Inside Dentistry
May 2006
Volume 2, Issue 4

The Efficiency of Three Different Films and Radiovisiography in Detecting Approximal Carious Lesions

Howard E. Strassler, DMD

Erten H, Akarslan ZZ, Topuz O. Quintessence Int. 2005;36(1):65-70.


OBJECTIVE: The aim of this study was to evaluate the efficiency of Ultra-speed, Ektaspeed Plus, and Insight radiographic films (Eastman Kodak Company, Rochester, NY), and radiovisiography in detecting approximal carious lesions. METHOD AND MATERIALS: Eighty approximal surfaces of 40 extracted human molars and premolars were evaluated. Radiographs of teeth blocks were taken with three different films and radiovisiography under standard conditions. The presence or absence of approximal caries was evaluated by three observers according to a five-point confidence scale. The actual status of each surface of the teeth was histologically determined from the teeth sections. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios of the imaging modalities were calculated, and observer responses were assessed with Kendall’s tau and Spearman’s rho tests. RESULT: The sensitivity values for Ultraspeed, Ektaspeed Plus, Insight, and radiovisiography were 0.39, 0.48, 0.45, and 0.49, respectively, while the specificity values were 0.91, 0.88, 0.84, and 0.90, respectively. The difference in detecting approximal carious lesions between the systems was not statistically significant. CONCLUSION: This study suggests that there is no significant difference between the four imaging modalities in detecting approximal carious lesions.


The diagnosis of approximal carious lesions is difficult. The ability to read a radiograph for differences in density and evaluating the changes in value to denote healthy and diseased tooth structure can be a major challenge to the clinician. In an effort to decrease the amount of ionizing radiation, films and digital x-ray systems have been developed with increased sensitivity to radiation, which allows imaging at lower dose levels. Unfortunately, the early higher-speed, radiation-sensitive films had decreaseddiagnostic abilities.

In the 1990s, radiovisiography was introduced, which lowered the amount of ionizing radiation from that of film. With all these changes focusing on reducing radiation, there has been a concern that the diagnostic ability of the images has been sacrificed.

The authors of this study used a well thought through protocol and study design and used a histological evaluation of the extracted teeth for approximal caries as the “gold standard” for the presence or absence of caries. This study provides the clinician with reliable data to compare film and digital radiographs. One aspect of this study that correlates with other studies is that there were differences between examiners. Although all 4 modalities were not statistically different, the quality of film processing is a major variable in a dental practice. For digital radiographs, software programs provide image postprocessing of contrast, density, and magnification, which can improve the ability to diagnose. In this study, no postprocessing was performed. Based on this study, radiovisiography is an equivalent to film in diagnosing approximal carious lesions. With the other benefits for diagnosis afforded by digital radiographs, the trend in the future may be the elimination or minimization of wet film processing.

About the Author

Howard E. Strassler, DMD
Professor and Director of Operative Dentistry
Department of Endodontics, Prosthodontics and Operative Dentistry
University of Maryland Dental School, Baltimore, Maryland

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