Influence of enhancement filters on the diagnosis of proximal caries lesions in radiographs obtained with a handheld X-ray unit.

OBJECTIVE

To assess the influence of enhancement filters on the diagnosis of proximal caries lesions in radiographs obtained with a handheld X-ray unit.

METHODS

Radiographs of 40 human teeth exhibiting white spots or enamel discolorations were obtained with an Eagle X-ray handheld unit (Alliage, São Paulo, Brazil) configured at 2.5 mA, 60 kVp, and 0.45 s of exposure time. Two digital imaging systems (VistaScan and Digora Toto) were used for radiographic acquisition. A total of 12 enhancement filters--six available in each system--were applied to the radiographs. A total of five dentomaxillofacial radiologists blinded to the filtering condition independently evaluated the radiographs for the presence of caries lesions using a 5-point scale. The area under the receiver operating characteristic curve, sensitivity, and specificity were determined based on the examiners' responses and were compared across the filters tested using one-way analysis of variance, with a significance level of 5%. The weighted Kappa index was used to assess both intra- and inter-examiner agreements in the diagnosis of proximal caries lesions.

RESULTS

Applying the enhancement filters tested did not influence the diagnostic metrics of proximal caries lesions in radiographs obtained using a handheld X-ray unit (p > 0.05). While the intra-examiner agreements were substantial, the inter-examiner agreements ranged from fair to moderate.

CONCLUSIONS

The enhancement filters available in the VistaScan and Digora Toto digital systems did not impact the diagnostic accuracy of proximal caries lesions in radiographs obtained using a handheld X-ray unit. Therefore, clinicians can apply these filters based on personal preference without compromising diagnostic reliability.