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.

研究目的：本研究旨在对比单纯视觉检查与垂直咬翼片（vertical bitewing, VBW）X线片在儿童乳磨牙龋病检测及治疗计划制定中的应用价值。

研究方法：纳入5~10岁龋病高风险儿童，由经过培训且校准的儿童口腔科医师实施检查。分别基于单纯视觉检查结果及垂直咬翼片X线检查结果制定治疗决策，将治疗方案划分为对照组（CT）、非修复治疗（NRT）、修复治疗（RT）及坏死牙治疗（TNT）四类。采用Stata 18.0软件开展描述性与统计学分析，检验水准设为α=5%。

研究结果：本研究共纳入75名儿童的1417个牙面，其中咬合面528个，邻面889个。在临床检查无异常的牙面中，7%经X线检查发现牙本质龋损。在无临床牙髓坏死征象的患牙中，近20%经X线检查检出牙髓坏死影像学征象，这使得乳磨牙的治疗方案从修复治疗显著调整为牙髓摘除术或拔除术。影像学检查后，共有221个牙面（15.60%）的治疗方案发生变更，具体为对照组转为非修复治疗120例、对照组转为修复治疗32例、非修复治疗转为修复治疗47例、修复治疗转为坏死牙治疗22例。与咬合面相比，邻面的治疗方案变更率显著更高（p<0.001）。

研究结论：与单纯视觉检查相比，垂直咬翼片X线检查可提高乳磨牙邻面龋损的检出率，但多数检出的龋损仅局限于牙釉质。影像学检查后治疗方案的变更主要集中于对照组转为非修复治疗。垂直咬翼片可明确牙本质龋损的深度、距牙髓的距离及牙髓坏死征象，同时可观察恒牙胚状态，上述信息对于深龋病损的治疗计划制定至关重要。