An in-vitro evaluation of Kodak Insight and Ektaspeed Plus film with a CMOS detector for natural proximal caries: ROC analysis.

This study compared the diagnostic efficacy of Kodak Ektaspeed Plus film, Kodak Insight film, a newly introduced E/F-speed film, and Schick CMOS-APS digital sensor, with respect to caries detection in 92 proximal surfaces of extracted unrestored teeth, 51 of which were carious. Ground truth was evaluated histologically and the lesions classified as enamel or dentinal. Eight observers read the radiographs using a five-point confidence rating scale to record their diagnoses. Analyses using receiver operating characteristic curves revealed the areas under each curve that indicated the diagnostic accuracy (Ektaspeed Plus - 0.760, Insight - 0.778 and CMOS-APS sensor - 0.732). ANOVA revealed significant differences with respect to caries depth (p<0.031) and observers (p<0.0001). Weighted kappa analyses indicated moderate to substantial inter- and intra-observer agreement (0.42 and 0.66, respectively). The results suggest that none of the imaging modalities evaluated in this study differed in their diagnostic capabilities with respect to proximal decay detection and that the Insight film which was used with 20% less radiation exposure than Ektaspeed Plus film was as good as the other two sensors for this purpose.