CBCT Accuracy in Detecting Interproximal Caries with and without Amalgam Restorations

Authors

  • Ali Hakiem Tawfieq college of Dentistry, university of Diyala, Iraq

DOI:

https://doi.org/10.5195/d3000.2026.1232

Keywords:

Dental Caries, Diagnosis, Cone-Beam Computed Tomography

Abstract

Objective: To evaluate the diagnostic accuracy of cone-beam computed tomography (CBCT) in detecting interproximal caries in human extracted teeth with and without amalgam restorations. Materials and Methods: This study included 200 human posterior extracted teeth. One hundred teeth had proximal amalgam restorations, and 100 were unrestored. All specimens were scanned using Planmeca ProMax 3D CBCT (FOV 8×8 cm; voxel size 0.2 mm). Caries presence was determined histologically (gold standard) and scored using ICDAS criteria. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated. Logistic regression assessed the influence of amalgam on diagnostic performance. Results: CBCT demonstrated lower sensitivity and specificity in teeth with amalgam compared to unrestored teeth. Beam-hardening artifacts significantly influenced diagnostic reliability (p < 0.05). Conclusion: Although CBCT shows acceptable diagnostic performance for interproximal caries detection, the presence of amalgam restorations moderately reduces accuracy. Conventional bitewing radiography should remain the primary modality when metallic restorations are present.

References

1. Takahashi N, Lee C, Da Silva JD, Ohyama H, Roppongi M, Kihara H, Hatakeyama W, Ishikawa-Nagai S, Izumisawa M. A comparison of diagnosis of early stage interproximal caries with bitewing radiographs and periapical images using consensus reference. Dentomaxillofac Radiol. 2019 Feb;48(2):20170450. doi: 10.1259/dmfr.20170450. Epub 2018 Sep 21. PMID: 30222021; PMCID: PMC6476375.

2. Al Saffan AD. Current Approaches to Diagnosis of Early Proximal Carious Lesion: A Literature Review. Cureus. 2023 Aug 14;15(8):e43489. doi: 10.7759/cureus.43489. PMID: 37719595; PMCID: PMC10499541.

3. Abesi F, Mirshekar A, Moudi E, Seyedmajidi M, Haghanifar S, Haghighat N, Bijani A. Diagnostic accuracy of digital and conventional radiography in the detection of non-cavitated approximal dental caries. Iran J Radiol. 2012 Mar;9(1):17-21. doi: 10.5812/iranjradiol.6747. Epub 2012 Mar 25. PMID: 23329955; PMCID: PMC3522338.

4. Shimada Y, Sato T, Inoue G, Nakagawa H, Tabata T, Zhou Y, Hiraishi N, Gondo T, Takano S, Ushijima K, Iwabuchi H, Tsuji Y, Alireza S, Sumi Y, Tagami J. Evaluation of Incipient Enamel Caries at Smooth Tooth Surfaces Using SS-OCT. Materials (Basel). 2022 Aug 28;15(17):5947. doi: 10.3390/ma15175947. PMID: 36079329; PMCID: PMC9457457.

5. Tawfieq, A. H. (2023). Detection of Vital Anatomical Landmarks in Lower Posterior Premolars and First Molar Area (BuccallyPositioned) During Different Surgical Intervention Using Cone Beam Ct Scan. Diyala Journal of Medicine, 24(1), 117-126.

6. Tawfieq, A. H., Hasan, H. A., Hassan, M. A. A., & Khlfi, M. S. (2023). Localization of the position of vital anatomical structures in the lateral wall of maxillary sinus during different surgical intervention using cone beam computed tomography. Diyala Journal of Medicine, 25(2), 61-71.

7. Idan, H. M., & Al-Aswad, F. D. (2025). Articular Eminence Inclination and Glenoid Fossa Measurements by CBCT in Patients with Temporomandibular Joint Disorders. Diyala Journal of Medicine, 28(1), 48-57.‏ Doi: https://doi.org/10.26505/djm.v28i1.1160

8. Idan, H. M., & Al-Aswad, F. D. (2020). Measurements of Horizontal condylar inclination by using Cadiax compactII in patients with TMJ clicking before and after different treatments modalities. Medico-legal Update, 20(1), 1071.‏ DOI:10.37506/v20/i1/2020/mlu/194443

9. Tawfieq, A. H., Khlfi, M. S., & Hasan, H. A. (2024). Assessment of Articular Eminence Shape and Dental Arch Correlation Using Cone Beam Computed Tomography in Iraqi Residents. Journal of Natural Science, Biology and Medicine, 15(1), 98.‏ DOI: https://doi.org/10.4103/jnsbm.JNSBM_15_1_12

10. Idan, H. M. (2024). The effect of gender and site on the condylar head measurements in Diyala. Diyala Journal of Medicine, 26(2), 80-89.‏ Doi: https://doi.org/10.26505/djm.v26i2.1099

11. Coşkun Albayrak S, Özdemir ÖS. Awareness of Cone Beam Computed Tomography (CBCT) use and radiation safety among dentists and specialists. BMC Oral Health. 2025 Sep 26;25(1):1436. doi: 10.1186/s12903-025-06754-0. PMID: 41013557; PMCID: PMC12465712.

