Detection Of Approximal Caries Research Articles

Clinical Analysis of the Diagnostic Accuracy and Time of Execution of a Transillumination Caries Detection Method Compared to Bitewing Radiographs.

Purposes: this clinical study evaluated the accuracy and execution time of a digital imaging fiber-optic transillumination (DIFOTI) technique for the detection of approximal caries in posterior teeth compared to intra-oral examination associated with bitewing radiographs. Methods: one hundred patients were selected and submitted to clinical inspection and bitewing radiographs. The outcomes of this process were converted into scores, according to the International Caries Detection and Assessment System (ICDAS): 0—sound tooth; 1, 2, and 3—carious lesion confined within enamel; 4, 5, and 6—dentin carious lesion. Subsequently, an independent investigator acquired digital images of the same teeth using a DIFOTI device (DIAGNOcam, Kavo Dental), which were also converted into ICDAS scores. The time required for executing diagnostic procedures was measured. The clinical sensitivity and specificity of DIFOTI were analyzed by receiver operating characteristic (ROC) curves. The time necessary to perform the diagnostic methods was evaluated by Mann–Whitney U (alfa = 0.05). Results: the overall test accuracy for the DIFOTI-based device ranged from 0.717 to 0.815 (area under the ROC curve) with p < 0.0001 for all ICDAS scores. Bitewing radiographs took almost twice the time required by DIFOTI (p < 0.001). Conclusions: the DIFOTI-based device DIAGNOcam provided accurate detection of approximal caries in posterior teeth, even at early stages. The technique employed for transillumination caries diagnosis by the same device took less time than conventional bitewing radiographs. Clinical Relevance: transillumination devices, such as DIAGNOcam, can be accurately used for caries diagnosis in approximal surfaces of posterior teeth, demanding less clinical time and without radiation-related risks.

Effect of Amalgam Restorations and Operation Parameters on Diagnostic Accuracy of Caries Detection Using Cone Beam Computed Tomography: An In Vitro Study.

This study was aimed to evaluate the diagnostic accuracy of cone beam computed tomography (CBCT) in detecting noncavitated approximal caries at different exposure parameters and to assess the impact of artifacts generated by amalgam restorations in an in vitro study. Seventy-eight approximal surfaces of extracted teeth were prepared with intentionally created noncavitated approximal caries of different depths; then, thirteen teeth with class 2 amalgam restorations were replaced with one tooth with normal surfaces in each block. CBCT volumes for all teeth were acquired using a Planmeca Promax 3D Mid imaging unit before and after placement of amalgam teeth, with different exposure parameters at low and high definition, both applying and omitting the Metal Artifact Reduction algorithm. The lesions were classified into four groups with regard to lesion extension. All teeth underwent histological analysis as gold standard. The histological examination showed that the distribution of lesions was as follows: 39.8% sound, enamel lesions of less and more than half the enamel thickness each 17.8%, and 24.6% dentin lesions. The detection sensitivity was found to be 0.972%, and specificity was found to be 0.937% for the detection of noncavitated approximal initial enamel and dentin caries. The highest diagnostic accuracy was found when using operating parameters of 90 kVp, 8 mA, and high resolution (75 μm) with nonamalgam teeth; all modes showed statistically significant higher AUCs than mode 2 (80 kVp, 7 mA, and 75 μm). However, for teeth with amalgam restorations, the highest accuracy was obtained at low resolution (200 μm) with the other parameters kept the same. It could be concluded that increasing the peak voltage and current improves diagnostic accuracy for the detection of noncavitated approximal caries. Moreover, diagnostic accuracy was found to be higher upon using high spatial resolution when diagnosing caries without adjacent amalgam restorations. There is a statistically significant difference with and without amalgam with respect to all modes.

