Machiulskiene V, Nyvad B, Baelum V
Department of Therapeutic Stomatology, Faculty of Stomatology, Kaunas Medical University, Kaunas, Lithuania.
Caries Res. 1999 Sep-Oct;33(5):340-8. doi: 10.1159/000016532.
Bite-wing radiography has been recommended for use in adolescents as clinical examinations alone may lead to underestimation of carious lesions in approximal and occlusal surfaces. The aim of this study was to describe the relationship between clinical and radiographic caries diagnoses among 12-year-old Lithuanians using a new clinical scoring system which differentiates between cavitated and non-cavitated caries lesions. Eight hundred and seventy-two children were examined clinically and two standardized posterior bite-wing radiographs were taken of each participant. Bite-wing radiography contributed significantly to the total number of lesions diagnosed only at the dentin level in approximal surfaces. Clinical examination performed better than radiographic examination at the non-cavitated/enamel level, particularly on occlusal surfaces. Less than 2% of the clinically sound surfaces were diagnosed with dentin lesions/fillings radiographically. When using the cavitated level of clinical diagnosis, the frequency of 'hidden' caries lesions increased from 1.9 to 2.9% in approximal surfaces, and from 1.7 to 5. 2% in occlusal surfaces. The intra-examiner reliability data for the clinical and radiographic recordings supported the conclusion of an additional diagnostic value of bite-wings only for approximal surfaces. The findings demonstrate that the diagnostic yield of bite-wing radiography is higher for approximal than for occlusal surfaces. The efficacy of bite-wings depends on the refinement of the clinical caries diagnostic criteria. 'Hidden' caries does not seem to be a major problem when the clinical caries diagnostic criteria include non-cavitated diagnoses.
由于单纯的临床检查可能会低估邻面和咬合面龋损情况，因此推荐对青少年使用翼片X线摄影。本研究旨在利用一种新的临床评分系统来描述12岁立陶宛儿童临床和X线摄影龋齿诊断之间的关系，该系统可区分已形成龋洞和未形成龋洞的龋损。对872名儿童进行了临床检查，并为每位参与者拍摄了两张标准化的后牙翼片X线片。翼片X线摄影对仅在邻面牙本质水平诊断出的龋损总数有显著贡献。在未形成龋洞/釉质水平，临床检查比X线摄影检查表现更好，尤其是在咬合面。临床上看似健康的表面中，不到2%在X线片上被诊断为牙本质龋损/充填。当使用临床诊断的龋洞形成水平时，邻面“隐匿性”龋损的发生率从1.9%增加到2.9%，咬合面从1.7%增加到5.2%。临床和X线摄影记录的检查者内可靠性数据支持了翼片仅对邻面具有额外诊断价值的结论。研究结果表明，翼片X线摄影对邻面的诊断率高于咬合面。翼片的有效性取决于临床龋齿诊断标准的细化。当临床龋齿诊断标准包括未形成龋洞的诊断时，“隐匿性”龋似乎不是一个主要问题。
