Computer-aided radiographic method

Digital radiographic methodDigital, filmless, techniques for intraoral radiography have been developed for several important reasons:1. Conventional film absorbs only a few percent of the x-rays that reach it, utilizing very little of the radiation to which the patient has been exposed.2. Poor darkroom procedure can lead to both unnecessarily high doses of radiation and loss of diagnostic information.3. Development of films is time consuming, and the developer and fixing solutions are hazardous to the environment.

Conventional bitewing radiographic methodSeveral factors have contributed to the general adoption of radiographic examination as an aid to the detection and subsequent treatment of caries:1. It discloses sites inaccessible to other diagnostic methods. Radiography facilitates detection of carious lesions at an earlier, potentially reversible stage. Usually, more approximal and occlusal lesions are recorded when clinical examinations are supplemented by radiography. 2. The depth of the lesion can be evaluated and scored, eg, by the radiographic index by Grondahl et al (1977), modified from Moller and Poulsen (1973): 0 = no radiographic changes in enamel; 1 = radiographic changes in enamel; 2 = radiolucency extending to the dentinoenamel junction; 3 = radiolucency penetrating approximately halfway through dentin; and 4 = radiolucency close to the pulp.

Visual method with temporary elective tooth separation and impression of the approximal lesionTemporary elective tooth separation, complemented by a localized impression of the opened interproximal space, allows a more sensitive diagnosis of cavitation than does the purely visual separation method. This also has the advantage of providing a replica as a reference for visual monitoring of changes in size or even measurement of serial impressions (Neilson and Pitts, 1993; Seddon, 1989).

Visual method with temporary elective tooth separationThe once popular technique of temporary elective tooth separation as an aid to diagnosis of caries in approximal smooth surfaces is now regaining popularity, albeit with more humane and less traumatic methods that seem acceptable to most patients and dentists. This method permits a more definite assessment of whether radiographically detectable approximal enamel (D1, D2) and dentin lesions (D3) are cavitated (Pitts and Longbottom, 1987; Pitts and Rimmer, 1992; Rimmer and Pitts, 1990).

Visual method used in European epidemiologic surveysProbing has been criticized for several reasons: It may allow transmission of  cariogenic bacteria from infected sites, it can irreversibly traumatize potentially remineralizable noncavitated lesions of enamel and dentin, and it may provide no more accuracy in diagnosis than visual inspection alone, particularly in the fissures and on the posterior approximal surfaces. Accordingly, a so-called European system of examination for surveys, based primarily on detailed visual examination, has been adopted by many epidemiologists.