Evaluation of computer-aided diagnosis system for detecting dental approximal caries lesions on periapical radiographs

Objective: To establish and to evaluate a computer-aided system based on deep-learning for detection and diagnosis of dental approximal caries on periapical radiographs. Methods: One hundred and sixty human premolars and molars extracted for orthodontic or periodontal reasons were obtained from Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Fujian Medical University. A total of 160 periapical radiographic images were divided into a training dataset (n=80) and a test dataset (n=80). A deep-learning based computer-aided caries diagnosis system was established and trained. The performances of computer-aided diagnosis system and human observer were compared using receiver operating characteristic (ROC) curves, precision-recall (P-R) curves, the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The AUC values of human observers and caries diagnosis system was compared by using an online statistical tool (SPSSAU 20.0). Chi-square test was used to analyze the differences between human observers and caries diagnosis system (ɑ=0.05). Results: The AUC values of human observers and caries diagnosis system were 0.729 (95%CI: 0.650-0.808) and 0.762 (95%CI: 0.685-0.839), respectively (P>0.05). No significant differences were found for the specificity, PPV and NPV between the caries diagnosis system and human observers (P all>0.05). The caries diagnosis system was significantly more sensitive in detecting dental proximal caries than human observers (P<0.05). For the diagnosis of level-1 caries (caries limited to outer 1/2 of enamel), the sensitivity of human observers and computer-aided detection system were 27% and 77%, respectively (P<0.05). Conclusions: The computer-aided diagnosis system provided similar accuracy as human observers and significantly better sensitivity than human observers, especially for shallow caries in enamel.

Detection ability and direction effect of photothermal-radiometry and modulated-luminescence for non-cavitated approximal caries

ObjectiveThe objective was to evaluate the ability of photothermal-radiometry and modulated-luminescence (PTR/LUM) to detect non-cavitated approximal caries lesions, including the effect of scanning direction. MethodsThirty human extracted premolars were selected based on micro-computed tomography [μ-CT: μ-CT = 0: sound (n = 12), μ-CT = 1: lesions into outer-half of enamel (n = 6), μ-CT = 2: lesions into inner-half of enamel (n = 6), and μ-CT = 3: lesions into outer one-third of dentine (n = 6)]. Teeth were mounted in a custom-made device to simulate approximal contact. Each tooth was scanned from three directions: buccal, lingual, and occlusal, then repeated 48 h later. Statistical analyses were performed by bootstrap analyses using average and maximum values across all directions. Sensitivity, specificity, area under ROC-curve (AUC), intraclass correlation coefficient (ICC) and correlation with μ-CT were calculated. Sensitivity was further evaluated based on lesion extension. ResultsUsing the manufacturer-suggested lesion cut-off, overall sensitivity ranged from 3%–61%, where the maximum value of all measurements (All-max) showed higher sensitivity (61 %) than other measurements except the buccal direction, which was also higher than the lingual and occlusal directions. As μ-CT score increased from μ-CT = 1–3, the sensitivity of All-max also increased from 50 % to 74 %. Specificity was 100 % regardless of direction, and AUC ranged from 0.65 to 0.88. All-max had the highest ICC (0.74). PTR/LUM values showed weak to moderate correlations with μ-CT. ConclusionWithin the limitations of this in vitro study, PTR/LUM non-cavitated approximal caries lesion detection achieved best individual results from the buccal direction, while using the maximum value from all directions might improve performance. Clinical significanceNon-cavitated approximal caries detection is a challenging procedure. PTR/LUM is a nondestructive, no ionized-radiation caries detection method that can scan from buccal, lingual, and occlusal directions of an approximal surface. PTR/LUM seems suitable to detect deeper non-cavitated approximal caries. The maximum PTR/LUM value from three directions may be optimal.

Guest Editorial

Guest Editorial

DOSIMETRY AND DIAGNOSTIC ACCURACY OF INTRAORAL AND EXTRAORAL BITEWINGS IN DETECTING APPROXIMAL CARIES

<h3>Background</h3> Traditionally, interproximal caries has been diagnosed radiographically by intraoral bitewing radiographs. Although this has been the conventional practice, the challenge of accommodating the film/ image receptor in the mouth, especially in patients with a gag reflex, has affected image acquisition and quality. A new method of acquiring bitewings with an extraoral approach has been recently introduced but the quality and diagnostic efficacy along with the radiation dosage of these techniques have not been well studied. <h3>Objective(s)</h3> The aim of this study was to evaluate the diagnostic accuracy of intraoral and extraoral bitewings (IOBs and EOBs) in their ability to detect proximal caries and to compare the effective doses from both techniques. <h3>Study Design</h3> Human teeth with or without proximal caries were used in this study. Carious lesions were created with different degrees of decalcification on 60 teeth (120 surfaces). These teeth were then placed into sockets of dry human skulls. Intraoral bitewings were acquired using a Kavo LM/CM109 wall-mounted X-ray tube with exposure parameters of 70 KVp, 7 mA, and 0.125 second. Extraoral bitewings were acquired with a Planmeca Promax at 74 kVp,7 mA, and 7.5 seconds. Two radiologists and a general dentist scored the radiographs using standardized software (MiPACS) and display monitors. Dose measurements were done on an anthropometric RANDO phantom. OSLdot dosimeters were used at 24 sites for radiation dose measurements. Fifteen exposures were performed for each dosimeter, and absorbed dose was calculated as an average of the15 exposures using the International Commission on Radiological Protection (ICRP, 2007) tissue weighting factors. <h3>Results</h3> For the diagnosis of interproximal caries, extraoral bitewings showed a sensitivity of 92.3% and specificity of 93.4%, whereas intraoral bitewings showed sensitivity of 94.5% and specificity of 96.8%, Interim dosimetry analysis showed that the doses for IOBs and EOBs were comparable but were slightly different for intraoral membranes. <h3>Discussion/Conclusions</h3> EOBs showed comparable results to IOBs in the detection of approximal caries and had similar effective doses.

