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Research Article | DOI: https://doi.org/10.31579/2690-1919/497
1Master Degree in Restorative and Esthetic Dentistry, Faculty of Dentistry, Sana’a University, Sana’a, Yemen.
2Professor in Restorative and Esthetic Dentistry, Faculty of Dentistry, Sana'a University, Yemen.
3Dean Faculty of Dentistry on 21 September University, Head of Restorative and Esthetic Dentistry Department, Dental Implant Consultant, Yemen
*Corresponding Author: Abdulwahab Ismail Al-Kholani, Dean Faculty of Dentistry on 21 September University, Sana'a Yemen.
Citation: Abdulrahman Ebrahim Al-Mansor, Ibrahim Zaid Al-Shami, Abdulwahab Ismail Al-kholani, (2025), The Efficiency of CBCT X-Ray in Detecting Caries Under Cemented and Uncemented Dental Fixed Prosthesis, J Clinical Research and Reports, 19(1); DOI:10.31579/2690-1919/497
Copyright: © 2025, Abdulwahab Ismail Al-Kholani. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 03 February 2025 | Accepted: 10 February 2025 | Published: 03 March 2025
Keywords: cone-beam computed tomography; CBCT; secondary caries; fixed prostheses; zirconia, porcelain-fused-to-metal; dental imaging; caries detection
Aim: This study aims to assess the efficiency of cone-beam computed tomography (CBCT) in detecting secondary caries under various types of fixed prostheses, including zirconia, e-max, porcelain-fused-to-metal, and acrylic CAD/CAM, and to evaluate whether dental cement acts as a barrier to caries detection.
Materials and Methods: An in vitro experimental study was conducted using 116 caries-free human premolar teeth, divided into four main groups based on the type of fixed prosthesis. Each group was further subdivided according to caries depth (0-1 mm, 1-2 mm, 2-3 mm). A pilot study was performed to establish the methodology, followed by CBCT imaging before and after cementation with glass ionomer cement. The images were analyzed using Ez3D-I software, and data were statistically evaluated using SPSS software.
Results: Significant differences in caries detection rates were observed before and after cementation for zirconia (100% to 58.33%, p = 0.002) and porcelain-fused-to-metal crowns (100% to 66.67%, p = 0.005). No significant differences were found for acrylic CAD/CAM and empress crowns. The study demonstrated excellent intraobserver reliability for caries and composite measurements.
Conclusion: CBCT is an effective tool for detecting secondary caries under cemented and uncemented dental fixed prostheses, particularly for zirconia and porcelain-fused-to-metal crowns. Early detection of secondary caries is crucial for preserving tooth structure and improving treatment outcomes. Given its non-invasive nature and superior imaging capabilities, CBCT should be integrated into clinical practice for enhanced diagnostic accuracy.
Cone-beam computed tomography (CBCT) has become an essential tool in dentistry for detecting caries beneath fixed prostheses. This imaging modality provides high-resolution, three-dimensional images, allowing for enhanced visualization of dental structures, which is crucial for accurate diagnosis and treatment planning in prosthodontics (Ludlow et al., 2013; Priyanka et al., 2016). CBCT has demonstrated superior sensitivity and specificity for caries detection compared to conventional radiography (Gowri et al., 2020; Alkhudhairy et al., 2018).
In addition to CBCT, other diagnostic aids such as ultrasound detectors, electric-based aids, and light-induced fluorescence are available. Recent advancements include deep learning applications for detecting proximal caries using intraoral photos (Emma et al., 2023). Early diagnosis of secondary caries is vital for preserving tooth structure and improving treatment outcomes, especially for patients requiring various types of crowns (Moataz et al., 2022).
The longevity of fixed dental prostheses (FDP) is typically around 10 years, with secondary caries being a leading cause of failure (Ali Alenezi et al., 2022). Despite advancements in materials and techniques, the need for removal due to secondary caries remains prevalent (Sharma et al., 2012). CBCT and intraoral preapical X-rays can detect caries without necessitating the removal of fixed prostheses (Farzaneh et al., 2022).
Various radiographic techniques, including periapical, bitewing, occlusal, panoramic, and CBCT imaging, are employed alongside clinical examinations to diagnose secondary caries and prevent prosthesis failure (Talaeipour et al., 2016). Conventional 2D radiographic techniques often fall short in detecting carious lesions located beneath restorations (Kandemir, 1997). CBCT offers a three-dimensional perspective, allowing for better evaluation of the region of interest (Elluru et al., 2017). Its advantages include reduced radiation dose and cost compared to medical CT (Khader et al., 2023).
Statement of the Problem
Evaluating secondary caries under fixed prostheses typically requires removal, which can lead to complications such as periodontal ligament breakdown and damage to both teeth and prostheses. CBCT may provide a solution by detecting secondary caries without the need for removal.
Justification
Secondary caries are a primary cause of fixed dental prosthesis failure. Early detection is crucial to prevent the spread of caries and subsequent failure without necessitating the removal of the prosthesis.
