A review of dentists' use of digital radiography and caries diagnosis with digital systems

Objectives: To investigate the evidence for (1) dentists' use of digital radiography and (2) the outcome of caries diagnosis with digital systems. Methods: A literature search with the software search package PubMed was used to get internet-based access to Medline through the website www.ncbi.nlm.nih.gov/pubmed. The search was limited to the years 1999-2005 since most papers dealing with the diagnostic value of digital radiography systems published before 1999 will hold little interest for today's users due to changes in the systems. The search strategies resulted in 123 articles (Table 1, #4 and #5). Original research articles (not reviews) were selected by the following inclusion criteria: (1) questionnaire studies on the use of direct digital intraoral radiography systems (not digitized film), (2) studies which used human teeth and natural caries lesions, and further in laboratory studies, the sectioned tooth was the gold standard for validating the presence or depth of a lesion. Results: The search resulted in 42 articles fulfilling the above criteria, which could be grouped into three types of studies: (a) questionnaire studies, (b) clinical (in vivo) studies, and (c) laboratory (in vitro) studies. Nine questionnaire studies, five clinical studies and 28 laboratory studies were found. These studies and their results are summarized in Tables 2-5. Conclusions: The number of studies was limited, and some of the digital systems were evaluated in only one or two studies. A conclusive judgment may therefore not be possible for the majority of the digital systems selected for this review. There is a continuous need for the evaluation of new digital intraoral radiography systems that appear on the market, first and foremost for their image quality and diagnostic accuracy, but certainly also for their performance in the clinic, a clear deficiency observed after the literature search for the present review.