In vitro visual and visible light transillumination methods for detection of natural non-cavitated approximal caries.

The objective was to evaluate a visible-light-transillumination (using Digital Imaging Fiber-Optic Transillumination machine: DIFOTI) method using occlusal view (DIFOTI-occl), axial view (buccal and lingual: DIFOTI-axial), and combination of all views (DIFOTI-all) for detecting non-cavitated approximal caries and to compare its performance to visual examination (International Caries Detection and Assessment System: ICDAS). Thirty extracted human premolars were selected (sound to lesions into the outer one-third of the dentine) based on micro-computed tomography (μ-CT). Teeth were mounted in a custom-made device to simulate approximal contact. DIFOTI (Electro-Optical Sciences Inc., Irvington, NY, USA) images were obtained from the occlusal, buccal, and lingual views. DIFOTI image and ICDAS examinations were performed and repeated by three trained/calibrated examiners. Sensitivity, specificity, area under receiver operating characteristics curve (Az), inter- and intra-class correlation coefficients (ICCs), and correlation were determined. Sensitivity/specificity was for DIFOTI-occl: 0.42/0.75, DIFOTI-axial: 0.86/0.93, DIFOTI-all: 0.91/0.69, and for ICDAS: 0.89/0.83. Az for DIFOTI-occl was significantly lower than that of DIFOTI-axial (p < 0.001), DIFOTI-all (p = 0.002), and ICDAS (p = 0.005). Spearman correlation coefficients with μ-CT for DIFOTI-occl (r = 0.39) showed weak association, while DIFOTI-axial (r = 0.80), DIFOTI-all (r = 0.91), and ICDAS (r = 0.90) showed moderate association. ICCs for intra-examiner repeatability/inter-examiner agreement were for DIFOTI-occl (0.64/0.58), DIFOTI-axial (0.92/0.89), DIFOTI-all (0.85/0.83), and ICDAS (0.79/0.72). The results of the current in vitro study suggest that, for detection of non-cavitated approximal caries lesions, DIFOTI performs better using axial than occlusal view. Approximal non-cavitated caries detection is challenging. DIFOTI can observe images from occlusal-, buccal-, and lingual views. DIFOTI and visual (ICDAS) examinations of buccal- and lingual- and all-views are more suitable than those of occlusal view for a detection of non-cavitated approximal caries.

Diagnostic accuracy of five different techniques for detection of approximal caries

