Bitewing Radiographs in Proximal Caries Diagnostics and Restorative Treatment of Adults: A Retrospective Study of Electronic Health Records.

Abstract

Introduction: The restorative threshold of dentists varies considerably. This retrospective study examined the association between the depth of radiolucency in proximal surfaces on bitewing radiographs and the probability of restorative treatment among Finnish dentists.

Methods: The study population comprised 160 patients aged 18-40 years who underwent routine dental examinations by 16 randomly selected dentists within the Public Dental Services of Kuopio, Finland, in 2022. Data on patient characteristics, caries lesions, radiographic findings, and treatment decisions were manually extracted from the local electronic health record system. The depth of radiolucency was measured for all proximal caries lesions that had been registered by the dentists and were visible on the radiographs. The association between radiolucency depth and treatment decisions was estimated using linear regression analyses with cluster-robust standard errors.

Results: Bitewing radiography had been used for 128 (80%) patients. Most of the 394 caries lesions that had been registered were radiographically confined to the enamel (57%) or outermost third of dentin (27%), whereas 12% were in the middle third of dentin, and 4% extended to the inner third of dentin. Regression analyses revealed that the predicted probability of restorative treatment was 8% for lesions reaching the dentinoenamel junction and 75% for those extending to the border between the outer and middle thirds of dentin.

Conclusions: The probability of restorative treatment increased sharply with the depth of radiolucency and was unexpectedly high for lesions confined to enamel or the outer third of dentin.