Performance of Some Diagnostic Systems in Examinations for Small Occlusal Carious Lesions

Abstract

The objective of this study was to compare the performance in occlusal caries diagnosis of various available diagnostic systems when applied to the same teeth. The sample investigated consisted of 13 children for whom 4 premolar and 19 molar teeth were judged to require a sealant. The indication was based on the criteria ‘fissure discoloration’, ‘enamel decalcification’ and ‘absence of dentinal decay’. For predefined locations within these occlusal fissures a diagnosis was obtained by the following diagnostic systems: clinical examination, examination on fiber-optic transillumination (FOTI), fissure discoloration, electrical resistance measurement, radiographic examination and ratings of fissure morphology. Tooth material was removed until no (more) carious enamel or dentin was left. Two dentists then jointly decided on the status of decay for each of the defined locations within the fissure. These ratings served as the ‘gold standard’ diagnoses. The electrical resistance measurement with a sensitivity of 0.96 and a specificity of 0.71 was the only diagnostic tool with acceptable performance. Radiographic diagnosis was characterized by a moderate sensitivity and specificity. All other diagnostic systems had either very low sensitivities or very low specificities, or both. The positive predictive value of FOTI examination and the negative predictive value of the electrical resistance measurements were very high, irrespective of the prevalence of occlusal dentinal decay.

Use of new minimum intervention dentistry technologies in caries management

“…In vitro and in vivo studies were performed, showing moderate sensitivity and specificity. [9][10][11][12] Measures are linked with a scale number giving information about the supposed severity of the decay ( Table 5). The metallic probe of the CarieScan ® is …”

Performance of laser fluorescence devices and visual examination for the detection of occlusal caries in permanent molars

“…Site-specific measurements have been evaluated in a number of in vitro studies [45][46][47][48] and in vivo studies. 49,50 Surface-specific electrical conductance measurements have been investigated under in vitro conditions, 51 which showed moderate sensitivity and specificity.…”

Avaliação in vitro do aparelho DIAGNOdent para diagnóstico oclusal

“…Estudos recentes demonstram que o exame clínico visual não apresenta resultados satisfató-rios no diagnóstico de cárie oclusal, apresentando de baixa a moderada sensibilidade e de alta a moderada especificidade, assim como o exame radiográfico interproximal convencional e o FO-TI 10,11,16,17,18,19,20,22 . Desse modo, o uso do aparelho de laser fluorescente, no caso em estudo o DIAGNOdent, seria uma nova e prestativa opção para o diagnóstico de cáries incipientes em esmalte, sendo que a união de vários métodos de diagnóstico auxiliaria na detecção de cárie em dentina.…”