Amaç: Bu çalışmanın amacı, beş farklı radyografik görüntüleme yönteminin posterior dişlerde arayüz çürük teşhisindeki doğruluk değerlerinin karşılaştırılmasıdır. Gereç ve Yöntem: Çalışmada çürüklü ve çürüksüz 72 adet posterior diş kullanıldı. Geleneksel bitewing radyograflar intraoral film kullanılarak, dijital bitewing radyograflar ise fosfor plak sistem kullanılarak alındı. Panoramik görüntüler dijital panoramik cihazın bitewing, ortogonal ve standart programları kullanılarak elde edildi. Görüntüler iki gözlemci tarafından değerlendirildi. Gözlemci içi ve gözlemciler arası uyum ağırlıklandırılmış kappa katsayısı hesaplanarak belirlendi. Çürük tespitinde altın standart kabul edilen histopatolojik skorlar ile beş yöntemden elde edilen skorlara ROC analizi uygulandı. Yöntemlere ait Az değerleri z-testi ile karşılaştırıldı ve anlamlılık düzeyi 0.05 olarak kabul edildi. Yöntemlere ait sensitivite, spesifisite ve yanlış pozitif oranları hesaplandı. Bulgular: Gözlemci içi ve gözlemciler arası uyuma ait κ değerleri sırasıyla 0.59-0.88 ve 0.54-0.87 arasında değişti. ROC analizinde ortalama Az değerleri en yüksek olarak geleneksel bitewing yönteminde (0.760) ve fosfor plak sisteminde (0.756), en düşük olarak ise panoramik cihazın standart programında (0.639) bulundu. Standart panoramik görüntüler çürük teşhisinde diğer yöntemlerden anlamlı olarak yetersiz bulundu (p<0.05). Yöntemlerin sensitivite ve spesifisite değerleri sırasıyla; geleneksel yöntem için 0.64-0.85, fosfor plak için 0.64-0.87, standart program için 0.40-0.87, ortogonal program için 0.56-0.85, ekstraoral bitewing için 0.59-0.90 olarak bulundu. Sonuç: Çalışmada geleneksel bitewing ve fosfor plak bitewing görüntüleri benzer doğruluk düzeyine sahip bulundu. Panoramik cihazdaki ortogonal ve bite-wing programların süperpozisyonların azaltılmasında etkili olduğu gözlendi. Yöntemlerin mine çürüğü düzeyinde sensitiviteleri düşük bulgulandı.

Comparison of micro-CT imaging and histology for approximal caries detection

Histological sectioning is a generally accepted in vitro validation method for caries detection techniques. However, it requires cumbersome sample preparation and induces irreversible sample destruction. Micro-Computer Tomography (micro-CT) allows non-destructive imaging of tooth structure. The aim of this study was to compare the performance of histological sectioning and micro-CT imaging in detecting approximal carious lesions. Unlike previous studies, evaluation is objectified by comparing visual appearance of exactly corresponding anatomical regions. Sixty extracted human teeth were scanned with a desktop micro CT system. Axial histological slices were prepared and photographed. Sample preparation, combined with dedicated image processing, ensured selection of identical anatomical regions on radiographic and histological images. Evaluation of the presence and extent of carious lesions was performed by four dentists using custom-designed software. Each section was scored independently (histo or micro CT). Scores of approximal surfaces were retained for further analysis. Spearman’s correlation coefficients (0.738 to 0.829, p < 0.0001) showed a good agreement between signs of carious lesions in the identical region obtained with both methods. Bland-Altman plots showed that 90.76% of the data points were within the limits of agreement. Micro-CT imaging was shown to provide an interesting alternative to histological sectioning as detection method for carious lesions.

In vitro performance of near infrared light transillumination at 780-nm and digital radiography for detection of non-cavitated approximal caries

ObjectivesTo evaluate the ability of a Near Infrared Light Transillumination (NILT) device to detect non-cavitated approximal caries lesions; and to compare its performance to Digital Radiography (DR). MethodsThirty human extracted premolars (sound to lesions into the outer one-third of dentin) were selected. Lesion depth was confirmed by micro-computed tomography (μ-CT). Teeth were mounted in a custom-made device to simulate approximal contact. DR and NILT (CariVu™, DEXIS, LLC, Hatfield, PA, USA) examinations were performed and repeated by three trained and calibrated examiners. Sensitivity, specificity, area under ROC curve (Az), inter- and intra-class correlation coefficients (ICCs) for each method, and correlation among the methods were determined. ResultsICCs for intra-/inter-examiner agreement were substantial for NILT (0.69/0.64), and moderate for DR (0.52/0.48). Sensitivity/specificity for NILT and DR were 0.68/0.93 and 0.50/0.64, respectively. Az for NILT was 0.81, while for DR it was 0.61. Spearman correlation coefficient with μ-CT for NILT (0.65, p<0.001) demonstrated moderate association, while that of DR suggested no association (0.19, p=0.289). ConclusionWithin the limitations of this in vitro study, NILT demonstrated a potential for early approximal caries detection. NILT and DR performed the same regarding the accuracy for non-cavitated approximal caries detection; however, NILT was superior to DR in terms of repeatability, agreement and correlation with μ-CT. Clinical significanceA commercial version of NILT was recently introduced as a non-irradiative adjunctive caries detection method. It uses near infrared (NIR) light at 780-nm to transilluminate teeth and captures live images from the occlusal surface. This study demonstrates that NILT can be used as an alternative to radiography for non-cavitated approximal caries detection.

