Detection Of Occlusal Caries Lesions Research Articles

Reliability of impedance spectroscopy versus digital radiograph and ICDAS-II in occlusal caries detection: a prospective clinical trial

The traditional methods in early caries detection had many limitations. So, this study aimed to evaluate the clinical performance of alternating current impedance spectroscopy ACIST in comparison with digital radiograph and ICDAS-II in detection of occlusal carious lesions. Occlusal surfaces of molar and premolar teeth from 40 adult participants were examined by two observers using three diagnostic methods: (1) international caries detection and assessment system (ICDAS-II) (2) digital radiograph (DR) and (3) Cariescan Pro device (ACIST). Agreement analysis and the difference in sensitivities and specificities were evaluated. The results showed an excellent agreement in the different groups. The difference from the visual tactile against ACIST scoring for enamel caries detection, was statistically significant (p = 0.012) and the agreement was moderate (k = 0.509). For dentinal caries the difference was not statistically significant (p > 0.05) and the agreement was similarly moderate (k < 0.6). The difference from the digital radiograph against ACIST scoring, for enamel caries, digital radiography had significantly higher sensitivity and specificity than ACIST (p < 0.001) while for dentinal caries detection and overall, ACIST had higher sensitivity and digital radiography had higher specificity and the difference was statistically significant (p < 0.001). Visual-tactile examination is a considered as feasible and valid technique for occlusal caries detection, digital radiography is superior to ACIST in diagnosing enamel caries, but it could underestimate the caries depth, ACIST is a reliable tool for detecting occlusal caries in dentin.

Performance of near-infrared light transillumination in the detection of occlusal caries lesions in deciduous teeth

BackgroundThis study compared the performance of near-infrared light transillumination (NILT; DIAGNOcam [DC]) in detecting occlusal caries lesions in deciduous molars with the performance of the International Caries Detection and Assessment System (ICDAS), digital radiographic method (RX) and laser fluorescence (DIAGNOdent pen [LFpen]). MethodsFifty-seven extracted deciduous molars with no frank cavitation caries lesions were selected. One site per tooth was evaluated twice each by two examiners using all methods. Then, a histological examination was performed using a stereomicroscope. The performance of the methods was assessed with respect to two thresholds: D1 (all visible caries lesions affecting enamel) and D3 (caries lesions extended into dentin). ResultsA weighted kappa and intraclass correlation coefficients were calculated for intra- and inter-observer reproducibilities, varying from 0.31 (RX) to 0.89 (LFpen). The intra-observer reproducibility at D1 and D3 thresholds varied from 0.51 (ICDAS) to 0.85 (DC) and from 0.30 (ICDAS) to 1.00 (RX), respectively. The inter-observer reproducibility varied from 0.28 (RX) to 0.47 (DC) and from 0.22 (LFpen) to 0.75 (DC), respectively. At the D1 threshold, higher sensitivity and accuracy were found for LFpen (0.76/0.71) and ICDAS (0.65/0.66); and higher specificities were found for RX (0.94), DC (0.79), and ICDAS (0.71). At the D3 threshold, all methods exhibited lower sensitivities (0.13–0.35) and higher specificity, accuracy, and area under the ROC curve values (0.70–1.00). All methods showed a correlation with histological results, especially for ICDAS and DC. ConclusionsNILT technology (DC) and LFpen exhibited similar performance for the detection of occlusal caries lesions in deciduous molars when compared with ICDAS criteria.

Diagnostic performance of different fluorescence systems on occlusal caries of permanent teeth correspondence

