Objective and Background: Proper diagnosis is integral in effective and efficient treatment in dentistry. While clinical examination provides important information in the diagnosis of periodontal disease and caries, bitewing radiography is one of the tools used for the examination of structures that cannot be readily seen with the naked eye. The ProMax S3 panoramic unit from Planmeca offers a True Bitewing program that can obtain bitewing images without the use of intraoral sensors. The aims of this study was to compare the diagnostic accuracy of intraoral bitewings and extraoral bitewings for the detection of 1. interproximal caries 2. interproximal bone loss Methods: Patients from the University of Minnesota School of Dentistry who recently received intraoral bitewings were recruited for extraoral bitewings. Five examiners (two board certified radiologists, one radiology clinical assistant professor, one general dentist and one graduate periodontics resident) evaluated both images for interproximal bone loss and interproximal caries as well as a consensus diagnosis was made. Results: The study population was one hundred sixteen patients. There was statistically significantly greater caries detection with extraoral radiographs (46.26% of surfaces) compared to intraoral radiographs (21.12% of surfaces) at p<0.0001. Assuming that the intraoral bitewing is the gold standard, for caries diagnosis, the extraoral bitewings had a sensitivity of 71.91% and a specificity of 61.99% with a false positive rate of 38.01%. When evaluating the bone loss detection, there was statistically significantly greater detection with extraoral bitewings (90.19% of teeth) compared to intraoral bitewings (77.95% of teeth) at p<0.0001. Assuming that the intraoral bitewing is the gold standard, for bone loss diagnosis, the extraoral bitewings had a sensitivity of 94.5% and a specificity of 26.86% with a false positive rate of 73.14%. Conclusions: The caries detection rate with extraoral bitewings was significantly greater than intraoral bitewings. The false-positive rate for caries detection with extraoral bitewings was 38.01%. The bone loss detection rate with extraoral bitewings was also significantly greater than intraoral bitewings. The false-positive rate for bone loss detection with extraoral bitewings was 73.14%. While extraoral bitewings provide efficient imaging with more patient comfort, it appeared to have more false positives, which would warrant cross-examination with clinical exams and re-evaluation with follow up exams.
University of Minnesota M.S. thesis. September 2015. Major: Dentistry. Advisor: MANSUR AHMAD. 1 computer file (PDF); vi, 45 pages.
A Comparison Of Intraoral Versus Extraoral Bitewing Radiography To Detect Proximal Caries And Loss Of Alveolar Bone.
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