Application of panoramic radiography with a multilayer imaging program for detecting proximal caries: a preliminary clinical study.

OBJECTIVE: The aim of this study is to introduce a novel program of panoramic radiography that shows 41 multilayer images from the buccal to lingual aspects in a region of interest, and to evaluate the effectiveness of this program for detecting proximal caries. METHODS: In total, 480 premolars and molars on 30 panoramic radiographs taken with the multilayer imaging program were included in this study. The presence or absence of caries in 960 proximal surfaces was assessed by three experienced oral and maxillofacial radiologists as a consensus-based gold-standard. Two general dentists evaluated and scored proximal caries on 980 surfaces on panoramic radiographs with and without the multilayer imaging program. The two general dentists' scores were compared with the gold-standard, and were analyzed for sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic (ROC) curve with and without using the program. The area under the ROC curve was analyzed using STATA/SE 13.1. RESULTS: When the multilayer imaging program was used for panoramic radiography, the inter- and intraobserver agreement of the two general dentists improved. All values, including the area under the ROC curve, were higher when the multilayer imaging program was used than when it was not used. The area under the ROC curve showed a statistically significant improvement only in Observer 1, whose diagnostic ability was poorer than that of Observer 2. CONCLUSIONS:O: This multilayer imaging program might help the inexperienced dentist to improve the diagnostic accuracy of proximal caries. If further studies would be performed in various clinical application, it could be useful when intraoral radiography taking is difficult for reasons such as mouth-opening limitations and the gag reflex of the patients.