Diagnostic agreement between radiologist, dentist and dental students for radiographic detection of approximal caries.

Sergio E Uribe, Felipe Lara-Abarzúa, Nicolas Ruiz-Miranda, Katherine Bravo-Gajardo, Daniela Huichaman


Aim: To assess intraobserver and interobserver agreement for radiographic detection of approximal caries among dentists, senior’s dental students and radiologists. Materials and methods:  75 standardized bitewing radiographs were examined by four maxillofacial radiologist, four dentist and four senior dental students.  Interobserver agreement was calculated using a weighted Kappa Cohen test. Two weeks later, the examiners re-evaluated 10% of the sample under the same conditions and  intraobserver agreement weighted Kappa Cohen test were calculated.Results: The interobserver Kappa value  was 0.68 (good) for the dentist-student pair, 0.51 (moderate) for the student-radiologist and 0.62 (good) for the dentist-radiologist pair. All these differences were significant. The intraobserver agreement Kappa values obtained were 0.56 (moderate) for students (p=0.46), 0.46 (moderate) for dentist (p<0.05) and 0.68 (good) for radiologist.Conclusion: The agreement for proximal caries detection by dental students, dentists and radiologist was moderate to good.


radiography, dental caries, diagnosis, observer variation.


Baelum V. What is an appropriate caries diagnosis? Acta Odontol Scand. 2010;68(2):65–79.

De Smet E, Jacobs R, Gijbels F, Naert I. The accuracy and reliability of radiographic methods for the assessment of marginal bone level around oral implants. Dentomaxillofacial Radiol. 2002;31(3):176–81.

Sim J, Wright CC. The Kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther. 2005;85(3):257–68.

National Center for Biotechnology Information. Resultado búsqueda [Internet]. 2014 [cited 2014 Oct 22]. Available from: http://j.mp/1s9aeZd

Kamburoglu K, Kolsuz E, Murat S, Yüksel S, Ozen T. Proximal caries detection accuracy using intraoral bitewing radiography, extraoral bitewing radiography and panoramic radiography. Dento Maxillo Facial Radiol. 2012;41(6):450–9.

Berkhout WER, Verheij JGC, Syriopoulos K, Li G, Sanderink GCH, van der Stelt PF. Detection of proximal caries with high-resolution and standard resolution digital radiographic systems. Dento Maxillo Facial Radiol. 2007;36(4):204–10.

Naitoh M, Yuasa H, Toyama M, Shiojima M, Nakamura M, Ushida M, Iida H, Hayashi M, Ariji E. Observer agreement in the detection of proximal caries with direct digital intraoral radiography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85(1):107–12.

Lawrence HP, Benn DK, Sheiham A. Digital radiographic measurement of approximal caries progression in fluoridated and non-fluoridated areas of Rio de Janeiro, Brasil. Community Dent Oral Epidemiol. 1997;25(6):412–8.

Townsend D. Detection of dentine caries using the oblique lateral radiograph. Int J Paediatr Dent. 2000;10(2):145–9.

Guay AH. The evolution of dental group practices. J Calif Dent Assoc. 2013;41(12):899–904.

Iranzo-Cortés JE, Montiel-Company JM, Almerich-Silla JM. Caries diagnosis: agreement between WHO and ICDAS II criteria in epidemiological surveys. Community Dent Health. 2013;30(2):108–11.

Ritter AV, Ramos MD, Astorga F, Shugars DA, Bader JD. Visual-tactile versus radiographic caries detection agreement in caries-active adults. J Public Health Dent. 2013;73(3):252–60.

Kottner J, Audigé L, Brorson S, Donner A, Gajewski BJ, Hróbjartsson A, et al. Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed. J Clin Epidemiol. 2011;64(1):96–106.

Liao JJZ. Sample size calculation for an agreement study. Pharm Stat. 2010;9(2):125–32.

Fleiss JL. Statistical methods for rates and proportions. 3rd ed. Hoboken, N.J: J. Wiley; 2003.

Brennan P, Silman A. Statistical methods for assessing observer variability in clinical measures. BMJ. 1992;304(6840):1491–4.

Tikhonova SM, Feine JS, Pustavoitava NN, Allison PJ. Reproducibility and diagnostic outcomes of two visual-tactile criteria used by dentists to assess caries lesion activity: a cross-over study. Caries Res. 2014;48(2):126–36.

Senel B, Kamburoglu K, Uçok O, Yüksel SP, Ozen T, Avsever H. Diagnostic accuracy of different imaging modalities in detection of proximal caries. Dento Maxillo Facial Radiol. 2010;39(8):501–11.

Neuhaus KW, Ciucchi P, Rodrigues JA, Hug I, Emerich M, Lussi A. Diagnostic performance of a new red light LED device for approximal caries detection. Lasers Med Sci. In press.

Uribe S, Gomez E. Handheld mobile devices for radiographic diagnosis of approximal caries. [abstract 50]. Caries Res. 2012;46:289.

Brocklehurst P, Ashley J, Walsh T, Tickle M. Relative performance of different dental professional groups in screening for occlusal caries. Community Dent Oral Epidemiol. 2012;40(3):239–46.

Diniz MB, Rodrigues JA, Neuhaus KW, Cordeiro RCL, Lussi A. Influence of examiner’s clinical experience on the reproducibility and accuracy of radiographic examination in detecting occlusal caries. Clin Oral Investig. 2010;14(5):515–23.

Bader JD, Shugars DA. Understanding dentists’ restorative treatment decisions. J Public Health Dent. 1992;52(2):102–10.

Lazarchik DA, Firestone AR, Heaven TJ, Filler SJ, Lussi A. Radiographic evaluation of occlusal caries: effect of training and experience. Caries Res. 1995;29(5):355–8.

Hellén-Halme K, Petersson GH. Influence of education level and experience on detection of approximal caries in digital dental radiographs. An in vitro study. Swed Dent J. 2010;34(2):63–9.

Schulte AG, Pitts NB, Huysmans MC, Splieth C, Buchalla W. European Core Curriculum in Cariology for undergraduate dental students. Eur J Dent Educ. 2011;15(Suppl 1):9–17.

Pitts N, Melo P, Martignon S, Ekstrand K, Ismail A. Caries risk assessment, diagnosis and synthesis in the context of a European Core Curriculum in Cariology. Eur J Dent Educ. 2011;15(Suppl 1):23–31.

Da Silva RP, Meneghim MC, Correr AB, Pereira AC, Ambrosano GMB, Mialhe EL. Variations in caries diagnoses and treatment recommendations and their impacts on the costs of oral health care. Community Dent Health. 2012;29(1):25–8.

Full Text: PDF


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.

Corresponding: Facultad de Odontología, Universidad de Concepción, Chile. Roosevelt 1550, Concepción, Chile. Phone +56-41-2204232 - Fax +56-41-2243311- Mailbox 160-C, Concepción, Chile. E-mail journal@joralres.com.