Abstract
Enhancement filters are potentially supposed to improve the diagnostic performance of digital images. Thus, the aim of this study was to compare the performance of digital radiography with and without enhancement filters for the detection of induced proximal caries lesions. The total sample consisted of 120 sound human teeth (40 premolars, 80 molars). Enamel subsurface demineralization was induced in one of the proximal surfaces of 60 teeth. Standardized radiographs of all teeth were acquired after the demineralization phase using the Digora-Optime® system. Four radiologists examined the digital radiographs and applied the following filters provided by the Digora® for Windows 2.6 package: Negative, Sharpen and both (Negative plus Sharpen). Validation of radiographic diagnosis was carried out by Knoop cross-sectional micro-hardness profiling on the proximal surfaces. Intraobserver agreement was estimated using Kappa statistics (k). Sensitivity, specificity and over-all accuracy were compared using ANOVA/Tukey test (α = 5%). Intraobserver agreement ranged from good to very good/optimal (k: 0.65-0.83). Although not statistically significant, the highest sensitivity (0.68 ± 0.22) and accuracy (0.76 ± 0.16) values were observed using the Sharpen filter as opposed to the Negative filter, which presented the lowest performance indices (0.57 ± 0.13 and 0.70 ± 0.10, respectively). Specificity ranged from 0.84 to 0.85, considering all imaging modalities (p > 0.05). Insofar as the Sharpen filter had the highest performance indices, it may be considered a useful adjunct for detecting subtle proximal caries lesions.
Highlights
No significant differences have been found between enhanced and original images acquired with RVG and Vistascan systems
Average sensitivity (0.68 ± 0.22) was higher for images enhanced with the Sharpen filter (Table 2)
One should not indicate the use of filter enhancement for the diagnosis of subtle proximal demineralization. Another experimental study did not report any significant differences between the original images acquired with photostimulable storage phosphor plates and those processed with task-specific filters (Caries 1 and Caries 2).[11]
Summary
Radiography is a very suitable method of diagnosing proximal caries lesions, in addition to its relatively good availability and simple technical demands.[1,2,3,4,5,6,7,8,9,10,11] The enhancement of brightness, contrast and edges carries the potential for increasing the diagnostic value of digital radiographs.[12,13] Some authors have stated that filter enhancement may increase the diagnostic accuracy for detection of proximal caries lesions.[14] On the other hand, no significant differences have been found between enhanced and original images acquired with RVG and Vistascan systems. The aim of this study was to compare the performance of digital radiographic images without filter enhancement and with enhancement by the Digora Sharpen, Negative, and combination of Negative and Sharpen filters, for the detection of subsurface proximal enamel demineralization. The null hypothesis stated no differences between filtered and non-filtered images
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