Background/Aim: Evaluating the performance of two fluorescence-based methods on the detection of occlusal carious lesions in permanent teeth, compared with visual inspection and radiographic examination was the aim of this study. Material and Methods: Occlusal surfaces of 150 extracted human permanent molars were examined by two researchers using the International Caries Detection and Assessment System ll (ICDAS-II), FluoreCam (Daraza) and DIAGNOdent Pen® (KaVo). Standardized periapical radiographs were taken. The teeth were sectioned for histological validation and examined under 25x magnification under a stereomicroscope (Leica M27.5) using Downer criteria 0-4 as the gold standard. The correlation of diagnostic methods with histological analyses was evaluated using Spearman's rank correlation coefficients (rho). Results: All teeth were scored from 0 to 6 for ICDAS-II. The highest correlation of the gold standard was found with ICDAS-II followed by FluoreCam and DIAGNOdent Pen®. The association strength of ICDAS-II, Radiography, FluoreCam and DIAGNOdent Pen® with the histological evaluation was quite strong (p&lt;0.05). Both fluorescence-based methods performed similarly. Conclusions: Radiograph is not specific for early carious lesions but may be used as an adjunct method for dentin caries. ICDAS-II classification is an accurate method for clinical examination of occlusal caries however additionally using fluorescence as a quantitative and visual examination is quite supportive and reinforcing especially for detecting enamel caries lesions.

Comparative Evaluation of ICDAS, WHO and Histological Examination in Detection of Occlusal Carious Lesions

Detection of occlusal carious lesions with visual scoring systems is in a continuous validation with the histological depth of carious demineralization. Objective: The present study aimed to compare the International Caries Detection and Assessment System (ICDAS), the World Health Organization (WHO) system and histological examination in detecting occlusal carious lesions. Material and Methods: 20 premolars were evaluated by visual examination using ICDAS, WHO and histological examination using stereomicroscope (SM) for occlusal caries detection. Occlusal surfaces were evaluated by two examiners then all teeth were visually and histologically assessed. Results: For each of three systems the inter class correlation coefficient was examined, the differences between the three systems of occlusal caries detection were minimal. The visual examination through WHO recorded the higher intercorrelation coefficient followed by ICDAS system then histological examination respectively. Conclusion: WHO and ICDAS have demonstrated reproducibility and diagnostic accuracy when compared with histological examination for detecting occlusal caries.KeywordsInternational caries detection and assessment system; World health organization; Histological examination; Occlusal caries.

Optical magnification has no benefits on the detection of occlusal caries lesions in permanent molars using different visual scoring systems: An in vitro study.

BackgroundSome studies have addressed the influence of optical magnification on the detection of caries lesions using a visual scoring system. However, there is a lack of research related to the use of the CAST and ADA-CCS visual scoring systems. In addition, the reliability and accuracy of ADA-CCS index in permanent teeth were not studied yet. So, the aim of this study was to evaluate, in vitro, the influence of different levels of optical magnification on the detection of occlusal caries lesions in permanent molars using three visual scoring systems. Material and MethodsOne occlusal site per tooth was analyzed in 120 extracted permanent molars. Two trained examiners inspected the teeth using ICDAS (International Caries Detection and Assessment System), CAST (Caries Assessment Spectrum and Treatment), and ADA-CCS (American Dental Association-Caries Classification System) visual criteria, twice with each scoring system, with a one-week interval between examinations. The study was conducted in three phases: (A) without optical magnification, (B) using a binocular lens (3.5× magnification), and (C) using an operating microscope (16× magnification). Then, the teeth were sectioned longitudinally through the center of the selected site and the section with the more severe lesion was histological evaluated considering the D1 (lesions in enamel and dentin) and D3 (dentin lesions) thresholds. ResultsKappa values for intra- and inter-examiner reproducibility were good to excellent for all systems. At the D1 threshold, sensitivity, accuracy, and area under the ROC curve were high for ICDAS and CAST in all phases. However, this was not the case for the ADA-CCS in phase C (<0.05). At the D3 diagnostic threshold, there was no significant difference between the visual scoring systems during the study phases (>0.05). ConclusionsThe magnification does not improve the accuracy of the visual scoring systems in the detection of occlusal caries lesions in permanent molars. Key words:Dental caries, caries detection, permanent teeth, visual examination, magnification.

