Influence of enhancement filters on the diagnosis of proximal caries lesions in radiographs obtained with a handheld X-ray unit.

Abstract

Objective: To assess the influence of enhancement filters on the diagnosis of proximal caries lesions in radiographs obtained with a handheld X-ray unit.

Methods: Radiographs of 40 human teeth exhibiting white spots or enamel discolorations were obtained with an Eagle X-ray handheld unit (Alliage, São Paulo, Brazil) configured at 2.5 mA, 60 kVp, and 0.45 s of exposure time. Two digital imaging systems (VistaScan and Digora Toto) were used for radiographic acquisition. A total of 12 enhancement filters--six available in each system--were applied to the radiographs. A total of five dentomaxillofacial radiologists blinded to the filtering condition independently evaluated the radiographs for the presence of caries lesions using a 5-point scale. The area under the receiver operating characteristic curve, sensitivity, and specificity were determined based on the examiners' responses and were compared across the filters tested using one-way analysis of variance, with a significance level of 5%. The weighted Kappa index was used to assess both intra- and inter-examiner agreements in the diagnosis of proximal caries lesions.

Results: Applying the enhancement filters tested did not influence the diagnostic metrics of proximal caries lesions in radiographs obtained using a handheld X-ray unit (p > 0.05). While the intra-examiner agreements were substantial, the inter-examiner agreements ranged from fair to moderate.

Conclusions: The enhancement filters available in the VistaScan and Digora Toto digital systems did not impact the diagnostic accuracy of proximal caries lesions in radiographs obtained using a handheld X-ray unit. Therefore, clinicians can apply these filters based on personal preference without compromising diagnostic reliability.