This study aims to assess the efficiency of CBCT in detecting secondary caries under various types of fixed prostheses (zirconia, e-max, porcelain-fused-to-metal, and acrylic CAD/CAM) and to evaluate whether dental cement acts as a barrier.
Specific Objectives
Pilot Study
A pilot study was conducted with four additional teeth (n=1 for each type) to prepare for the main experiment. Each tooth received a dental crown, and artificial buccal caries (2-3 mm deep) was created. The specimens underwent CBCT imaging before and after crown cementation with glass ionomer cement to identify potential irregularities in the study.
Study Design
This study was designed as an in vitro experimental study.
Place of Study
The research was conducted at the Laboratory of the Restorative Department, College of Dentistry, Sana’a University, Yemen, from May 2022 to August 2024.
Sample Grouping
A total of 116 caries-free human premolar teeth were selected, with 96 specimens and 20 control teeth. The main groups included:
Each main group was divided into three subgroups based on caries depth (0-1 mm, 1-2 mm, 2-3 mm). The control group consisted of 20 teeth, with 5 teeth for each type of FDP, prepared without artificial caries.
Materials
A table detailing the materials used in the study was included.
Methodology
Collection of Teeth
Caries-free premolars were collected from orthodontic patients in Sana’a, Yemen.
Sterilization
Teeth were sterilized with 10% formalin and 5.25% sodium hypochlorite, then stored in normal saline solution.
Preparation of Extracted Teeth
Teeth were fixed in a custom acrylic box for preparation. Each tooth was prepared according to aCAD emic standards using a high-speed handpiece and diamond bur. Artificial caries were created at the cervical third of the teeth, and cavities were filled with red wax to simulate the crown structure.
Procedures at the Dental Lab
Teeth were scanned using an ultra-high-speed 3D dental scanner, and crowns were designed using Exocad software. The crowns were fabricated using a dental milling machine for acrylic, empress, and zirconia crowns, and a metal laser melting machine for PFM crowns.
Procedures at the Dental X-Ray Center
CBCT imaging was performed using an X-Mind Trium machine. The imaging parameters included a small field of view (8 cm x 8 cm), 1 mm slice thickness, and an exposure time of 14 seconds. Images were reconstructed with Ez3D-I software, and data were evaluated by three observers (two specialists and one radiologist) using specific criteria for detecting caries and restorations.
CBCT Image Analysis
The mean grayscale feature in Ez3D-I software was utilized to detect carious lesions. Data was collected, tabulated, and analyzed using SPSS software.
This section presents the findings of the study derived from data analysis and interpretation. It begins with data screening, which includes coding and checking for missing data using SPSS. The sample profile is described, detailing the characteristics of the specimens or subjects in tabular form. Finally, the results of the comparative analysis are presented.
The SPSS software (Statistical Package for the Social Sciences, Version 26) was utilized to conduct the following statistical tests:
Frequency Distribution of Specimens by Group
Table 4.1 presents a comprehensive frequency distribution of specimens categorized by their respective groups. This organization is crucial for understanding the distribution and prevalence of different specimen types within the study.
Understanding Frequency Distribution
A frequency distribution summarizes how often each different value occurs in a dataset, providing a clear picture of the data's structure. In the context of specimens, this distribution reveals which groups are more common and which are less so, aiding in further analysis and decision-making.
Key Components of Frequency Distribution
| Group | Depth | Frequency | Percent |
| Zirconia | 0 to 1 | 8 | 8.33% |
| 1 to 2 | 8 | 8.33% | |
| 2 to 3 | 8 | 8.33% | |
| Acrylic CAD CAM | 0 to 1 | 8 | 8.33% |
| 1 to 2 | 8 | 8.33% | |
| 2 to 3 | 8 | 8.33% | |
| Impress | 0 to 1 | 8 | 8.33% |
| 1 to 2 | 8 | 8.33% | |
| 2 to 3 | 8 | 8.33% | |
| Porcelain fused to metal | 0 to 1 | 8 | 8.33% |
| 1 to 2 | 8 | 8.33% | |
| 2 to 3 | 8 | 8.33% | |
| Total | 96 | 100% |
Table 1: Frequency Distribution of Specimens by Group.
Interpreting Table 1
When analyzing Table 1, consider the following:
Caries Depth Analysis
Table 2 presents the percentage of caries depth appearance obtained from CBCT images according to the type of dental prosthesis. In the Zirconia crown group, statistically significant differences in caries depth were observed before and after cementation, with a p-value of 0.002, indicating a meaningful impact of cementation on caries detection. Before cementation, all 24 specimens (100%) exhibited caries. After cementation, the number of detected cases decreased to 14 specimens, representing 58.33%.
