The aim of this study was to compare the caries diagnostic outcome of a two–film and a four–film routine bite–wing examination undertaken in an adult population. A digital bite–wing examination using two and four films, respectively, was performed in 174 patients. The radiographs from the two examinations were assessed jointly by 2 observers for the number of imaged surfaces in the area from the distal surface of the canine to the distal surface of the third molar and for the detection of carious lesions. Significantly more surfaces were available for examination by the four–film than by the two–film examination. Overlapping surfaces were recorded in 14 and 10%, respectively, of the surfaces imaged by the two–film and four–film set. The prevalence of primary enamel and dentinal caries was 6.8% with the two–film and 5.6% with the four–film method. In 1,684 surfaces only imaged by the four–film method caries was detected in 20 surfaces. If these extra lesions were added to the number of lesions found by the two–film method the total disease prevalence using the last–mentioned method would increase by 2‰. The majority (92–99%) of all recorded lesions were detected in surfaces located between the occlusal surface of the first premolar and the mesial surface of the third molar. The little additional diagnostic outcome obtained by the use of four instead of two films did not seem to match the extra resources (double patient charge and radiation dose, and extended scan/developing and recording time for the dentist) connected to the four–film method. Thus, it may be recommended that a routine bite–wing examination undertaken in young adults should be performed with only two films: one in each side of the mouth, placed behind the premolars and the first and second molars.

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