Alternative methods to visual and radiographic examinations for approximal caries detection.

A shift in caries prevalence from occlusal surfaces to approximal surfaces has been demonstrated by epidemiological studies. Two recent meta-analyses evaluated the performance of visual examination and radiography for carious lesion detection, and reported low sensitivity but high specificity for early approximal caries detection. This suggests that the conventional methods have a higher risk of failing to detect approximal lesions. Consequently, in caries susceptible populations, there is a risk of progression of non-cavitated lesions to irreversible tooth destruction before the lesions are detected. This paper aims to review the performance of unconventional and novel methods for approximal caries detection. In vitro and in vivo studies identified through a MEDLINE search using keywords such as caries detection, approximal caries detection, light fluorescence and dental caries, and transillumination and dental caries were reviewed. The unconventional methods known to be used for approximal caries detection and included in this review are: cone beam computed tomography, fiber-optic trans-illumination, digital imaging fiber optic trans-illumination, near-infrared digital imaging transillumination, optical coherence tomography, laser fluorescence, ultrasound, and LED reflection and refraction.

The effects of different restorative materials on the detection of approximal caries in cone-beam computed tomography scans with and without metal artifact reduction mode

The aim of this study was to investigate the influence of artifacts produced by different restorative materials on the detection of approximal caries in cone-beam computed tomography (CBCT) scans with and without the application of an artifact-reduction (AR) option. Ninety-eight noncavitated premolar and molar teeth were placed with approximal contacts consisting of 2 sound or carious teeth and 1 mesial-occlusal-distal restored tooth with resin-modified glass-ionomer cement (RMGIC), amalgam, composite, ceramic-based composite (CBC), or computer-aided design-computer-aided manufacturing (CAD-CAM) zirconia materials in between. The teeth were scanned with a CBCT system with and without the AR option. Images were evaluated by 2 observers. The teeth were histologically evaluated, and sensitivity, specificity, and areas under the receiver operating characteristic (ROC) curve were calculated according to the appropriate threshold. Specificity and sensitivity values for contact surfaces ranged from 0-48.39 and 82.93-98.40, respectively. The AR option affected (P<.05) approximal caries detection of the amalgam, composite, CAD-CAM, and CBC groups in contact surfaces and composite and RMGIC groups in noncontact surfaces. Artifacts produced by different restorative materials could affect approximal caries detection in CBCT scans. Use of the AR option with CBCT scans increases the accuracy of approximal caries detection.

Comparison of different caries detectors for approximal caries detection

Background/purposeDetection of approximal caries may be difficult using conventional methods including visual inspection (VI) and radiography. The purpose of this in vitro research was to evaluate the efficiency of light-emitting diode (LED) and laser fluorescence (LF) devices, and radiographic and visual examination in approximal caries diagnosis. Materials and methodsOne hundred and fifty-six approximal regions were evaluated. All approximal regions were investigated using LED and LF tools after radiography and VI were performed. Histological evaluation of teeth was performed using stereomicroscopy. The area under the receiver operating characteristic curve and accuracy, specificity, sensitivity values calculated regarding approximal caries diagnose. ResultsThe specificity of the bitewing examination was higher for both T1 and T2 thresholds (0.97 and 0.99, respectively), and the LF device showed better sensitivity at each threshold compared with the other devices used for caries diagnosis (0.94 at T1 and 0.79 at T2). The receiver operating characteristic curves presented that the LF device was more successful than the other techniques at T1 threshold and VI was better than the other caries detection methods at T2 threshold. The kappa values for interobserver agreements were 0.43 (LF pen), 0.33 (LED device), 0.55 (VI), and 0.75 (bitewing examination). ConclusionThe ability of bitewing radiography to identify sound surfaces was better than that of the other methods. The LF device was the most sensitive tool for detecting approximal surfaces with caries, followed by the LED device.

Effect of Different Contact Materials on Approximal Caries Detection by Laser Fluorescence and Light-Emitting Diode Devices.

