Performance of Fluorescence Methods, Radiographic Examination and ICDAS II on Occlusal Surfaces in vitro

Abstract

This study compared the performance of fluorescence-based methods, radiographic examination, and International Caries Detection and Assessment System (ICDAS) II on occlusal surfaces. One hundred and nineteen permanent human molars were assessed twice by 2 experienced dentists using the laser fluorescence (LF and LFpen) and fluorescence camera (FC) devices, ICDAS II and bitewing radiographs (BW). After measuring, the teeth were histologically prepared and assessed for caries extension. The sensitivities for dentine caries detection were 0.86 (FC), 0.78 (LFpen), 0.73 (ICDAS II), 0.51 (LF) and 0.34 (BW). The specificities were 0.97 (BW), 0.89 (LF), 0.65 (ICDAS II), 0.63 (FC) and 0.56 (LFpen). BW presented the highest values of likelihood ratio (LR)+ (12.47) and LR– (0.68). Rank correlations with histology were 0.53 (LF), 0.52 (LFpen), 0.41 (FC), 0.59 (ICDAS II) and 0.57 (BW). The area under the ROC curve varied from 0.72 to 0.83. Inter- and intraexaminer intraclass correlation values were respectively 0.90 and 0.85 (LF), 0.93 and 0.87 (LFpen) and 0.85 and 0.76 (FC). The ICDAS II ĸ values were 0.51 (interexaminer) and 0.61 (intraexaminer). The BW ĸ values were 0.50 (interexaminer) and 0.62 (intraexaminer). The Bland and Altman limits of agreement were 46.0 and 38.2 (LF), 55.6 and 40.0 (LFpen) and 1.12 and 0.80 (FC), for intra- and interexaminer reproducibilities. The posttest probability for dentine caries detection was high for BW and LF. In conclusion, LFpen, FC and ICDAS II presented better sensitivity and LF and BW better specificity. ICDAS II combined with BW showed the best performance and is the best combination for detecting caries on occlusal surfaces.

Clinical effectiveness of fluorescence, digital images and ICDAS for detecting occlusal caries

“…The complex anatomy of dental grooves and fissures on the occlusal surfaces of teeth make it difficult to accurately detect caries lesions [6][7][8] . Although several detection methods have been described in the literature [7][8][9]17 , choosing the ideal method it is not an easy task.…”

“…Although several detection methods have been described in the literature [7][8][9]17 , choosing the ideal method it is not an easy task.…”

“…After drying with an air jet for 5 seconds, the camera was positioned perpendicularly to the occlusal surface of the teeth. The results were automatically interpreted by DBSWIN software, which created images of 720×576 pixels that ranged from green (around 510 nm wavelength) 7 to red (around 685 nm wavelength) and provided a numerical value for the severity of the lesion (Figure 2). Subsequently, examiner B classified the images based on their scores (Table 1).…”

“…However, the detection of small lesions, especially on occlusal surfaces, is still a challenge for dental professionals [2][3][4][5] , mainly due to the complex anatomy of dental grooves and fissures [6][7][8] , overlapping structures during radiography and the increased number of hidden caries lesions caused by the continuous use of fluorides 9,10 .…”

“…A digital image is then generated, showing lesions in different colors, and numerical information about the depth of caries is also provided. Since the images can be stored in the patient's database, Vista Proof can facilitate the control of the lesion's progress over time 7,13,20 .…”