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. 2024 Dec 16:35:e246005.
doi: 10.1590/0103-644020246005. eCollection 2024.

Impact of using bitewing radiographs alone or in combination with clinical information on treatment decisions

Gabriele Soares Maydana  1 , Vitor Henrique Digmayer Romero  2   3 , Cacia Signori  4 , Juliana Lays Stolfo Uehara  2 , Françoise Hélène van de Sande  2 , Maximiliano Sérgio Cenci  3 , Anelise Fernandes Montagner  2 ; CaCIA collaborative group
Affiliations

Impact of using bitewing radiographs alone or in combination with clinical information on treatment decisions

Gabriele Soares Maydana et al. Braz Dent J. .

Abstract
in English, Portuguese

The combination of different methods has been advocated to increase sensitivity in detecting secondary caries lesions. This cross-sectional study compared the detection of caries lesions around posterior restorations and treatment decisions using bitewing radiographs alone or in combination with clinical information from patient records. The radiographs (n = 212) were randomly distributed into two sequences for assessment across two phases, with a wash-out period of two weeks. In the first phase (X-ray group), the radiographic images were evaluated without clinical information; in the second phase (X-ray/CARS group), the radiographic images were assessed in conjunction with the CARS score (Caries Associated with Restorations or Sealants) and lesion activity. A radiographic classification system for carious lesions around restorations was adapted to classify the bitewing radiographs included in this study. Evaluations were conducted in consensus by a panel of specialists, focusing on the detection of caries around restorations and subsequent treatment decisions. A chi-squared test was used to compare treatment decisions between the groups, and Cohen's kappa coefficient was employed to assess the agreement of scores. The results showed a significant difference in the distribution of decisions regarding the need for restorative intervention between the groups (p < 0.001), with the X-ray/CARS group leading to more decisions favoring restorative intervention. There was a moderate to good agreement of scores (κ = 0.749). The combination of clinical and radiographic information was found to influence the treatment decision-making process by increasing the likelihood of opting for restorative intervention.

A combinação de diferentes métodos tem sido defendida para aumentar a sensibilidade no processo de detecção de lesões de cárie ao redor de restaurações. Este estudo transversal comparou a detecção de lesões de cárie ao redor de restaurações em dentes posteriores e a decisão de tratamento usando radiografias interproximais isoladamente ou em combinação com as informações clínicas. As radiografias (n = 212) foram organizadas em 2 sequências aleatórias para avaliação em 2 fases, com um intervalo de 2 semanas. Na primeira fase (grupo RX), as imagens radiográficas foram avaliadas sem informações da avaliação clínica; e na segunda fase (grupo RX/CARS), as imagens radiográficas foram avaliadas associadas ao escore CARS (Caries Associated with Restorations or Sealants) e à atividade da lesão. Um sistema de classificação radiográfica para lesões de cárie ao redor de restaurações foi adaptado para classificar as radiografias interproximais incluídas neste estudo. As avaliações foram realizadas em consenso por um painel de especialistas, considerando a detecção de cárie ao redor da restauração e decisão de tratamento. Um teste Qui-quadrado foi realizado para comparar as decisões de tratamento entre os grupos, e um kappa de Cohen para avaliar a concordância dos escores. Os resultados mostraram uma diferença significativa na distribuição de decisões de necessidade de intervenção restauradora entre os grupos (p < 0,001), com o grupo RX/CARS resultando em mais decisões de intervenção restauradora, e uma concordância moderada a boa dos escores (κ = 0,749). A combinação de informações clínicas e radiográficas influencia o processo de tomada de decisão de tratamento, aumentando a probabilidade de intervenção restauradora.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1. Radiographic scores for classifying caries around restorations.
Figure 2
Figure 2. Flowchart of the study's assessment phases.
Figure 3
Figure 3. Examples of bitewing radiographs showing the presence of radiolucency incompatible with lesion around restoration. A: White arrow showing radiolucency line around the restoration compatible with an adhesive layer. B: White arrow showing radiolucency below the restoration compatible with residual caries issue after selective caries removal.
Figure 4
Figure 4. The radiographic aspect scored as C for the presence of a lesion around the restoration that clinically presented CARS 0 and activity 0, possibly due to difficulty in visualization during the clinical examination.
See this image and copyright information in PMC

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