The aim of this in vitro study was to investigate the influence of the adjacent tooth surface on pen type laser fluorescence (LFpen) and light-emitting diode (LED) device readings in detecting approximal caries lesions in permanent teeth. Early detection of noncavitated dental caries is important, because disease progression can be easily halted at this stage with certain applications, such as fluoride therapy, antibacterial therapy, dietary changes, or low-intensity laser irradiation. A total of 87 permanent molars with 156 approximal surfaces were assessed with LED- and LF-based devices in contact with sound tooth surfaces (the control group) as well as approximal amalgam, composite, zirconia, and full ceramic restorations. All teeth were assessed once by one trained examiner. After the LF and LED assessments, the teeth were histologically evaluated using stereomicroscopy as the gold standard. The sensitivity, specificity, accuracy, and area under the receiver operating characteristics (ROC) curve were calculated according to the appropriate thresholds (T1, sound surface or enamel caries; T2, dentin caries). For the LFpen device, higher sensitivity and accuracy was found when the adjacent surface was sound at the T1 threshold and no significant differences were found among accuracy at the T2 threshold. For the LED-based device, no significant differences were found among sensitivities at the T1 threshold. At the T2 threshold, specificity was higher when the adjacent tooth had a zirconia restoration. It was found that both devices could be used effectively for evaluating approximal surfaces with adjacent restored teeth, regardless of the different kinds of restorative materials.

Designing of a Computer Software for Detection of Approximal Caries in Posterior Teeth.

Background:Radiographs, adjunct to clinical examination are always valuable complementary methods for dental caries detection. Recently, progressing in digital imaging system provides possibility of software designing for automatically dental caries detection.Objectives:The aim of this study was to develop and assess the function of diagnostic computer software designed for evaluation of approximal caries in posterior teeth. This software should be able to indicate the depth and location of caries on digital radiographic images.Materials and Methods:Digital radiographs were obtained of 93 teeth including 183 proximal surfaces. These images were used as a database for designing the software and training the software designer. In the design phase, considering the summed density of pixels in rows and columns of the images, the teeth were separated from each other and the unnecessary regions; for example, the root area in the alveolar bone was eliminated. Therefore, based on summed intensities, each image was segmented such that each segment contained only one tooth. Subsequently, based on the fuzzy logic, a well-known data-clustering algorithm named fuzzy c-means (FCM) was applied to the images to cluster or segment each tooth. This algorithm is referred to as a soft clustering method, which assigns data elements to one or more clusters with a specific membership function. Using the extracted clusters, the tooth border was determined and assessed for cavity. The results of histological analysis were used as the gold standard for comparison with the results obtained from the software. Depth of caries was measured, and finally Intraclass Correlation Coefficient (ICC) and Bland-Altman plot were used to show the agreement between the methods.Results:The software diagnosed 60% of enamel caries. The ICC (for detection of enamel caries) between the computer software and histological analysis results was determined as 0.609 (95% confidence interval [CI] = 0.159-0.849) (P = 0.006). Also, the computer program diagnosed 97% of dentin caries and the ICC between the software and histological analysis results for dentin caries was determined as 0.937 (95% CI=0.906-0.958) (P < 0.001). Bland-Altman plot showed an acceptable agreement for measuring the depth of caries in enamel and dentin.Conclusions:The designed software was able to detect a significant number of dentin caries and acceptable measuring of the depth of carious lesions in enamel and dentin. However, the software had limited ability in detecting enamel lesions.

Diagnostic agreement between radiologist, dentist and dental students for radiographic detection of approximal caries.

Aim: To assess intraobserver and interobserver agreement for radiographic detection of approximal caries among dentists, senior’s dental students and radiologists. Materials and methods: 75 standardized bitewing radiographs were examined by four maxillofacial radiologist, four dentist and four senior dental students. Interobserver agreement was calculated using a weighted Kappa Cohen test. Two weeks later, the examiners re-evaluated 10% of the sample under the same conditions and intraobserver agreement weighted Kappa Cohen test were calculated.Results: The interobserver Kappa value was 0.68 (good) for the dentist-student pair, 0.51 (moderate) for the student-radiologist and 0.62 (good) for the dentist-radiologist pair. All these differences were significant. The intraobserver agreement Kappa values obtained were 0.56 (moderate) for students (p=0.46), 0.46 (moderate) for dentist (p<0.05) and 0.68 (good) for radiologist.Conclusion: The agreement for proximal caries detection by dental students, dentists and radiologist was moderate to good.