12. Safi Y, Shamloo Mahmoudi N, Aghdasi MM, Eslami Manouchehri M, Rahimian R, Valizadeh S, Vasegh Z, Azizi Z. Diagnostic accuracy of Cone Beam Computed Tomography, conventional and digital radiographs in detecting interproximal caries. J Med Life. 2015;8(Spec Iss 3):77-82. PMID: 28316670; PMCID: PMC5348938.

13. Hinchy NV, Anderson NK, Mahdian M. Metal artifact reduction using common dental materials. Dentomaxillofac Radiol. 2022 Feb 1;51(2):20210302. doi: 10.1259/dmfr.20210302. Epub 2021 Aug 18. PMID: 34406821; PMCID: PMC8802694.

14. Dioguardi M, Guerra C, Sovereto D, Martella A, Zhurakivska K, Tisci A, Esperouz F, Bizzoca ME, Sanesi L, Mastrangelo F, Lo Muzio L, Cirillo N, Ciavarella D, Ballini A. Radiographic artifacts in the diagnosis of dental caries: systematic review with meta-analysis. Oral Radiol. 2025 Dec 2. doi: 10.1007/s11282-025-00879-2. Epub ahead of print. PMID: 41331196.

15. Afkhami F, Ghoncheh Z, Khadiv F, Kaviani H, Shamshiri AR. How Does Voxel Size of Cone-beam Computed Tomography Effect Accurate Detection of Root Strip Perforations. Iran Endod J. 2021;16(1):43-48. doi: 10.22037/iej.v16i1.25145. PMID: 36704411; PMCID: PMC9709875.

16. Ghoncheh Z, Kaviani H, Soleimani S, Nasri S, Malekpour F, Afkhami F. Assessment of the diagnostic accuracy of strip and furcal perforations in different sizes by cone beam computed tomography. Oral Radiol. 2023 Oct;39(4):654-660. doi: 10.1007/s11282-023-00681-y. Epub 2023 Mar 24. Erratum in: Oral Radiol. 2025 Apr;41(2):310. doi: 10.1007/s11282-024-00790-2. PMID: 36961620.

17. Jadu FM, Hill ML, Yaffe MJ, Lam EW. Optimization of exposure parameters for cone beam computed tomography sialography. Dentomaxillofac Radiol. 2011 Sep;40(6):362-8. doi: 10.1259/dmfr/81159071. PMID: 21831976; PMCID: PMC3520345.

18. Mosavat F, Ahmadi E, Amirfarhangi S, Rafeie N. Evaluation of diagnostic accuracy of CBCT and intraoral radiography for proximal caries detection in the presence of different dental restoration materials. BMC Oral Health. 2023 Jun 23;23(1):419. doi: 10.1186/s12903-023-02954-8. PMID: 37353807; PMCID: PMC10290356.

19. Abu El-Ela WH, Farid MM, Abou El-Fotouh M. The impact of different dental restorations on detection of proximal caries by cone beam computed tomography. Clin Oral Investig. 2022 Mar;26(3):2413-2420. doi: 10.1007/s00784-021-04207-w. Epub 2021 Oct 3. PMID: 34601634.

20. Ussaini S, Glogauer M, Sheikh Z, Al-Waeli H. CBCT in Dental Implantology: A Key Tool for Preventing Peri-Implantitis and Enhancing Patient Outcomes. Dent J (Basel). 2024 Jun 26;12(7):196. doi: 10.3390/dj12070196. PMID: 39056983; PMCID: PMC11276053.

21. Dagassan-Berndt DC, Zitzmann NU, Walter C, Schulze RK. Implant treatment planning regarding augmentation procedures: panoramic radiographs vs. cone beam computed tomography images. Clin Oral Implants Res. 2016 Aug;27(8):1010-6. doi: 10.1111/clr.12666. Epub 2015 Jul 30. PMID: 26227397.

22. Sahota J, Bhatia A, Gupta M, Singh V, Soni J, Soni R. Reliability of Orthopantomography and Cone-beam Computed Tomography in Presurgical Implant Planning: A Clinical Study. J Contemp Dent Pract. 2017 Aug 1;18(8):665-669. doi: 10.5005/jp-journals-10024-2103. PMID: 28816186. 2018;22:2845–2854. doi:10.1007/s00784-018-2574-4

23. Fokas G, Vaughn VM, Scarfe WC, Bornstein MM. Accuracy of linear measurements on CBCT images related to presurgical implant treatment planning: A systematic review. Clin Oral Implants Res. 2018 Oct;29 Suppl 16:393-415. doi: 10.1111/clr.13142. PMID: 30328204.

