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Abstract
Initial proximal caries is both diagnostic and therapeutic challenge. The disadvantages of the conventional methods for caries detection and the development of technologies led to the creation of contemporary optical devices for early caries detection. In vitro comparison of the diagnostic accuracy of several methods for early proximal caries detection - visual-tactile, bitewing radiography and laser fluorescence device (DIAGNOdent pen). Fifty-eight proximal surfaces of extracted human permanent premolars and molars were examined by two examiners using visual inspection, bitewing radiography, DIAGNOdent with proximal contact, and DIAGNOdent directly in the lesion. Results were compared with the histological gold standard. Statistical analysis with ROC curve, sensitivity, specificity and diagnostic accuracy of each detection method was performed. Analysis was conducted in 3 diagnostic thresholds - initial, developed and advanced demineralization. Sensitivity of visual inspection was 16%-33%, specificity 93.3%-100%, sensitivity of bitewing radiography 54%-67%, speci-ficity 93%-94%, sensitivity of DIAGNOdent with proximal surfaces in contact 88%-91%, specificity 79%-89%, sensitivity of DIAG-NOdent directly 89%-92.5%, specificity 81.29%-93%. The highest diagnostic accuracy, increasing with the rise of the level of demin-eralization, was shown by DIAGNOdent directly, followed by DIAGNOdent with proximal contact, bitewing radiography, and visual inspection with the lowest accuracy. The use of contemporary diagnostic devices significantly increases the possibility for early detection of proximal lesions. DIAGNOdent can be used as an adjunct to and increasing the diagnostic accuracy of the conventional caries detection methods.
Highlights
Initial proximal caries is both diagnostic and therapeutic challenge
The use of adjunct contemporary diagnostic methods significantly increases the possibility of early detection of non-cavitated proximal lesions and their non-operative treatment
The diagnostic accuracy of the tested methods increases with the increase of the diagnostic threshold and the level of demineralization
Summary
Initial proximal caries is both diagnostic and therapeutic challenge. The disadvantages of the conventional methods for caries detection and the development of technologies led to the creation of contemporary optical devices for early caries detection. Aim: In vitro comparison of the diagnostic accuracy of several methods for early proximal caries detection – visual-tactile, bitewing radiography and laser fluorescence device (DIAGNOdent pen). Materials and methods: Fifty-eight proximal surfaces of extracted human permanent premolars and molars were examined by two examiners using visual inspection, bitewing radiography, DIAGNOdent with proximal contact, and DIAGNOdent directly in the lesion. Results: Sensitivity of visual inspection was 16%–33%, specificity 93.3%–100%, sensitivity of bitewing radiography 54%–67%, specificity 93%–94%, sensitivity of DIAGNOdent with proximal surfaces in contact 88%–91%, specificity 79%–89%, sensitivity of DIAGNOdent directly 89%–92.5%, specificity 81.29%–93%. The highest diagnostic accuracy, increasing with the rise of the level of demineralization, was shown by DIAGNOdent directly, followed by DIAGNOdent with proximal contact, bitewing radiography, and visual inspection with the lowest accuracy. Bitewing radiography, which is considered a gold standard in diagnosing proximal caries, tends to underestimate the real lesion depth and exposes the patient to ionizing
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