Supplementary Material for: The influence of vertical bitewing radiographs in treatment decision-making for primary molars: a cross-sectional study

Aim: The aim of the present study was to evaluate the use of vertical bitewing (VBW) radiographs compared to visual examination alone for caries detection and treatment planning of primary molars in children. Methods: Children aged 5-10 years with high caries risk were examined by trained and calibrated paediatric dentists. Treatment decisions were made based on visual examination alone and after VBW findings and categorised into control (CT), non-restorative treatment (NRT), restorative treatment (RT) and treatment of the necrotic tooth (TNT). Descriptive and statistical analysis was performed using Stata 18.0 (α=5%). Results: A total of 1417 surfaces in 75 children were included in the study (occlusal=528; proximal=889). Radiographic dentine caries lesions were detected in 7% of clinically sound surfaces. Radiographic signs of pulp necrosis were observed in almost 20% of teeth that had no clinical signs of pulp necrosis. This led to significant changes from restorative treatment to pulpectomy/extraction of primary molars. Treatment changes were required for 221 surfaces (15.60%) after radiographic examination (CT to NRT=120; CT to RT=32; NRT to RT=47; RT to TNT=22). Changes were significantly more frequent in proximal surfaces when compared to occlusal ones (p<0.001). Conclusion: VBW increased the detection of proximal caries lesions in primary molars compared to visual examination, however most of those lesions were restricted to enamel. The majority of changes in the treatment decision after radiographic examination occurred from CT to NRT. Vertical bitewings allowed the determination of the depth of dentine caries, proximity to pulp signs of pulp necrosis, and presence of permanent successors, which are essential for treatment planning for deep caries lesions.