Cone-Beam Computed-Tomography vs. Conventional Diagnostic Methods for Occlusal Caries Detection

Objectives: The purpose of this study was to compare the validity of visual (VE), radiological (RE), and cone beam computed tomography (CBCT) examination methods for the detection of the occlusal non-cavitated caries in permanent posterior teeth.
Methods: Two examiners assessed 121 selected sites on the occlusal surfaces of 44 molar teeth by visual (ICDAS), radiographic (bite-wing projection) and CBCT examination methods. After a 1-week interval, each measurement was repeated by two examiners. Then, the teeth were sectioned, and histological evaluation was performed, which serves as the gold standard. The lesion depths were classified and correlated with the methods evaluated for validation. The intra- and inter-examiner reliability (sensitivity, specificity) and reproducibility of all examination methods were calculated using a weighted Cohen’s Kappa statistic. The correlation between the examination methods was determined using receiver operating characteristic (ROC) analysis indicating the area under the curve (AUC).
Results: CBCT exhibited excellent intra-examiner (0.76 for examiner 1, 0.78 for examiner 2) and fair to good inter-examiner (0.63 for the first, 0.64 for the second measurements) reproducibility. Among the combined methods, the highest AUC values (0.81-0.95) were obtained for the CBCT method performed by the two examiners at both the first and second measurements.
Conclusions: Examination with CBCT was significantly more accurate than bitewing radiography for detecting occlusal carious lesions in posterior permanent teeth. Cone beam computed tomography showed better performance compared to conventional diagnostic methods.