Reproducibility of Subtraction Radiography in Monitoring Changes in Approximal Carious Lesions in Children: An In Vivo Study

Mona Al-Sane (Lead / Corresponding author), David N. Ricketts, Fausto M. Mendes, Yacoub Altarakemah, Christopher Deery, Nicola Innes, Sam Rollings

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
113 Downloads (Pure)


Background: Laboratory studies have shown that digital subtraction radiography (DSR) can be a more effective tool, than conventional radiography, in monitoring changes in carious lesions. The clinical performance of the technique, however, has not been sufficiently researched. Aim: To compare the reproducibility of DSR to that of bitewing radiographs, in monitoring changes in approximal caries in the mixed dentition. A secondary aim was to determine whether assessment outcomes differed as a function of the method used. Design: Six assessors evaluated 310 lesions first on bitewings, then with DSR. The overall reproducibility was evaluated via intra-class correlation coefficient (ICC). Intra- and inter-rater reproducibility were assessed using weighted Kappa. Paired t test was used to assess differences in the reproducibility across methods. Results: The overall reproducibility for DSR was (ICC = 0.47, 95% CI = 0.31-0.56). Intra- and inter-rater reproducibility were 0.65 and 0.44, respectively. The overall reproducibility for bitewings was ICC = 0.45, 95% CI = 0.42-0.57. Intra- and Inter-rater reproducibility were 0.71 and 0.46, respectively. Differences in the reproducibility across methods were not statistically significant. Significantly more lesions were scored as progressed using DSR. Conclusions: The reproducibility of DSR in monitoring changes in approximal caries is comparable to that of bitewings. Additionally, DSR detected higher proportion of progression than bitewing assessments.

Original languageEnglish
Pages (from-to)587-596
Number of pages10
JournalInternational Journal of Paediatric Dentistry
Issue number5
Early online date17 Mar 2020
Publication statusPublished - 1 Sept 2020


  • caries
  • caries progression
  • proximal caries
  • reproducibility
  • subtraction radiography

ASJC Scopus subject areas

  • Dentistry(all)


Dive into the research topics of 'Reproducibility of Subtraction Radiography in Monitoring Changes in Approximal Carious Lesions in Children: An In Vivo Study'. Together they form a unique fingerprint.
  • No photo of David Ricketts

    Ricketts, David

    • Dentistry - Professor of Evidence Based Operative Dentistry & Evidence Based Operative Dentistry

    Person: Academic

Cite this