Evidence map›Paper›PMID 41331196›Full record

SynthesisOral radiology2026

Radiographic artifacts in the diagnosis of dental caries: systematic review with meta-analysis.

Mario Dioguardi, Ciro Guerra, Diego Sovereto, Angelo Martella, Khrystyna Zhurakivska, Angela Tisci, Fariba Esperouz, Maria Eleonora Bizzoca, Lorenzo Sanesi, Filiberto Mastrangelo and 4 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Oral radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Mario DioguardiDepartment of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, Foggia, 71122, Italy. mario.dioguardi@unifg.it.ORCID 0000-0003-0949-3457
Ciro GuerraDepartment of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, Foggia, 71122, Italy.
Diego SoveretoDepartment of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, Foggia, 71122, Italy.
Angelo MartellaDataLab, Department of Engineering for Innovation, University of Salento, Lecce, Italy.
Khrystyna ZhurakivskaDepartment of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, Foggia, 71122, Italy.
Angela TisciDepartment of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, Foggia, 71122, Italy.
Fariba EsperouzDepartment of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, Foggia, 71122, Italy.
Maria Eleonora BizzocaDepartment of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, Foggia, 71122, Italy.
Lorenzo SanesiDepartment of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, Foggia, 71122, Italy.
Filiberto MastrangeloDepartment of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, Foggia, 71122, Italy.
Lorenzo Lo MuzioDepartment of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, Foggia, 71122, Italy.
Nicola CirilloDepartment of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, Foggia, 71122, Italy.
Domenico CiavarellaDepartment of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, Foggia, 71122, Italy.
Andrea BalliniDepartment of Life Science, Health and Health Professions, Link Campus University, Rome, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThe radiographic diagnosis of dental caries is often complicated by the presence of radiographic optical effects, such as the Mach band effect and triangular-shaped radiolucencies (TSR). These phenomena can give rise to false-positive diagnoses, especially in bite-wing radiographs, thus influencing clinical decision-making and possibly leading to overdiagnosis and overtreatment. The aim of this systematic review and meta-analysis was to clarify the real prevalence of these radiographic optical effects in dental radiographs and to quantify their influence on diagnostic errors in caries detection.

methodsThis systematic literature review follow the PRISMA guidelines and registered in PROSPERO (CRD420251083823), prior to its execution. Electronic searches were conducted on PubMed, Scopus and the Cochrane Library, with the addition of Grey literature and references of the main reviews on the topic. Inclusion criteria included clinical, in vitro and ex vivo studies evaluating the impact of TSR and Mach band effects on intraoral radiographs (bitewing or periapical), reporting diagnostic performance, prevalence or misinterpretation rates. Data extraction and risk of bias assessment (AXIS, QUADAS-2) were performed independently by two reviewers. Meta-analyses were performed using random effects models.

resultsOf 640 identified reports, only five studies were included. The overall prevalence of non-carious TSR on maxillary molars was 26.44%, 270/1021. The meta-analysis showed that effects (TSR or Mach band) led to false positive diagnoses of caries or fractures, in approximately 13% of observations (60/464). Heterogeneity was high (I² > 90%) and the certainty of the evidence was classified as low to very low due to the type of studies included and the consistency indices.

conclusionsRadiographic optical effects, especially TSR and Mach band effect, are highly prevalent in bitewing images and significantly increase the risk of false positive caries diagnoses, especially in children. Given the low certainty of the available evidence, clinicians should interpret radiographic findings with caution and always correlate them with a thorough clinical examination. Further high-quality research is needed to develop standardized diagnostic criteria and strategies to mitigate radiographic optical effects in dental practice.

Indexed as

ArtifactsDental CariesRadiography, DentalDiagnostic ErrorsFalse Positive ReactionsHumansArtifacts analysisCariesCervical burnoutDentalMach band effectPeriapical X-Rays

Identifiers

PMID41331196
PMCPMC12988984

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.