Is there hidden caries or is this a limitation of the conventional exams?

The aim of this study was to verify the existence of hidden caries and compare the diagnosis agreement among different examiners by visual, dental radiography and computed microtomography images of hidden dental caries lesions on the occlusal surface of extracted molars. Two hundred and fifteen teeth were examined visually and extracted from cadavers of adolescents with a mean age of 12 years. Eleven teeth which showed hidden occlusal caries were included in the study. Occlusal sites were examined both visually and by dental radiograph by 3 different dental practitioners. Results were compared and validated independently by each examiner with computed microtomography; hence, the gold-standard in current investigation. The coefficient of agreement was calculated by the Cohen's Kappa test. The agreement among examiners for the diagnosis by standard microtomography was excellent (K = 0.924) and moderate for both the visual (K = 0.515) and the radiographic (K = 0.583) examinations. Computed microtomography-produced images which allowed the examiners to visualize radiolucent areas unseen in previous radiographic images and visual examinations showed anatomic communication between enamel and/or dentine to the external environment, not necessarily due to enamel collapse. Occlusal hidden caries was being over detected by clinicians because of the limitations of the conventional dental visual and radiographic examination, which indicate that the examinations are not accurate enough to detect the lesions.