Diagnostic validity of the use of ICDAS II and DIAGNOdent pen verified by micro-computed tomography for the detection of occlusal caries lesions\u2014an in vitro evaluation

The aim of this study is to assess the extent of early carious lesions using the International Caries Detection and Assessment System (ICDAS) II and DIAGNOdent pen compared with microCT examination. Forty-eight molars and premolars were qualified for the study. The visual and the DIAGNOdent pen device examinations were carried out by two examiners. The actual extent of the lesions was determined using micro-CT examination. The optimal cutoff test value was determined using the Youden index. For the two methods, inter- and intra-examiner reproducibility was calculated using intraclass correlation coefficient. The sensitivity, specificity, and accuracy of these methods were compared using the mid-P McNemar test. The level of significance was set at p < 0.05. In terms of the enamel threshold for the ICDAS II scale, insignificantly higher mean evaluated parameters were noticed in comparison with the DIAGNOdent pen device. For the dentin threshold, all the assessed parameters had higher mean values on the ICDAS II scale compared with the DIAGNOdent pen. The optimal cutoff points of the enamel and dentin thresholds are lower than that suggested by the manufacturer. The ICDAS II and the DIAGNOdent pen device were characterized by high inter - and intra-observer reproducibility of the test results. To improve the diagnostic efficiency of the DIAGNOdent pen, modifying the cutoff values recommended by the manufacturers should be considered. After modifying the cutoff values, the combination ICDAS II and DIAGNOdent pen device would be the better choice in order to detect caries on occlusal surfaces.

The impact of ICDAS on occlusal caries treatment recommendations for high caries risk patients: an in vitro study

BackgroundThe diagnostic criteria and tools used in caries lesion detection have been shown to affect the decision-making for caries treatment. Compared to other diagnostic criteria/classifications, ICDAS has been shown to provide a more accurate method for the detection of occlusal caries lesions. The influence of using ICDAS on caries treatment recommendations has received increasing attention in recent years. Therefore, the aim of this study was to assess the impact of ICDAS on dentists’ occlusal caries lesions’ treatment decisions for patients at high risk for caries.MethodsFive dentists examined the occlusal surfaces of 270 extracted premolars and permanent molars. For a predetermined clinical scenario, the examiners were asked to indicate their treatment recommendations for each tooth. Four weeks later, all the examiners were trained and calibrated for the use of ICDAS. Then the investigators examined the same 270 teeth independently and indicated their treatment recommendations using the same clinical scenario. Histological validation was used to determine the caries lesions detection performance of the examiners using ICDAS and to assess the relationship between the presence of dentin caries and treatment recommendations for each examiner before and after ICDAS training. Specificity, sensitivity, area under the receiver operating characteristic curve (AUC), and Spearman’s correlation coefficients were calculated. The Wilcoxon two-related sample rank test was used to test for differences between treatment recommendations.ResultsThe strongest correlation for inter-examiner reproducibility was found between the ICDAS D2 cut-off point (ICDAS codes 3–6 as dentin caries) and histologic dentin caries. Treatment recommendations among different examiners before and after ICDAS training demonstrated a statistically significant increase in operative intervention and an increase in the percentage of overtreatment recommendations for two examiners.ConclusionsThe impact of ICDAS on the examiners’ caries lesion treatment recommendations varied among the dentists in this study. Treatment decision-making can be influenced by the caries lesion’s detection and classification system used.

Diagnostic performance of the visual caries classification of International Caries Detection and Assessment System II versus conventional radiography for the detection of occlusal carious lesions in primary molars

Objective: The aim of the present study was to evaluate the accuracy in the diagnosis of the occlusal caries lesion using the International Caries Detection and Assessment System II (ICDAS II) and conventional bitewing radiographs in primary molars. Materials and Methods: A total of 35 children was selected randomly and recruited for visual ICDAS II and conventional bitewing radiographic examination by two independent trained examiners. Two hundred and fifty-four teeth were examined at D1 (enamel caries lesions) and D3 (dentine caries lesions) thresholds. Results: Sensitivity and specificity at D1 for ICDAS II was 100%, whereas it was 2.97% and 100%, respectively, for bitewing radiographs. At D3 threshold, sensitivity and specificity of ICDAS II was 94.55% and 96.45%, whereas it was 60.0% and 98.99% respectively for bitewing radiographs. Conclusion: ICDAS II is better than conventional bitewing radiographs in detecting carious lesions that confined to enamel, and both are equally effective in the detection of dentinal carious lesions.

