Influence of Contact Points on the Performance of Caries Detection Methods in Approximal Surfaces of Primary Molars: An in vivo Study

Abstract

This in vivo study aimed to evaluate the influence of contact points on the approximal caries detection in primary molars, by comparing the performance of the DIAGNOdent pen and visual-tactile examination after tooth separation to bitewing radiography (BW). A total of 112 children were examined and 33 children were selected. In three periods (a, b, and c), 209 approximal surfaces were examined: (a) examiner 1 performed visual-tactile examination using the Nyvad criteria (EX1); examiner 2 used DIAGNOdent pen (LF1) and took BW; (b) 1 week later, after tooth separation, examiner 1 performed the second visual-tactile examination (EX2) and examiner 2 used DIAGNOdent again (LF2); (c) after tooth exfoliation, surfaces were directly examined using DIAGNOdent (LF3). Teeth were examined by computed microtomography as a reference standard. Analyses were based on diagnostic thresholds: D1: D₀ = health, D₁-D₄ = disease; D2: D₀, D₁ = health, D₂-D₄ = disease; D3: D₀-D₂ = health, D₃, D₄ = disease. At D1, the highest sensitivity/specificity were observed for EX1 (1.00)/LF3 (0.68), respectively. At D2, the highest sensitivity/specificity were observed for LF3 (0.69)/BW (1.00), respectively. At D3, the highest sensitivity/specificity were observed for LF3 (0.78)/EX1, EX2 and BW (1.00). EX1 showed higher accuracy values than LF1, and EX2 showed similar values to LF2. We concluded that the visual-tactile examination showed better results in detecting sound surfaces and approximal caries lesions without tooth separation. However, the effectiveness of approximal caries lesion detection of both methods was increased by the absence of contact points. Therefore, regardless of the method of detection, orthodontic separating elastics should be used as a complementary tool for the diagnosis of approximal noncavitated lesions in primary molars.

In vivo validity of proximal caries detection in primary teeth, with histological validation

“…Radiographic examination had the lowest sensitivity at the (D 1 ) level of diagnosis which agrees with the findings of previous studies . Although histological examination showed 35% of surfaces to have enamel caries, radiographic examination showed only 11% of the surfaces to have enamel caries which shows that radiographic examination was only able to detect less than one‐third of the enamel lesions.…”

“…For these reasons, temporary tooth separation (TTS) is used by some clinicians for the detection of proximal caries and this adjunct to visual examination has been shown to be useful in identifying dental caries in the proximal surfaces of permanent premolars and molars and of primary molars …”

Alternative methods to visual and radiographic examinations for approximal caries detection

“…Lussi and Hellwig (65) reported that its performance was similar to the traditional LF on occlusal surfaces. Ribeiro et al (66) compared the performance of visual examination, bitewing radiography, and LF pen for detection of approximal caries on primary teeth in vivo, and micro CT after tooth exfoliation served as the gold standard (66). Before tooth separation, the LF pen demonstrated higher Sn and lower Sp than visual and bitewing radiographic examinations for detection of enamel caries.…”

“…After tooth exfoliation, in vitro LF pen examination was performed and improved Sn and Sp for both enamel and dentinal lesions was observed. This could be because the laser light could now directly access the tooth surface (66). A systematic review of LF (67) concluded that it exhibited higher Sn than other traditional diagnostic methods.…”

Pen-type laser fluorescence device versus bitewing radiographs for caries detection on approximal surfaces

“…Mendes et al speculated that the combined strategies could perform better in permanent teeth with a higher prevalence of non-evident caries lesions [10]. Nevertheless, most of the studies do not recommend the use of the LF or LF pen for permanent or primary teeth as the gold standard or sole diagnostic tool for occlusal caries detection [4, 39, 44, 45] or approximal caries detection [4] diagnostic tool to be used in combination with visual diagnostic techniques and/or radiography to assist the clinician when making operative decisions [46]. …”