.284.
  24. A comparative study of the diagnostic accuracy of cone beam computed tomography and intraoral radiographic modalities for the detection of noncavitated caries. Clin Oral Investig 2015;19(3):667–672. DOI: 10.1007/s00784-014-1282-6.
  25. 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 2010;109(5):e63–e69. DOI: 10.1016/j.tripleo.2009.12.048.
  26. Effects of various cone-beam computed tomography settings on the detection of recurrent caries under restorations in extracted primary teeth. Imaging Sci Dent 2017;47(2):109–115. DOI: 10.5624/isd.2017.47.2.109.
  27. Occlusal caries depth measurements obtained by five different imaging modalities. J Digit Imaging 2011;24(5):804–813. DOI: 10.1007/s10278-010-9355-9.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.