Maydana Gabriele Soares, Romero Vitor Henrique Digmayer, Signori Cacia, Uehara Juliana Lays Stolfo, Sande Françoise Hélène van de, Cenci Maximiliano Sérgio, Montagner Anelise Fernandes
Dental School, Federal University of Pelotas, Pelotas, Brazil.
Graduate Program in Dentistry, Dental School, Federal University of Pelotas, Pelotas, Brazil.
Braz Dent J. 2024 Dec 16;35:e246005. doi: 10.1590/0103-644020246005. eCollection 2024.
The combination of different methods has been advocated to increase sensitivity in detecting secondary caries lesions. This cross-sectional study compared the detection of caries lesions around posterior restorations and treatment decisions using bitewing radiographs alone or in combination with clinical information from patient records. The radiographs (n = 212) were randomly distributed into two sequences for assessment across two phases, with a wash-out period of two weeks. In the first phase (X-ray group), the radiographic images were evaluated without clinical information; in the second phase (X-ray/CARS group), the radiographic images were assessed in conjunction with the CARS score (Caries Associated with Restorations or Sealants) and lesion activity. A radiographic classification system for carious lesions around restorations was adapted to classify the bitewing radiographs included in this study. Evaluations were conducted in consensus by a panel of specialists, focusing on the detection of caries around restorations and subsequent treatment decisions. A chi-squared test was used to compare treatment decisions between the groups, and Cohen's kappa coefficient was employed to assess the agreement of scores. The results showed a significant difference in the distribution of decisions regarding the need for restorative intervention between the groups (p < 0.001), with the X-ray/CARS group leading to more decisions favoring restorative intervention. There was a moderate to good agreement of scores (κ = 0.749). The combination of clinical and radiographic information was found to influence the treatment decision-making process by increasing the likelihood of opting for restorative intervention.
人们提倡采用不同方法相结合的方式来提高检测继发龋损的敏感性。这项横断面研究比较了仅使用咬合翼片或结合患者病历中的临床信息来检测后牙修复体周围龋损情况及做出治疗决策的差异。将212张X线片随机分为两个序列，分两个阶段进行评估，中间有两周的洗脱期。在第一阶段（X线组），仅根据X线影像进行评估，不参考临床信息；在第二阶段（X线/CARS组），结合CARS评分（修复体或窝沟封闭剂相关龋病）及病损活性对X线影像进行评估。采用一种针对修复体周围龋损的X线分类系统对本研究中的咬合翼片进行分类。由一组专家达成共识进行评估，重点关注修复体周围龋损的检测及后续治疗决策。采用卡方检验比较两组之间的治疗决策，并用Cohen's kappa系数评估评分的一致性。结果显示，两组在关于是否需要进行修复干预的决策分布上存在显著差异（p < 0.001），X线/CARS组做出更多倾向于修复干预的决策。评分一致性为中度到高度一致（κ = 0.749）。研究发现，临床信息与X线影像信息相结合会影响治疗决策过程，增加选择修复干预的可能性。