24. Felemban OM, Loo CY, Ramesh A. Accuracy of Cone-beam Computed Tomography and Extraoral Bitewings Compared to Intraoral Bitewings in Detection of Interproximal Caries. J Contemp Dent Pract. 2020 Dec 1;21(12):1361-1367. PMID: 33893259.

25. Rindal DB, Gordan VV, Fellows JL, Spurlock NL, Bauer MR, Litaker MS, Gilbert GH; DPBRN Collaborative Group. Differences between reported and actual restored caries lesion depths: results from The Dental PBRN. J Dent. 2012 Mar;40(3):248-54. doi:10.1016/j.jdent.2011.12.015. Epub 2011 Dec 27. PMID: 22245444; PMCID: PMC3279178.

26. Cassetta M, Pranno N, Stasolla A, Orsogna N, Fierro D, Cavallini C, Cantisani V. The effects of a common stainless steel orthodontic bracket on the diagnostic quality of cranial and cervical 3T- MR images: a prospective, case-control study. Dentomaxillofac Radiol. 2017 Aug;46(6):20170051. doi: 10.1259/dmfr.20170051. Epub 2017 Jun 21. PMID: 28452576; PMCID: PMC5606284.

27. Hassan B, et al. Interobserver reliability in CBCT proximal caries detection. Clin Oral Investig. 2018;22:2831–2839. doi:10.1007/s00784-018-2481-0

28. Cebe F, Aktan AM, Ozsevik AS, Ciftci ME, Surmelioglu HD. The effects of different restorative materials on the detection of approximal caries in cone-beam computed tomography scans with and without metal artifact reduction mode. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Mar;123(3):392-400. doi: 10.1016/j.oooo.2016.11.008. Epub 2016 Dec 7. PMID: 28111155.

29. Spin-Neto R, Gotfredsen E, Wenzel A. Impact of voxel size variation on CBCT-based diagnostic outcome in dentistry: a systematic review. J Digit Imaging. 2013 Aug;26(4):813-20. doi: 10.1007/s10278-012-9562-7. PMID: 23254628; PMCID: PMC3705012

30. Sang YH, Hu HC, Lu SH, Wu YW, Li WR, Tang ZH. Accuracy Assessment of Three-dimensional Surface Reconstructions of In vivo Teeth from Cone-beam Computed Tomography. Chin Med J (Engl). 2016 Jun 20;129(12):1464-70. doi: 10.4103/0366-6999.183430. PMID: 27270544; PMCID: PMC4910372.

31. Esmaeilyfard R, Bonyadifard H, Paknahad M. Dental Caries Detection and Classification in CBCT Images Using Deep Learning. Int Dent J. 2024 Apr;74(2):328-334. doi: 10.1016/j.identj.2023.10.003. Epub 2023 Nov 7. PMID: 37940474; PMCID: PMC10988262.

32. Valizadeh S, Tavakkoli MA, Karimi Vasigh H, Azizi Z, Zarrabian T. Evaluation of Cone Beam Computed Tomography (CBCT) System: Comparison with Intraoral Periapical Radiography in Proximal Caries Detection. J Dent Res Dent Clin Dent Prospects. 2012 Winter;6(1):1-5. doi: 10.5681/joddd.2012.001. Epub 2012 Mar 13. PMID: 22991626; PMCID: PMC3442440.

33. Shavakhi M, Soltani P, Aghababaee G, Patini R, Armogida NG, Spagnuolo G, Valletta A. A Quantitative Evaluation of the Effectiveness of the Metal Artifact Reduction Algorithm in Cone Beam Computed Tomographic Images with Stainless Steel Orthodontic Brackets and Arch Wires: An Ex Vivo Study. Diagnostics (Basel). 2024 Jan 10;14(2):159. doi: 10.3390/diagnostics14020159. PMID: 38248036; PMCID: PMC10813925.

Downloads

Published

2026-04-27

Issue

Vol. 14 No. 1 (2026)

Section

Adults & the Elderly

License

Copyright (c) 2026 Ali Hakiem Tawfieq

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

  1. The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
  2. Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
  3. The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
    1. Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;
    with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
  4. The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.
  5. Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
  6. Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
  7. The Author represents and warrants that:
    1. the Work is the Author’s original work;
    2. the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
    3. the Work is not pending review or under consideration by another publisher;
    4. the Work has not previously been published;
    5. the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
    6. the Work contains no libel, invasion of privacy, or other unlawful matter.
  8. The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.

Revised 7/16/2018. Revision Description: Removed outdated link.