Evaluating the effects of orthodontic materials, field of view, and artifact reduction mode on accuracy of CBCT-based caries detection



To investigate the influence of orthodontic materials, field of view (FOV), and artifact reduction (AR) on the assessment of approximal caries using cone beam computed tomography.

Materials and methods

Forty non-cavitated and restoration-free human premolars and molars ranging from sound to various grades of lesions without cavitations were assigned to 13 groups with different combination of fix appliance equipment. CBCT (cone beam computed tomography) (Planmeca ProMax 3D Mid, Helsinki, Finland) images were obtained using combinations of three orthodontic bracket materials and two orthodontic archwire with small and large FOVs and with and without AR activation. Receiver operating characteristic (ROC) analysis was used to calculate the area under the ROC curve (AUC).


Interobserver agreement ranged from 0.44 to 0.92 and intraobserver agreement ranged from 0.50 to 0.99. Teeth lacking orthodontic materials had the highest Az values at 0.84. FOV and AR activation did not significantly affect AUC values (P > 0.05). The AUC data were significantly reduced by the addition of stainless steel wire, NT wire, or a combination of a stainless steel bracket with stainless steel wire (P < 0.05).


The addition of stainless steel wire, NT wire, or a stainless steel bracket with stainless steel wire combination prevented the diagnosis of non-cavitated interproximal tooth caries by CBCT. With and without AR modes and different FOVs did not influence the diagnosis of interproximal caries lesions with different types of orthodontic equipment.

Clinical relevance

A wide variety of brackets and wire combinations are used in the clinic; however, the extent to which these combinations impact the diagnosis of caries by CBCT as the effects of FOV and AR algorithms are unknown.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2


  1. 1.

    Tsuchida R, Araki K, Okano T (2007) Evaluation of a limited cone-beam volumetric imaging system: comparison with film radiography in detecting incipient proximal caries. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104:412–416. https://doi.org/10.1016/j.tripleo.2007.02.028

    Article  PubMed  Google Scholar 

  2. 2.

    Zhang ZL, Qu XM, Li G, Zhang ZY, Ma XC (2011) The detection accuracies for proximal caries by cone-beam computerized tomography, film, and phosphor plates. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 111:103–108. https://doi.org/10.1016/j.tripleo.2010.06.025

    Article  PubMed  Google Scholar 

  3. 3.

    Qu X, Li G, Zhang Z, Ma X (2011) Detection accuracy of in vitro approximal caries by cone beam computed tomography images. Eur J Radiol 79:e24–e27. https://doi.org/10.1016/j.ejrad.2009.05.063

    Article  PubMed  Google Scholar 

  4. 4.

    Aglarci OS, Bilgin MS, Erdem A, Ertas ET (2015) Is it possible to diagnose caries under fixed partial dentures with cone beam computed tomography? Oral Surg Oral Med Oral Pathol Oral Radiol 119:579–583. https://doi.org/10.1016/j.oooo.2015.02.004

    Article  PubMed  Google Scholar 

  5. 5.

    Sanders MA, Hoyjberg C, Chu CB, Leggitt VL, Kim JS (2007) Common orthodontic appliances cause artifacts that degrade the diagnostic quality of CBCT images. J Calif Dent Assoc 35:850–857

    PubMed  Google Scholar 

  6. 6.

    Bechara BB, Moore WS, McMahan CA, Noujeim M (2012) Metal artefact reduction with cone beam CT: an in vitro study. Dentomaxillofac Radiol 41:248–253. https://doi.org/10.1259/dmfr/80899839

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Rodrigues AF, Campos MJ, Chaoubah A, Fraga MR, Farinazzo Vitral RW (2015) Use of gray values in CBCT and MSCT images for determination of density: influence of variation of FOV size. Implant Dent 24:155–159. https://doi.org/10.1097/ID.0000000000000179

    Article  PubMed  Google Scholar 

  8. 8.

    Pinheiro LR, Scarfe WC, Augusto de Oliveira Sales M, Gaia BF, Cortes AR, Cavalcanti MG (2015) Effect of cone-beam computed tomography field of view and acquisition frame on the detection of chemically simulated peri-implant bone loss in vitro. J Periodontol 86:1159–1165. https://doi.org/10.1902/jop.2015.150223

    Article  PubMed  Google Scholar 

  9. 9.

    Kulczyk T, Dyszkiewicz Konwinska M, Owecka M, Krzyzostaniak J, Surdacka A (2014) The influence of amalgam fillings on the detection of approximal caries by cone beam CT: in vitro study. Dentomaxillofac Radiol 43:20130342. https://doi.org/10.1259/dmfr.20130342

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Gorelick L, Geiger AM, Gwinnett AJ (1982) Incidence of white spot formation after bonding and banding. Am J Orthod 81:93–98

    Article  Google Scholar 

  11. 11.

    Mizrahi E (1982) Enamel demineralization following orthodontic treatment. Am J Orthod 82:62–67

    Article  Google Scholar 

  12. 12.

    Schwendicke F, Tzschoppe M, Paris S (2015) Radiographic caries detection: a systematic review and meta-analysis. J Dent 43:924–933. https://doi.org/10.1016/j.jdent.2015.02.009

    Article  PubMed  Google Scholar 

  13. 13.