| Group | Depth | Before cementation | After cementation | P value1 | ||
| Detected | Not Detected | Detected | Not Detected | |||
| Zirconia | 0 to 1 | 8 (33.3%) | 0 (0.0%) | 0 (0.0%) | 8 (33.33%) | 0.000* |
| 1 to 2 | 8 (33.3%) | 0 (0.0%) | 6 (25.0%) | 2 (8.33%) | 0.157 | |
| 2 to 3 | 8 (33.3%) | 0 (0.0%) | 8 (33.33%) | 0 (0.0%) | 1.000 | |
| Total | 24 (100%) | 0 (0.0%) | 14 (58.33%) | 10 (41.67%) | 0.002* | |
| P value2 | 1.000 | 0.000* | ||||
| Acrylic CAD CAM | 0 to 1 | 8 (33.3%) | 0 (0.0%) | 8 (33.3%) | 0 (0.0%) | 1.000 |
| 1 to 2 | 8 (33.3%) | 0 (0.0%) | 8 (33.3%) | 0 (0.0%) | 1.000 | |
| 2 to 3 | 8 (33.3%) | 0 (0.0%) | 8 (33.3%) | 0 (0.0%) | 1.000 | |
| Total | 24 (100%) | 0 (0.0%) | 24 (100%) | 0 (0.0%) | 1.000 | |
| P value2 | 1.000 | 1.000 | ||||
| Impress | 0 to 1 | 8 (33.3%) | 0 (0.0%) | 8 (33.3%) | 0 (0.0%) | 1.000 |
| 1 to 2 | 8 (33.3%) | 0 (0.0%) | 8 (33.3%) | 0 (0.0%) | 1.000 | |
| 2 to 3 | 8 (33.3%) | 0 (0.0%) | 8 (33.3%) | 0 (0.0%) | 1.000 | |
| Total | 24 (100%) | 0 (0.0%) | 24 (100%) | 0 (0.0%) | 1.000 | |
| P value2 | 1.000 | 1.000 | ||||
| Porcelain fused to metal | 0 to 1 | 8 (33.3%) | 0 (0.0%) | 0 (0.0%) | 8 (33.33%) | 0.000* |
| 1 to 2 | 8 (33.3%) | 0 (0.0%) | 8 (33.3%) | 0 (0.0%) | 1.000 | |
| 2 to 3 | 8 (33.3%) | 0 (0.0%) | 8 (33.3%) | 0 (0.0%) | 1.000 | |
| Total | 24 (100%) | 0 (0.0%) | 16 (66.7%) | 8 (33.3%) | 0.005* | |
| P value2 | 1.000 | 0.000* | ||||
P value1: Wilcoxon Signed Ranks Test, P value2: Kruskal-Wallis Test, * P value ≤ 0.05
Table 2: Shows the percentage of caries depth appearance obtained from the CBCT image according to the type of dental prosthesis.
Overall Caries Appearance
Table 3 summarizes the significant differences in caries appearance observed before and after cementation across the various groups of dental prostheses. Before cementation, a total of 96 specimens (100%) exhibited caries, while after cementation, the number of detected cases decreased to 78 specimens, representing 81.25%. This reduction resulted in a statistically significant p-value of 0.000, indicating a meaningful impact of cementation on caries detection.
| Group | Before cementation | After cementation | P value | ||
| Detected | Not Detected | Detected | Not Detected | ||
| Zirconia | 24 (100%) | 0 (0.0%) | 14 (58.33%) | 10 (41.67%) | 0.002* |
| Acrylic CAD CAM | 24 (100%) | 0 (0.0%) | 24 (100%) | 0 (0.0%) | 1.000 |
| Impress | 24 (100%) | 0 (0.0%) | 24 (100%) | 0 (0.0%) | 1.000 |
| Porcelain fused to metal | 24 (100%) | 0 (0.0%) | 16 (66.7%) | 8 (33.3%) | 0.005* |
| Total | 96 (100%) | 0 (0.0%) | 78 (81.25%) | 18 (18.75%) | 0.000* |
Table 3: Comparison between caries appearance before and after cementation according to the types of dental prosthesis.
Reliability Analysis
Reliability analyses were conducted to assess the consistency of caries and composite measurements. One-way ANOVA tests confirmed no significant differences among the three readings, indicating excellent agreement in both measurements.
Reliability analyses were conducted to assess the consistency of caries and composite measurements. One-way ANOVA tests confirmed no significant differences among the three readings, indicating excellent agreement in both measurements.
The results of this study highlight the significant advantages of cone-beam computed tomography (CBCT) in the early detection of secondary caries beneath various types of fixed dental prostheses. The findings indicate that CBCT is particularly effective in identifying caries under zirconia and porcelain-fused-to-metal crowns, with statistically significant differences observed in caries detection rates before and after cementation. Specifically, the detection rate for zirconia crowns decreased from 100
In conclusion, this study confirms the efficiency of CBCT in detecting secondary caries under cemented and uncemented dental fixed prostheses. The significant differences in caries detection rates before and after cementation for zirconia and porcelain-fused-to-metal crowns highlight the importance of advanced imaging techniques in clinical practice. Early detection of secondary caries is crucial for preserving tooth structure and improving treatment outcomes, ultimately contributing to the longevity of fixed dental prostheses. Given the advantages of CBCT, including its non-invasive nature and superior imaging capabilities, it should be considered a valuable tool in the diagnostic arsenal of dental practitioners. Future research should focus on expanding the sample size and exploring the effectiveness of CBCT in detecting caries in a broader range of dental materials and clinical scenarios.
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