Caries is a disease with a high prevalence, which may be due to the lack of adequate methods for its early diagnosis, becomes difficult to detect initial caries lesions in posterior teeth due to the occlusal anatomy of these and because on many occasions they start in the interproximal zone below the contact areas.

Different techniques have been used for the diagnosis of caries, such as visual-tactile inspection, radiography, tomography, and transillumination, but none of them seems to have complete sensitivity or specificity.


This study aims to establish the degree of agreement between radiographic diagnosis with 2D intraoral digital radiography in relation to cone beam computed tomography in extracted carious and healthy posterior teeth, practicing the CariesCare International ™ practical guide as a reference.

Materials and Methods:

A total number of 117 teeth with or without carious lesions were selected. Digital images of all teeth were obtained from 2D digital radiographs (instrumentarium ™ films) obtained with Kavo focus equipment and CBCT scanner I-CAT ™ model 1719, ISI (imaging science international), Pennsylvania (blue sky plan 4 software).

Observers evaluated the images for the detection of carious lesions. The sensitivity and specificity ratio between the systems was determined using the area under the curve statistical tool ROC (Receiver Operating Characteristic).

For the statistical analysis, the statistical program STATA IC/16 was used, in which the calculation of absolute and relative frequencies for each category of CariesCare international in CBCT and radiography was performed, in addition to the Friedman and post-hoc Wilcoxon test by pairs; the distribution according to the classification of CariesCare international was contrasted between the CBCT slices. The calculation of weighted Kappa and dichotomous Kappa and the calculation of validity (sensitivity and specificity) and prediction (predictive values and predictive ratios) were performed.

The distribution according to CariesCare international classification was contrasted between the CBCT slices.


The results of the present study confirm that diagnosis of caries with the 2D digital radiographic method, initial caries lesions tend to go undetected relative to CBCT.


2D digital radiographs showed low sensitivity for caries detection and high specificity relative to CBCT for caries lesions in vitro. Diagnosis with 2D digital Rx is considered non-discriminative in identifying initial caries lesions.

Keywords: Dental caries, Cone beam computed tomography, Diagnosis, Radiography, Dental, Digital, Sensitivity and specificity, Caries Care International.
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