Evaluation of the interpretation of bitewing radiographs in treating interproximal caries

Abstract

Abstract Objective: Misinterpretation of bitewing radiographs may lead to the selection of surgical approach rather than medical approach in treating proximal caries lesions. We aimed to determine the sensitivity, specificity, and diagnostic accuracy of bitewing radiography interpretation by various groups of dentists for the detection of proximal caries and subsequent treatment decision-making. Materials and Methods: This in vitro study was performed using 60 extracted molar and premolar teeth. The target proximal carious surfaces were categorized and coded according to the International Caries Detection and Assessment System (ICDAS) as category 1: ICDAS = 0, category 2: ICDAS = 1 or 2, and category 3: ICDAS = 3, 4, or 5. All the teeth were randomly divided and mounted onto 15 quadrants made of two premolars and two molars, and a digital bitewing image was taken from each quadrant. A checklist was given to four groups of participants (dentistry students, dentists with a DDS degree, restorative dentistry specialists, and oral radiology specialists) to indicate for which lesion depth they would intervene restoratively. The data acquired through the checklists were compared with direct visual examination of target surfaces before mounting. Results: Sensitivity and accuracy of bitewing radiography showed no significant difference among the groups. However, specificity was significantly higher in Group D. Conclusions: According to our results, interpretation of bitewing radiographs was different among the groups. Although not significant, the radiologists had the highest diagnostic accuracy than the other groups of participants, and the students showed the weakest performance in the diagnosis of restorative treatment needed. Furthermore, the highest percentage of decision error occurred when lesions had ICDAS 1 or 2, followed by ICDAS 3, 4, or 5, and finally 0 in all the four groups.