Dental Students' Performance in Detecting In Vitro Occlusal Carious Lesions Using ICDAS with E-Learning and Digital Learning Strategies.

The aim of this study was to assess the performance of dental students for detecting in vitro occlusal carious lesions using the International Caries Detection and Assessment System (ICDAS) with different learning strategies. A convenience sample of all 64 fourth-year dental students at a dental school in Brazil who had no previous experience with ICDAS was selected for the study in 2015. First, students performed the in vitro examination of the occlusal surfaces of 80 teeth according to ICDAS. Two weeks later, students were randomly allocated to three groups: G1 (n=21), ICDAS e-learning; G2 (n=22), ICDAS e-learning + digital learning tool (DLT); G3 (n=21), no training (control group). All students reexamined the 80 teeth according to ICDAS two weeks later. Sensitivity, specificity, and area under the ROC curve (AUC) were calculated according to three thresholds. Of the 64 students, 59 completed all study phases, for a 92.2% participation rate. The intra-group comparison found significantly higher sensitivity and specificity values for G1 and G2 students. G3 students showed an increased sensitivity at the D2 threshold. G2 was the only training strategy that resulted in significant improvement for the AUC. In the comparison of groups at the same threshold, G1 showed higher specificity at D3 threshold (0.78) than G2 (0.72) and G3 (0.73). Regarding sensitivity, G1 showed a lower value at D2 (0.91) threshold than G2 (0.94) and G3 (0.94). In this study, both training strategies (ICDAS e-learning and ICDAS e-learning + DLT) improved the performance of dental students for the in vitro detection of occlusal carious lesions, mainly when the association of methods was used.

Validation of DIAGNOdent laser fluorescence and the International Caries Detection and Assessment System (ICDAS) in diagnosis of occlusal caries in permanent teeth: an in vivo study.

The aim of this in vivo study was to validate the DIAGNOdent laser fluorescence method and the International Caries Detection and Assessment System (ICDAS) for caries classification against the gold standard, histological examination, for detecting occlusal caries on permanent molars; the thresholds used were the outer enamel (D1), the inner enamel and outer third of the dentine (D2), and the inner two-thirds of the dentine (D3). Patients with non-impacted third molars (n = 43) were recruited from a university clinic. A trained examiner performed the examinations. After the teeth were extracted, the histological criterion was used to determine the severity of the lesions. Intra-examiner agreement (weighted kappa) for ICDAS was 0.60 and reliability (intraclass correlation coefficient) for DIAGNOdent was 0.968. The correlations with the histological reference were weak for DIAGNOdent (rs = 0.369) and moderate for ICDAS (rs = 0.515). The areas under the receiver-operating characteristics (ROC) curve at D1, D2, and D3 were 0.60, 0.69, and 0.91, respectively, for ICDAS and 0.55, 0.65, and 0.92, respectively, for DIAGNOdent. ICDAS and DIAGNOdent proved to be reproducible methods with similar performance in the detection of occlusal carious lesions in dentine. The ability of DIAGNOdent to detect initial enamel lesions was higher than that of ICDAS, but with low specificity. The usefulness of DIAGNOdent as an adjunct method for assessment of initial occlusal caries in permanent molars is questionable.

Detection of Occlusal Carious Lesion using the SoproLife® Camera: A Systematic Review.

The aim of this systematic review was to assess the in vivo scientific evidence regarding the ability of a recently developed light fluorescence device, SoproLife® (Sopro-Acteon group, La Ciotat, France) in detecting occlusal carious lesions. The PubMed database was searched for in vivo trials that evaluated the validity of the SoproLife® camera for the detection of occlusal carious lesions. Among the 11 articles originally identified with the keyword "Soprolife," only three articles were included. The three included surveys used the International Caries Detection and Assessment System (ICDAS)-II criteria as gold standard for the assessment of SoproLife® compared or not to other detection devices (DIAGNOdent® and Spectra Caries Detection Aid®). Two of the included studies reported only on permanent teeth or both primary and permanent teeth. The SoproLife® validity values varied markedly among studies with a sensitivity ranging between 0.43 and 0.95 and a specificity between 0.55 and 1. Interobserver reproducibility with the SoproLife® was reported in two of the three studies (0.98 and 0.72) and none of the studies reported about intraobserver reproducibility. No clear-cut conclusion can be made based on the three included clinical studies; further in vivo investigations are needed to confirm the validity of the SoproLife® camera in terms of detection of occlusal carious lesions.