Validation of quantitative light-induced fluorescence-digital (QLF-D) for the detection of approximal caries in vitro

ObjectivesDetection of approximal caries lesions can be difficult due to their anatomical position. This study aimed to assess the ability of the quantitative light-induced fluorescence-digital (QLF-D) in detecting approximal caries, and to compare the performance with those of the International Caries Detection and Assessment System II (ICDAS II) and digital radiography (DR). MethodsExtracted permanent teeth (n=100) were selected and mounted in pairs. The simulation pairs were assessed by one calibrated dentist using each detection method. After all the examinations, the teeth (n=95) were sectioned and examined histologically as gold standard. The modalities were compared in terms of sensitivity, specificity, areas under receiver operating characteristic curves (AUROC) for enamel (D1) and dentine (D3) levels. The intra-examiner reliability was assessed for all modalities. ResultsAt D1 threshold, the ICDAS II presented the highest sensitivity (0.80) while the DR showed the highest specificity (0.89); however, the methods with the greatest AUC values at D1 threshold were DR and QLF-D (0.80 and 0.80 respectively). At D3 threshold, the methods with the highest sensitivity were ICDAS II and QLF-D (0.64 and 0.64 respectively) while the method with the lowest sensitivity was DR (0.50). However, with regard to the AUC values at D3 threshold, the QLF-D presented the highest value (0.76). All modalities showed to have excellent intra-examiner reliability. ConclusionsThe newly developed QLF-D was not only able to detect proximal caries, but also showed to have comparable performance to the visual inspection and radiography in detecting proximal caries. Clinical significanceQLF-D has the potential to be a useful detection method for proximal caries.

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

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.

A comparative study of the diagnostic accuracy of cone beam computed tomography and intraoral radiographic modalities for the detection of noncavitated caries

ObjectivesThe aim of this study was to determine the diagnostic accuracy of cone beam computed tomography (CBCT) in the detection of approximal and occlusal noncavitated carious lesions.MethodsA total of 135 extracted human posterior teeth were used. They were radiographed using the following: conventional film (Kodak Insight), a digital system (PSP plates Digora Optime, Soredex), and a CBCT system (NewTom 3G, Quantitative Radiology). All the images were assessed by two independent observers twice. Receiver operating characteristic analysis (Az) was used.ResultsNewTom 3G 9″ CBCT was statistically inferior to conventional film and a digital system for the detection of approximal caries. NewTom 3G 9″ had significantly higher Az values than PSP plate (p < 0.05), but there were no statistically significant differences between the Az values for CBCT and film (p > 0.33) for occlusal surface caries.ConclusionThe diagnostic accuracy of all three tested radiographic systems is low, and it is necessary to use other methods to improve early caries detection.Clinical relevanceCBCT has found a wide application in different fields of dentistry. The report from a CBCT examination performed for any of these reasons should include all abnormal findings, and the detection of noncavitated caries lesions is especially important because it facilitates the use of noninvasive treatment.

The influence of amalgam fillings on the detection of approximal caries by cone beam CT:invitrostudy

The aim of this CBCT investigation on the detection of caries was to assess the influence of artefacts produced by the presence of amalgam fillings located in the vicinity. 102 non-cavitated pre-molar and molar teeth were placed in blocks of silicone with approximal contacts consisting of 3 sound or carious teeth and 1 mesial-occlusal-distal amalgam-filled tooth in-between. Radiographs of all the teeth were recorded using the CBCT system (NewTom™ 3G; QR Srl, Verona, Italy; field of view, 9 inches). Data from the CBCT unit were reconstructed and sectioned in the mesiodistal tooth plane. Images were evaluated twice by two observers, using a five-step confidence scale. After the CBCT examination, the teeth were individually sectioned in the mesiodistal direction with a diamond saw. Using a light microscope at ×40 magnification, the true morphological status of all approximal surfaces was established. Sensitivity of the CBCT for the detection of caries on surfaces located proximally and distally to an amalgam filing ranged from 0.27 to 0.30 for enamel and from 0.47 to 0.56 for dentin. Specificity values for enamel proximal and distal lesions were 0.48 and 0.53, respectively, for enamel and 0.33 to 0.38, respectively, for proximal and distal dentin cases. Intra-observer reliability was 0.84, and interobserver reliability was 0.49. Owing to its low specificity, scans from a CBCT examination should not be used to determine the presence of demineralization of the tooth surface when amalgam fillings are present in the region of interest.