Arayüz çürüklerinin saptanmasında beş farklı tekniğin diagnostik doğruluğu

Amaç: Bu çalışmanın amacı, beş farklı radyografik görüntüleme yönteminin posterior dişlerde arayüz çürük teşhisindeki doğruluk değerlerinin karşılaştırılmasıdır. Gereç ve Yöntem: Çalışmada çürüklü ve çürüksüz 72 adet posterior diş kullanıldı. Geleneksel bitewing radyograflar intraoral film kullanılarak, dijital bitewing radyograflar ise fosfor plak sistem kullanılarak alındı. Panoramik görüntüler dijital panoramik cihazın bitewing, ortogonal ve standart programları kullanılarak elde edildi. Görüntüler iki gözlemci tarafından değerlendirildi. Gözlemci içi ve gözlemciler arası uyum ağırlıklandırılmış kappa katsayısı hesaplanarak belirlendi. Çürük tespitinde altın standart kabul edilen histopatolojik skorlar ile beş yöntemden elde edilen skorlara ROC analizi uygulandı. Yöntemlere ait Az değerleri z-testi ile karşılaştırıldı ve anlamlılık düzeyi 0.05 olarak kabul edildi. Yöntemlere ait sensitivite, spesifisite ve yanlış pozitif oranları hesaplandı. Bulgular: Gözlemci içi ve gözlemciler arası uyuma ait κ değerleri sırasıyla 0.59-0.88 ve 0.54-0.87 arasında değişti. ROC analizinde ortalama Az değerleri en yüksek olarak geleneksel bitewing yönteminde (0.760) ve fosfor plak sisteminde (0.756), en düşük olarak ise panoramik cihazın standart programında (0.639) bulundu. Standart panoramik görüntüler çürük teşhisinde diğer yöntemlerden anlamlı olarak yetersiz bulundu (p<0.05). Yöntemlerin sensitivite ve spesifisite değerleri sırasıyla; geleneksel yöntem için 0.64-0.85, fosfor plak için 0.64-0.87, standart program için 0.40-0.87, ortogonal program için 0.56-0.85, ekstraoral bitewing için 0.59-0.90 olarak bulundu. Sonuç: Çalışmada geleneksel bitewing ve fosfor plak bitewing görüntüleri benzer doğruluk düzeyine sahip bulundu. Panoramik cihazdaki ortogonal ve bite-wing programların süperpozisyonların azaltılmasında etkili olduğu gözlendi. Yöntemlerin mine çürüğü düzeyinde sensitiviteleri düşük bulgulandı.

Anahtar Kelimeler:

Isırtma radyografisi, panoramik radyografi, diş çürükleri

Diagnostic accuracy of five different techniques for detection of approximal caries

Objective: The aim of this study was to compare the accuracy of five different radiographic methods for the detection of approximal caries on posterior teeth. Materials and Method: Seventy-two extracted posterior teeth with and without caries were studied. Intraoral bitewing radiographs were taken with film and a storage phosphor-plate system. Extraoral panoramic images were obtained by using the bitewing, orthogonal and standard programs of a digital panoramic radiography device. Images were evaluated by two observers. Intra- and inter-observer weighted-kappa coefficients were calculated. Scores obtained from the five techniques were compared against the histological gold standard using receiver operating characteristics (ROC) curve analysis. Az values for each image type were compared using z-test and the level of statistical significance was set at 0.05. Sensitivity, specificity and false-positive rates were calculated for each method. Results: Intra- and inter-observer agreement κ values were between 0.59-0.88 and 0.54-0.87, respectively. The Az value was greatest with conventional bitewing (0.760) and phosphor plate bitewing (0.756) and lowest with standard panoramic image program (0.639). The standard panoramic image program was significantly inferior to the other diagnostic methods (p<0.05). Sensitivity and specificity values were 0.64 and 0.85 for conventional bitewing, 0.64 and 0.87 for phosphor plate bitewing, 0.40 and 0.87 for standard program, 0.56 and 0.85 for orthogonal program, and 0.59 and 0.90 for extraoral bitewing program, respectively. Conclusion: In this study, conventional and phosphor plate bitewing images were found to confer similar diagnostic accuracy. Orthogonal and extraoral bitewing programs on panoramic devices were effective for reducing superimpositions. The diagnostic sensitivity of the studied methods for approximal caries was found to be low at the level of enamel.

Keywords:

Bitewing radiography, panoramic radiography, dental caries,

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