Evaluation of diagnostic tests using information theory for multi-class diagnostic problems and its application for the detection of occlusal caries lesions.

Several methods are available to evaluate the performance of the tests when the purpose of the diagnostic test is to discriminate between two possible disease states. However multi-class diagnostic problems frequently appear in many areas of medical science. Hence, there is a need for methods which will enable us to characterize the accuracy of diagnostic tests when there are more than two possible disease states. To show that two information theory measures, information content (IC) and proportional reduction in diagnostic uncertainty (PRDU), can be used for the evaluation of the performance of diagnostic tests for multi-class diagnostic problems that may appear in different areas of medical science. Diagnostic accuracy study. Sixty freshly extracted permanent human molar and pre-molar teeth suspected to have occlusal caries lesions were selected for the study and were assessed by two experienced examiners. Each examiner performed two evaluations. Histological examination was used as the gold standard. The scores of the histological examination were defined as sound (n=11), enamel caries (n=22) and dentin caries (n=27). Diagnostic performance of i) visual inspection, ii) radiography, iii) laser fluorescence (LF) and iv) micro-computed tomography (M-CT) caries detection methods was evaluated by calculating IC and PRDU. Micro-computed tomography examination was the best method among the diagnostic techniques for the diagnosis of occlusal caries in terms of both IC and PRDU. M-CT examination supplied the maximum diagnostic information about the diagnosis of occlusal caries in the first (IC: 1.056; p<0.05), (PRDU: 70.5%) and second evaluation (IC: 1.105; p<0.05), (PRDU: 73.8%) for the first examiner. M-CT examination was the best method among the diagnostic techniques for the second examiner in both the first (IC:1.105; p<0.05), (PRDU:73.8%) and second evaluation (IC:1.061; p<0.05), (PRDU:70.8%). IC and PRDU were lowest for visual inspection. The present study demonstrates that IC and PRDU can be used to evaluate diagnostic test performance when multiple disease states are being evaluated.

Fluorescence methods (VistaCam iX proof and DIAGNODent pen) for the detection of occlusal carious lesions in teeth recovered from archaeological context.

Diagnosis of occlusal enamel caries in archaeologically derived collections remains a controversial problem because the accumulation of contaminants in fissures can interfere with diagnosis. Certain novel light-induced fluorescence methods, such as the DIAGNODent pen 2190 (DD) and VistaCam iX Proof (VC), have been used to detect dental caries in clinical settings. In this study, the abilities of DD and VC to detect initial enamel caries in archaeologically derived material is determined and compared with those of other methods (visual inspection, X-ray, histology, and micro-CT). Dental material encompassing the remains of 58 individuals, including a total of 380 teeth from each of three historical periods: modern Islamic (AD 1850-1950), Islamic (AD 600-1200) and late Roman (AD 200-400), obtained from two archaeological sites (Terqa and Tell Masaikh) located in the Middle Euphrates valley (Syria), were analyzed. VC was found to have excellent sensitivity (98), while DD obtained lower sensitivity (76) in detecting dental caries in its early stages. The results obtained by VC and micro-CT, considered the most reliable imaging technique, were not statistically significant (P = 0.3068). By contrast, results obtained by DD and micro-CT results, and DD and VC results were statistically significant (P < 0.0001, P = 0.0015, respectively). However the presence of dirt, stain, calculus, and plaque in the pits and fissures of the occlusal surface compromise correct diagnosis of caries by VC and DD. Consequently, for teeth recovered from archaeological contexts where staining, calculus and plaque are present, the best solution remains micro-CT.

