Optimum Diagnostic Tools for Proximal Caries Detection in Modern Dentistry

Objectives: Caries detection remains one of the most basic and yet difficult skills in reliability. The proximal caries is clinically difficult to determine comparing with others. Clinical examination alone could underestimate prevalence of proximal caries, especially in early lesion. Routinely dental professions’ diagnostic tool in detection of proximal caries is visual-tactile combine with bitewing radiograph. However, researchers recently suggested that contemporary panoramic machines can be programmed to allow the horizontal angulation of the beam to be directed through the interproximal contacts of the teeth, which eliminates overlap regions. Then, additional bitewing and panoramic radiograph could be increase the sensitivity of proximal lesion detection. Thus, this study aims to find the best baseline measurement of proximal caries detection by determining the percentage agreement and diagnostic value between clinical examination, bitewing and panoramic radiographs for detection of proximal carious lesions.

Methods: Two examiners were standardized with percentage of agreement of 80%. Samples in this study consisted of 1000 proximal posterior teeth surfaces which had visual-tactile examination performed before having improved interproximal mode panoramic and bitewing radiographic images taken. The examiners detected and recorded proximal lesions by using ICDASII system for clinical staging and radiographic interpreted scoring.

Results: Data was analyzed by comparing between visual-tactile examination combining with bitewing radiograph versus visual-tactile examination combining with improved interproximal mode panoramic. The combination of clinical examination and bitewing imaging revealed detection of proximal caries higher than the combination of clinical examination and improved interproximal mode panoramic. However both groups have high diagnostic accuracy in detection of proximal caries, in addition, they also have agreement on cavitated lesions more than non-cavitated lesions.

Conclusions: This study suggested that the optimum diagnostic tools for interproximal caries assessment should consist of clinical examination and bitewing radiograph or clinical examination and improved interproximal mode of panoramic radiograph could be substitute in some cases.