DIAGNOSTIC ACCURACY OF INTRAORAL, EXTRAORAL, AND CBCT-GENERATED BITEWINGS FOR DETECTING APPROXIMAL CARIES AND PERIODONTAL BONE LOSS

BACKGROUND: With the current coronavirus disease pandemic, dental offices are trying their best to limit intraoral imaging. One solution to overcome this problem is to use extraoral imaging techniques. OBJECTIVE(S): The objective of this study was to evaluate the diagnostic accuracy of intraoral bitewings, extraoral bitewings generated by a panoramic machine, and cone beam computed tomography (CBCT)–generated bitewings with 180° and 360° rotations in the detection of dental caries and bone loss. STUDY DESIGN: The study examined carious defects, alveolar bone levels, and interdental vertical defects in the posterior mandible in 100 interproximal surfaces in a dry human skull. Simulated cavities were created at specific locations and interdental defects were created on both buccal and lingual surfaces where measured amounts of bone were removed to simulate bone loss. Physical measurements of bone removed served as the gold standard. Intraoral bitewings were acquired using photostimulable phosphor sensors with a Kavo LM/CM109 x-ray tube at 70 kVp,7mA and 0.125 seconds. Extraoral bitewings were acquired with a J. Morita panoramic unit at 90 kVp,7mA and 5.5 seconds. CBCT scans were acquired with the J. Morita 3D Accuitomo at 90 kVp and 7 mA setting with a 40 × 40 mm FOV in the Hi-Res-Mode. Four examiners scored the presence and extent of caries and performed alveolar bone measurements. RESULTS: No statistically significant results were noted with all imaging modalities for the diagnostic efficacy and linear measurement of the defects. Kappa analysis for interoperator reliability was very high. DISCUSSION/CONCLUSIONS: The diagnostic accuracy of extraoral bitewings generated from panoramic and CBCT machines for detecting dental caries and periodontal bone loss is comparable for all imaging modalities tested. FUTURE DIRECTIONS: In this study there was no metallic scatter like in clinical situations, so future studies that will incorporate varying degrees of metallic scatter must be done to evaluate the diagnostic efficacy.