Detection of proximal caries with high-resolution and standard resolution digital radiographic systems

Aims: The aim of this study was to: (1) compare the diagnostic accuracy of the high-resolution and standard resolution settings of four digital imaging systems for caries diagnosis and (2) compare the effect on the diagnostic accuracy of reducing the high-resolution image sizes to the standard resolution dimensions, and vice versa. Materials and methods: 90 extracted human premolars were mounted in groups of 5 in plaster blocks, containing 4 test teeth and I non-test tooth. Two blocks at a time were placed in a jig to simulate a bitewing radiograph. Radiographs were taken using four digital systems (Planmeca Dixi 2; Gendex Visualix HDI; Durr Vistascan; Digora Optime), each at two resolution settings. Next, the teeth were sectioned and a total of 65 surfaces were incorporated in the study. Additionally, the bicubic interpolation method was applied to reduce the high-resolution original images and to enlarge the standard resolution images. The original, reduced and enlarged images were randomly shown to five observers in two random sessions. The observers were asked to assess caries depth on a 4-point scale. The observers' scores were compared with the results from a histological examination. Data were analysed using the statistical theory for multivariate discrete data. Cohen's kappa was used to determine the agreement with the gold standard. Results: None of the comparisons between the spatial resolution settings, or the comparisons between increased or reduced image size and the original image sizes, showed significant differences in the probability of caries detection (chi(2) = 26.59, df = 26, P similar to 0.50). The four digital systems used in this study differ significantly in the probability of caries detection (chi(2) = 41.55, df = 24, P < 0.02). Compared with the gold standard, the Gendex Visualix HDI CCD sensor has the highest measure of agreement (kappa = 0.31). Conclusion: Caries diagnosis does not improve when using high-resolution settings compared with the standard settings. The use of bicubic convolution interpolation for zooming has no detectable effect on caries diagnosis and therefore is recommended to use when enlarging or reducing radiographs. The probability of caries detection, however, was different for the sensor systems of the different manufacturers.