Abstract
The aim of this in vitro study was to systematically investigate new caries diagnostic tools, including three intraoral scanners, and compare them to established diagnostic methods. For a standardized analysis of occlusal and proximal caries lesions, human permanent and primary teeth (n = 64) were embedded in models and investigated in a phantom head using six different caries diagnostic methods: visual examination, bitewing radiography, Diagnocam (KaVo, Biberach, Germany), Trios 4 (3Shape, Copenhagen, Denmark), iTero Element 5D (Align Technology, San José, CA, USA), and Planmeca Emerald S (Planmeca, Helsinki, Finland). The diagnostic methods were investigated and compared to reference µ-CT for permanent and primary teeth separately. For occlusal caries diagnostics in permanent teeth, the best agreement to the reference (reliability) was obtained for Planmeca Emerald S (ĸ = 0.700), whereas in primary teeth, for visual examination (ĸ = 0.927), followed by Trios 4 (ĸ = 0.579). Regarding proximal caries diagnostics, bitewing radiography, as the gold standard, exhibited the highest agreement for permanent (ĸ = 0.643) and primary teeth (ĸ = 0.871). Concerning the analysis of the diagnostic quality (sensitivity and specificity) using receiver operating characteristic (ROC) curve analysis, comparable findings were obtained for area under curve (AUC) values as for reliability. No diagnostic method could be identified that is generally suitable for occlusal and proximal lesions in both dentitions. Overall, caries diagnostics with intraoral scanners seem to be interesting tools that should be further investigated in clinical studies.
Highlights
Today, intraoral scanners offer many additional applications beyond digital impression acquisition, including the determination of tooth color, treatment simulation, and the monitoring of tooth movement and wear [1–4]
Sufficient agreement could be shown for iTero Element 5D (k = 0.366)
For proximal surfaces in permanent teeth, the gold standard bitewing radiography still exhibited the highest agreement with the reference μ-CT (k = 0.643), followed by the Planmeca Emerald S (k = 0.451) with moderate agreement
Summary
Intraoral scanners offer many additional applications beyond digital impression acquisition, including the determination of tooth color, treatment simulation, and the monitoring of tooth movement and wear [1–4]. Due to the fact that dental caries is still the most common non-communicable disease worldwide and remains a significant and costly public health issue [6,7], intraoral scanner-based diagnostics might help to detect and monitor enamel caries lesions at an early stage to enable minimally invasive treatment options [8–10]. The caries diagnostic tools involving intraoral scanners might be useful for orthodontics, in particular in children from lower socio-economic backgrounds. False negative findings may result in caries lesions being detected too late, making minimally invasive treatment methods obsolete. False positive results may cause unnecessary invasive treatments [13]
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