Document Type


Date of Degree

Spring 2017

Access Restrictions


Degree Name

MS (Master of Science)

Degree In

Oral Science

First Advisor

Allareddy, Veeratrishul

First Committee Member

Vargas, Marcos

Second Committee Member

Melo, Saulo L Sousa


Objectives: To evaluate the influence of five different displays on the diagnosis of artificial caries-like lesions on restored and unrestored tooth surfaces.

Materials & Methods: 60 extracted human teeth (30 premolars and 30 molars) were selected. All molars had class II cavities prepared and restored. Half of the premolars and molars were randomly selected and a 7mm² area was exposed to a demineralizing solution for 120 days. Phantoms with four teeth (two premolars and two molars) were created. Periapical radiographs were obtained on RVG 6100 digital sensor (Kodak Dental Systems, New York, USA). The images were evaluated under subdued lighting on five viewing displays (Barco MDNC-3321, NEC Wide, Apple iPad Pro, Microsoft Surface Pro 4 and Dell flat panel monitor) by three observers using a five-point rating scale. Sensitivity (Sn), specificity (Sp), accuracy (Ac) and Receiver Operating Characteristic (ROC) curves and their areas under the curves (AUC) were calculated and compared by Analysis of variance and post-hoc Tukey test. Intraobserver and interobserver agreement were accomplished after a three month interval observational.. The observer agreement was evaluated with the Cohen’s kappa test.

Results: Even though the tablets slightly improved accuracy over the medical monitors, there was no statistically significant difference in sensitivity, specificity, accuracy or AUC among the five monitors when the same tooth group was considered (p< 0.05) with the exception of the iPad Pro which had a specificity p-value of 0.014 when comparing the two materials within the iPad Pro.

Conclusion: There is no perceivable disadvantage to utilizing a higher resolution tablet viewing platform for plane images. No advantage to the medical grade monitors over the tablets or the consumer monitor. Both tablets improved detection accuracy on the unrestored premolars. However further evaluation especially in a clinical lighting setting is warranted to evaluate a displays impact on observer performance within common clinical practice lighting parameters.

Public Abstract

Dental x-ray images are commonly viewed as digital images on computer monitors. The process and technology to acquire the image is independent of the viewing and interpretation of the radiographs. The difference in cost, technical, and software abilities of computer monitors is vast. There are two established categories of monitors currently in use: The off the shelf desktop and the highly specialized medical grade monitor. With the advancements in screen technology, tablet computer platforms offer an additional consideration for an interpretational monitors.

The initial stages of tooth decay are known to be loss of mineral concentration of the tooth’s enamel, creating a visible white spot. The areas between the teeth are not visible to the naked-eye. For this reason dental radiographs can be made to assess those areas. After sufficient progression the white spots will become noticeable on a dental radiograph. If appropriate imaging, viewing, and accurate interpretation are accomplished early decay intervention can be recommended. Often with effective less invasive treatment protocols.

With multiple monitors available to dentists, we wanted to know if more advanced viewing options would impact the diagnostic ability of a dentist to accurately diagnose early tooth decay. The dentists looked at 120 images on five monitors: Two medical grade, one consumer, and two tablet monitors. We found that the medical grade monitors did not offer a diagnostic advantage or that tablets did not have a negative impact on the dentist’s diagnostic accuracy. For this specific application there is no significant difference between the monitors tested.


Artifical caries, Caries detection, Display accuracy, Monitors, Radiology


vii, 34 pages


Includes bibliographical references (pages 31-34).


Copyright © 2017 Shawn C. Countryman