Influence of the ICDAS E‐Learning Program for Occlusal Caries Detection on Dental Students

The aim of this study was to evaluate the influence of ICDAS training in a group of dental students for occlusal caries detection in permanent teeth. Premolars and molars (N=104) with occlusal surfaces varying from ICDAS scores 0 to 6 were cleaned, one occlusal site per tooth was selected, and a photograph taken to identify the site. Eight senior dental students examined the teeth twice with a one-week interval between examinations during each of two phases: before and after the ICDAS e-learning program. Teeth were histologically assessed for caries extension. Intraclass correlation coefficients for intra- and interexaminer repeatability were high, both before (0.75 and 0.72, respectively) and after e-learning (0.82 and 0.78, respectively). The ICDAS scores decreased significantly from before to after e-learning (p=0.0001). Correlation between ICDAS scores and histology scores was moderate (0.57 before e-learning and 0.61 after). Although the ROC curve shows an improvement in the use of the ICDAS scoring after e-learning, the difference was not significant (p=0.10). Specificity of the ICDAS scores significantly improved after e-learning (77 percent vs. 36 percent), and sensitivity was reduced slightly after e-learning (87 percent vs. 92 percent). The ICDAS e-learning program improved the performance of the diagnostic skills of the investigated students for the detection of occlusal caries lesions.

The Influence of PVC Wrapping on the Performance of Two Laser Fluorescence Devices on Occlusal Surfaces in Vitro

The aim of this study was to determine the influence of polyvinyl chloride (PVC) wrapping on the performance of two laser fluorescence devices (LF and LFpen) by assessing tooth occlusal surfaces. Protection of their tips may influence LF measurements. To date there are no studies evaluating the influence of this protection on the performance of the LFpen on permanent teeth, or comparing it to the original LF device. One hundred nineteen permanent molars were assessed by two experienced dentists using the LF and the LFpen devices, both with and without PVC wrapping. The teeth were histologically prepared and assessed for caries extension. The LF values with and without PVC wrapping were significantly different. For both LF devices, the sensitivity and accuracy were lower when the PVC wrapping was used. The specificity was statistically significantly higher for the LFpen with PVC. No difference was found between the areas under the ROC curves with and without PVC wrapping. The ICC showed excellent interexaminer agreement. The Bland and Altman method showed a range between the upper and the lower limits of agreement of 63.4 and 57.8 units for the LF device, and 49.4 and 74.2 for the LFpen device, with and without PVC wrapping, respectively. We found an influence of the PVC wrapping on the performance of the LF and LFpen devices. However, since its influence on detection of occlusal caries lesions is considered for, the use of one PVC layer is suggested to avoid cross-contamination in clinical practice.

Clinical performance of a new laser fluorescence device for detection of occlusal caries lesions in permanent molars

Objectives To determine the clinical performance of a laser fluorescence device (DIAGNOdent pen, KaVo) to discriminate between different occlusal caries depths (D 0–D 1–4; D 0–2–D 3,4) in permanent molars. Methods In this prospective, randomized two-centre-study 120 sound/uncavitated carious sites in 120 patients were measured after visual and radiographic caries assessment. In cases of operative intervention ( n = 86), the lesion depths after caries removal were recorded (reference). In cases of preventive intervention ( n = 34), the sites were reassessed visually/radiographically after 12 months to verify the status assessed before (reference). The discrimination performance was determined statistically (Mann–Whitney test, Spearman’s rho coefficient, and areas under the receiver operating characteristic curves (AUCs)). Sensitivities (SE) and specificities (SP) were plotted as a function of the measured values and cut-off values for the mentioned thresholds suggested. Results Sound sites ( n = 13) had significantly minor fluorescence values than carious sites ( n = 107) ( P < 0.0001) as had sites with no/enamel caries ( n = 63) compared to dentinal caries ( n = 57). The AUCs for the same discriminations were 0.92 and 0.78 ( P < 0.001). For the D 0–D 1–4 threshold, a cut-off at a value of 12 (SE: 0.88, SP: 0.85) and for the D 0–2–D 3,4 threshold at 25 (SE: 0.67, SP: 0.79) can be suggested. A moderate positive correlation between the measurements and the caries depths was calculated (rho = +0.57, P = 0.01). Conclusion Within this study, the device’s discrimination performance for different caries depths was moderate to very good and it may be recommended as adjunct tool in the diagnosis of occlusal caries.

