Standardised Radiographic Visualisation in Preclinical Restorative Dentistry: A Feasibility Study Using Artificial Teeth

OBJECTIVES: The aim of this feasibility study was to determine whether standardised bitewing radiographs of simulated restorations in artificial teeth provide sufficient radiographic visibility for faculty observers to visualise selected restorative features. The study did not assess students, learning outcomes, diagnostic accuracy, restoration quality, faculty calibration, reliability, grading validity, cognitive load, or readiness for clinical practice. MATERIALS AND METHODS: A laboratory-based feasibility study with a repeated-measures faculty-observer component was conducted using 17 radiographic specimens: five restorations for each of three composite resins, one amalgam restoration as a positive radiopaque control and one unrestored preparation as a negative reference. Digital bitewing radiographs were acquired under standardised conditions with a 1- to 10-mm aluminium step wedge. Ten restorative dentistry instructors rated the perceived ease of visualising contour, homogeneity, marginal adaptation and proximal contact using a five-category Likert-type instrument (1 = very easy to 5 = not possible). Because the same instructors evaluated multiple images, evaluator-level median ratings were analysed using Friedman repeated-measures tests, with paired Wilcoxon signed-rank comparisons and Holm adjustment. Kendall's W was reported as the Friedman effect-size estimate. RESULTS: The restorative materials were clearly distinguishable from the artificial tooth substrate. Filtek Z350 XT and Filtek Bulk Fill Posterior showed mean radiopacity values of 7.40 and 8.64 mm Al, respectively. Enamel Plus HRI and amalgam exceeded the measured 10-mm Al calibration range; extrapolated estimates were 11.90 and 10.92 mm Al, respectively, and were treated as estimates rather than directly calibrated measurements. Across restored conditions, ratings were predominantly in the 'very easy' or 'easy' categories. Overall condition effects were significant for all four parameters (Friedman p < 0.001; Kendall's W = 0.562-0.804). No Holm-adjusted pairwise differences were detected among restored conditions, whereas each restored condition differed from the unrestored reference (adjusted p = 0.0195-0.0410). CONCLUSION AND CLINICAL RELEVANCE: Under the controlled conditions of this feasibility study, standardised bitewing radiographs of restored artificial teeth provided sufficient visibility for faculty observers to visualise the four prespecified restorative features. These findings establish preliminary technical feasibility only; they do not establish diagnostic accuracy, restoration quality, educational benefit, assessment reliability, or grading validity. Larger and balanced studies using student-performed restorations, clinically realistic comparators, prespecified defect categories and formal reliability and learning-outcome analyses are required.