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. 2014;43(7):20130342.
doi: 10.1259/dmfr.20130342. Epub 2014 Jul 2.

The influence of amalgam fillings on the detection of approximal caries by cone beam CT: in vitro study

T Kulczyk  1 , M Dyszkiewicz Konwińska, M Owecka, J Krzyżostaniak, A Surdacka
Affiliations

The influence of amalgam fillings on the detection of approximal caries by cone beam CT: in vitro study

T Kulczyk et al. Dentomaxillofac Radiol. 2014.

Abstract

Objectives: The aim of this CBCT investigation on the detection of caries was to assess the influence of artefacts produced by the presence of amalgam fillings located in the vicinity.

Methods: 102 non-cavitated pre-molar and molar teeth were placed in blocks of silicone with approximal contacts consisting of 3 sound or carious teeth and 1 mesial-occlusal-distal amalgam-filled tooth in-between. Radiographs of all the teeth were recorded using the CBCT system (NewTom™ 3G; QR Srl, Verona, Italy; field of view, 9 inches). Data from the CBCT unit were reconstructed and sectioned in the mesiodistal tooth plane. Images were evaluated twice by two observers, using a five-step confidence scale. After the CBCT examination, the teeth were individually sectioned in the mesiodistal direction with a diamond saw. Using a light microscope at ×40 magnification, the true morphological status of all approximal surfaces was established.

Results: Sensitivity of the CBCT for the detection of caries on surfaces located proximally and distally to an amalgam filing ranged from 0.27 to 0.30 for enamel and from 0.47 to 0.56 for dentin. Specificity values for enamel proximal and distal lesions were 0.48 and 0.53, respectively, for enamel and 0.33 to 0.38, respectively, for proximal and distal dentin cases. Intra-observer reliability was 0.84, and interobserver reliability was 0.49.

Conclusions: Owing to its low specificity, scans from a CBCT examination should not be used to determine the presence of demineralization of the tooth surface when amalgam fillings are present in the region of interest.

Keywords: CBCT; amalgam; artefacts; caries.

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Figures

Figure 1
Figure 1
Arrangement of four-tooth sets. A, surfaces next to filling; B, surfaces distal to filling.
Figure 2
Figure 2
A sound pre-molar tooth used in the study: (a) the microscopic section reveals a sound enamel and dentine on both the mesial and distal sides; (b) corresponding cropped image of CBCT examination that was interpreted by one observer as caries on both enamel and dentin on the mesial side. The second observer stated that there was only enamel demineralization but on both mesial and distal sides.
Figure 3
Figure 3
Microscopic image of a section of a pre-molar tooth and the corresponding CBCT scans. Microscopic examination reveals the presence of enamel and dentine caries on distal side. CBCT examination suggests enamel and dentine caries on distal side but the extent of demineralization is more severe in comparison with histological view.
Figure 4
Figure 4
Microscopic image of a section of a pre-molar tooth and the corresponding CBCT scans. Microscopic examination reveals the presence of enamel caries on the mesial side. CBCT examination is severely compromised by the presence of diagonally shaped artefact that makes diagnosis of enamel demineralization very uncertain.
See this image and copyright information in PMC

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