Reproducibility of Electrical Caries Measurements: A Technical Problem?

The currently available instrument for electrical detection of occlusal caries lesions [Electronic Caries Monitor (ECM)] uses a site-specific measurement with co-axial air drying. The reproducibility of this method has been reported to be fair to good. It was noticed that the measurement variation of this technique appeared to be non-random. It was the aim of this study to analyse how such a non-random reproducibility pattern arises and whether it could be observed for other operators and ECM models. Analysis of hypothetical measurement pairs showed that the pattern was related to measurements at the high and low end of the measurement range for the instrument. Data sets supplied by other researchers to a varying degree showed signs of a similar non-random pattern. These data sets were acquired at different locations, by different operators and using 3 different ECM models. The frequency distribution of measurements in all cases showed a single or double end-peaked distribution shape. It was concluded that the pattern was a general feature of the measurement method. It was tentatively attributed to several characteristics such as a high value censoring, insufficient probe contact and unpredictable probe contact. A different measurement technique, with an improved probe contact, appears to be advisable.

Performance of methods of occlusal caries detection in permanent teeth under clinical and laboratory conditions

To compare performance of visual inspection and Laser fluorescence methods to detect occlusal caries lesions under clinical and laboratory conditions in permanent teeth. One hundred and ten sites in 57 third molars scheduled for extraction were examined with visual inspection and laser fluorescence (DIAGNOdent) device by two trained examiners. After the extraction, teeth were re-examined. Then, teeth were sectioned to perform histological validation. Best cut-off points were calculated with ROC analysis, and sensitivity, specificity and accuracy were calculated at D2 and D3 thresholds. Comparisons between the methods and conditions of examination were performed using McNemar test. Inter-examiner agreement in the same conditions and agreement between the methods performed in vivo and in vitro conditions were assessed by Kappa test. Laser fluorescence values obtained in two conditions were compared with Wilcoxon test. No difference was observed with visual inspection in both conditions. Laser fluorescence performed in vitro presented higher specificity and accuracy at D3 threshold. Visual inspection showed higher reproducibility. After adjustment of cut-off points for laser fluorescence method, there was no difference between the evaluated parameters. Only slightly differences were observed between the examinations performed under clinical and laboratory conditions in the detection of occlusal caries lesions in permanent teeth.

Validity of Diagnosis of Questionable Caries Lesions in Occlusal Surfaces of Extracted Third Molars

This study was to evaluate the accuracy of visual inspection, conventional radiography, and digital radiographic methods for the detection of occlusal carious lesions in third molars from a present-day adolescent population. Seventy-eight third molars, considered clinically to be without occlusal cavities, were extracted from young soldiers. Before extraction, an intra-oral radiograph was obtained. After extraction, the teeth were examined visually as per the criteria: 0 = no caries, 1 = chalky/stained fissure indicative of enamel caries, 2 = chalky and dark-stained fissure considered indicative of a dentinal lesion, and 3 = as per criterion 2, but with small surface defects (microcavities). The radiographs were digitised, and image enhancement with contrast stretch and a filtering procedure was performed, respectively. The three types of radiographic image were assessed as per the criteria: 1 = no caries/caries confined to enamel, 2 = caries involving the outermost dentine, and 3 = deep dentinal caries extending half-way or more to the pulp. Ground sections (500-600 microns in thickness) served as validation for lesion depth. The digital radiographic method with contrast stretch performed overall best of the four methods (greater than 70% detection rate) while visual inspection (53% detection rate) performed better than conventional radiography (48% detection rate). When results from visual inspection and conventional radiography were combined, an increase in the detection rate of 11% was obtained with a 7% increase in false-positive scorings. When digitally contrast-manipulated radiographs were combined with visual inspection, a gain of 33% was obtained with an 11% increase in false positives.(ABSTRACT TRUNCATED AT 250 WORDS)

Early Detection of Occlusal Caries by Measuring the Electrical Resistance of the Tooth

The tooth resistance measuring instrument was compared to the traditional method of the explorer examination for the detection of occlusal carious lesions. The findings of the instrument were more sensitive as compared to the traditional method when verified by a histological examination.