Diagnostic accuracy of intraoral film and direct digital images for detection of simulated recurrent decay

This study compared the diagnostic accuracy of bitewing images for detectio n of simulated recurrent caries using the following imaging modalities: Ekt aspeed Plus film and different digital imaging system technologies comprise d of a charge-coupled device (CCD) based digital imaging unit, a photo-stim ulable phosphor (PSP) based unit and contrast-and brightness-enhanced PSP i mages. Study Design: Twenty-four extracted posterior teeth with MOD inlay preparat ions were secured in models simulating a natural arrangement of teeth. Lesi ons were created in proximal boxes using dental burs of varying sizes. Defe cts were filled with wax and plaster and preparations were restored with co mposite or amalgam. Results: Averages of receiver operating curve areas (A(2)) revealed diagnos tic performances of Az=0.74 for film, Az=0.80 for CCD, Az=0.73 for unenhanc ed PSP and Az=0.64 for enhanced PSP. The differences between these means we re significant (MANOVA p <0.0001). Unenhanced PSP produced significantly po orer performance than other modalities. CCD performance was not significant ly better than enhanced PSP. Lesions under radiopaque composite restoration s were easier to detect, followed by those under amalgam and radiolucent co mposites across imaging modalities and lesion locations. Based on lesion lo cation, those located at the buccal point angle were easiest to detect, fol lowed by those at midgingival floor and lingual-point angle sites. Conclusions: Contrast and brightness-enhanced digital images enabled better signal detection and a comparable performance with film for detection of a rtificially induced recurrent caries.