    Haiter-Neto F, Wenzel A, Gotfredsen E (2008) Diagnostic accuracy of cone beam computed tomography scans compared with intraoral image modalities for detection of caries lesions. Dentomaxillofac Radiol 37:18–22. https://doi.org/10.1259/dmfr/87103878

    Article  PubMed  Google Scholar 

  14. 14.

    Prell D, Kyriakou Y, Struffert T, Dörfler A, Kalender W (2010) Metal artifact reduction for clipping and coiling in interventional C-arm CT. Am J Neuroradiol 31:634–639

    Article  Google Scholar 

  15. 15.

    Obuchowski NA (2003) Receiver operating characteristic curves and their use in radiology 1. Radiology 229:3–8

    Article  Google Scholar 

  16. 16.

    Valizadeh S, Tavakkoli MA, Karimi Vasigh H, Azizi Z, Zarrabian T (2012) Evaluation of cone beam computed tomography (CBCT) system: comparison with intraoral periapical radiography in proximal caries detection. J Dent Res Dent Clin Dent Prospects 6:1–5. https://doi.org/10.5681/joddd.2012.001

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Kalathingal SM, Mol A, Tyndall DA, Caplan DJ (2007) In vitro assessment of cone beam local computed tomography for proximal caries detection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104:699–704. https://doi.org/10.1016/j.tripleo.2006.08.032

    Article  PubMed  Google Scholar 

  18. 18.

    Hintze H, Frydenberg M, Wenzel A (2003) Influence of number of surfaces and observers on statistical power in a multiobserver ROC radiographic caries detection study. Caries Res 37:200–205. https://doi.org/10.1159/000070445

    Article  PubMed  Google Scholar 

  19. 19.

    Rino Neto J, Silva FP, Chilvarquer I, Paiva JB, Hernandez AM (2012) Hausdorff distance evaluation of orthodontic accessories’ streaking artifacts in 3D model superimposition. Braz Oral Res 26:450–456

    Article  Google Scholar 

  20. 20.

    Bechara B, Alex McMahan C, Moore WS, Noujeim M, Teixeira FB, Geha H (2013) Cone beam CT scans with and without artefact reduction in root fracture detection of endodontically treated teeth. Dentomaxillofac Radiol 42:20120245. https://doi.org/10.1259/dmfr.20120245

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Candemil AP, Salmon B, Freitas DQ, Ambrosano GMB, Haiter-Neto F, Oliveira ML (2019) Are metal artefact reduction algorithms effective to correct cone beam CT artefacts arising from the exomass? Dentomaxillofac Radiol 48:20180290. https://doi.org/10.1259/dmfr.20180290

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Kamburoglu K, Kolsuz E, Murat S, Eren H, Yuksel S, Paksoy CS (2013) Assessment of buccal marginal alveolar peri-implant and periodontal defects using a cone beam CT system with and without the application of metal artefact reduction mode. Dentomaxillofac Radiol 42:20130176. https://doi.org/10.1259/dmfr.20130176

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    de Rezende Barbosa GL, Sousa Melo SL, Alencar PN, Nascimento MC, Almeida SM (2016) Performance of an artefact reduction algorithm in the diagnosis of in vitro vertical root fracture in four different root filling conditions on CBCT images. Int Endod J 49:500–508. https://doi.org/10.1111/iej.12477

    Article  PubMed  Google Scholar 

  24. 24.

    Queiroz PM, Groppo FC, Oliveira ML, Haiter-Neto F, Freitas DQ (2017) Evaluation of the efficacy of a metal artifact reduction algorithm in different cone beam computed tomography scanning parameters. Oral Surg Oral Med Oral Pathol Oral Radiol 123:729–734. https://doi.org/10.1016/j.oooo.2017.02.015

    Article  PubMed  Google Scholar 

  25. 25.

    Da Silveira PF, Fontana MP, Oliveira HW, Vizzotto MB, Montagner F, Silveira HL et al (2015) CBCT-based volume of simulated root resorption - influence of FOV and voxel size. Int Endod J 48:959–965. https://doi.org/10.1111/iej.12390

    Article  PubMed  Google Scholar 

  26. 26.

    Shokri A, Jamalpour MR, Khavid A, Mohseni Z, Sadeghi M (2019) Effect of exposure parameters of cone beam computed tomography on metal artifact reduction around the dental implants in various bone densities. BMC Med Imaging 19:34. https://doi.org/10.1186/s12880-019-0334-4

    Article  PubMed  PubMed Central  Google Scholar 

Download references


The authors would like to thank Prof. Dr. Hasan Hüseyin Yılmaz for his contributions as a scientific advisor.

Author information



Corresponding author

Correspondence to Ozlem Isman DDS, PhD.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This study was approved by the Gaziantep University Faculty of Medicine Ethic Committee Presidency (Protocol code: 407).

Informed consent

For this type of study, formal consent is not required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Isman, O., Aktan, A.M. & Ertas, E.T. Evaluating the effects of orthodontic materials, field of view, and artifact reduction mode on accuracy of CBCT-based caries detection. Clin Oral Invest 24, 2487–2496 (2020). https://doi.org/10.1007/s00784-019-03112-7

Download citation


  • CBCT
  • Diagnosis
  • Orthodontic brackets
  • Field of view
  • Artifact reduction