Wenzel A, Hintze H, Hörsted-Bindslev P
Department of Oral Radiology, Royal Dental College, Faculty of Health Sciences, University of Aarhus, Denmark.
Caries Res. 1998;32(1):17-22. doi: 10.1159/000016425.
The aim of this study was to evaluate the diagnostic accuracy of radiographic examination for the detection of residual caries after tunnel preparation and filling with glass ionomer cement. Further, two different radiographic modalities were compared. Forty-five extracted human premolars and molars with clinical signs of approximal caries were selected for the study. The teeth were radiographed in order to identify surfaces with dentinal lesions suitable for tunnel preparation. Seventeen of the teeth had lesions that were as a minimum through the enamel and as a maximum into the outer half of the dentin (14 teeth = 1 lesion, 3 teeth = 2 lesions). Seventeen surgically removed third molars were thereafter included. These teeth were sound with respect to caries. The teeth were arranged in blocks with approximal contacts and radiographed using two image receptors: Ektaspeed Plus film (E) and the Digora (D) digital storage phosphor plate system. The 20 carious surfaces and 20 surfaces of the impacted teeth were prepared following the guidelines for the class II tunnel technique and filled with glass ionomer cement. The radiographic examination was repeated with both modalities after filling, and the approximal surfaces scored on the radiographs by 5 observers using the criteria: 0 = no filling, 1 = filling with residual caries, 2 = filling with no adjacent caries. All teeth except the unerupted third molars were sectioned, and the sections examined under the microscope. Residual caries was observed in 8 surfaces. On average, sensitivity was 0.25 for E and 0.32 for D, specificity 0.83 for E and 0.76 for D, positive predictive value 0.38 for E and 0.32 for D, and negative predictive value 0.75 for E and 0.77 for D. The differences between the two modalities were not statistically significant (p > 0.3). Based on the relatively small number of lesions in this study, it is suggested that radiography immediately after tunnel restoration cannot be recommended, as the diagnostic benefit from this examination seems to be minuscule.
本研究的目的是评估X线检查对检测采用隧道预备和玻璃离子水门汀充填后残留龋的诊断准确性。此外，还比较了两种不同的X线检查方式。选择45颗有邻面龋临床症状的拔除人类前磨牙和磨牙用于本研究。对牙齿进行X线摄影，以确定适合进行隧道预备的有牙本质病变的表面。其中17颗牙齿的病变至少穿通釉质，最多累及牙本质外半层（14颗牙齿 = 1处病变，3颗牙齿 = 2处病变）。此后纳入17颗手术拔除的第三磨牙。这些牙齿无龋损。将牙齿按邻面接触排列成组，使用两种影像接收器进行X线摄影：Ektaspeed Plus胶片（E）和Digora（D）数字存储磷光板系统。按照II类隧道技术指南对20个龋损表面和20个阻生牙表面进行预备，并用玻璃离子水门汀充填。充填后用两种方式再次进行X线检查，5名观察者根据以下标准对X线片上的邻面进行评分：0 =无充填物，1 =有残留龋的充填物，2 =无邻面龋的充填物。除未萌出的第三磨牙外，所有牙齿均进行切片，并在显微镜下检查。在8个表面观察到残留龋。平均而言，E的敏感度为0.25，D的敏感度为0.32；E的特异度为0.83，D的特异度为0.76；E的阳性预测值为0.38，D的阳性预测值为0.32；E的阴性预测值为0.75，D的阴性预测值为0.77。两种方式之间的差异无统计学意义（p > 0.3）。基于本研究中相对较少的病损数量，建议不推荐在隧道修复后立即进行X线摄影，因为这种检查的诊断益处似乎微乎其微。
