Detection Of Occlusal Caries Research Articles

Patients' attitudes toward artificial intelligence in dentistry and their trust in dentists.

This study intended to evaluate patients' attitudes toward the use of AI in dental radiographic detection of occlusal caries and the impact of AI-based diagnosis on their trust in dentists. A total of 272 completed questionnaires were included in this study. In the first part of the study, approval was obtained from the patients, and data were collected about their socio-demographic characteristics. In the second part the 11-item Dentist Trust Scale was applied. In the third and fourth parts, there were questions about two clinical scenarios, the patients' knowledge of attitudes toward AI, and how the AI-based diagnosis had affected their trust. Evaluation was performed using a Likert-type scale. Data were analyzed with the Chi-square, one-way ANOVA, and ordinal logistic regression tests (p < 0.05). The patients believed that "AI is useful" (3.86 ± 1.03) and were not afraid of the use of AI in dentistry (2.40 ± 1.05). Educational level was considerably related to the patients' attitudes to the use of AI for dental diagnostics (p < 0.05). The patients stated that "dentists are extremely thorough and careful" (4.39 ± 0.77). The patients displayed a positive attitude to AI-based diagnosis in the dental field and appear to exhibit trust in dentists. The use of Al in routine clinical practice canprovide important benefit to physicians as a clinical decision support system in dentistry and understanding patients' attitudes may allow dentists to shape AI-supported dentistry in the future.

Evaluation of the Accuracy of Different Occlusal Caries Detection Methods: A Comparative Study

Evaluation of the Accuracy of Different Occlusal Caries Detection Methods: A Comparative Study

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.

AI-Assisted Detection of Interproximal, Occlusal, and Secondary Caries on Bite-Wing Radiographs: A Single-Shot Deep Learning Approach.

Tooth decay is a common oral disease worldwide, but errors in diagnosis can often be made in dental clinics, which can lead to a delay in treatment. This study aims to use artificial intelligence (AI) for the automated detection and localization of secondary, occlusal, and interproximal (D1, D2, D3) caries types on bite-wing radiographs. The eight hundredand sixty bite-wing radiographs were collected from the School of Dentistry database. Pre-processing and data augmentation operations were performed. Interproximal (D1, D2, D3), secondary, and occlusal caries on bite-wing radiographs were annotated by two oral radiologists. The data were split into 80% for training, 10% for validation, and 10% for testing. The AI-based training process was conducted using the YOLOv8 algorithm. A clinical decision support system interface was designed using the Python PyQT5 library, allowing for the use of dental caries detection without the need for complex programming procedures. In the test images, the average precision, average sensitivity, and average F1 score values for secondary, occlusal, and interproximal caries were obtained as 0.977, 0.932, and 0.954, respectively. The AI-based dental caries detection system yielded highly successful results in the test, receiving full approval from dentists for clinical use. YOLOv8 has the potential to increase sensitivity and reliability while reducing the burden on dentists and can prevent diagnostic errors in dental clinics.

Occlusal caries detection and monitoring using a 3D intraoral scanner system. An in vivo assessment

ObjectiveTo assess the agreement in detecting and monitoring occlusal caries over thirty months using conventional visual and radiographic assessment and an intraoral scanner system which supports automated caries scoring. MethodsNinety-one young participants aged 12–19 years were included in the study. All occlusal surfaces were examined visually, radiographically (when indicated), and scanned with the TRIOS 4 intraoral scanner. TRIOS Patient Monitoring software (vers. 2.3, 3Shape TRIOS A/S, Denmark) was used for automated caries detection on the 3D digital models. ResultsFifty-five of the study participants were re-examined after 30-months. Significant differences regarding caries detection were found between the conventional methods and the automated caries scoring system (p < 0.01), with moderate positive percent agreement (49–61%) and high negative percent agreement (87–98%). All methods reported significant caries progression over the follow-up period (p < 0.01). However, the automated system showed significantly more caries progression than the other methods (p < 0.01). ConclusionsThe software for automated caries detection and classification showed moderate positive agreement and strong negative agreement with the conventional methods considering both the baseline and the follow-up assessments. The automated caries scoring system detected significantly fewer caries lesions and tended to underestimate the caries severity. All methods indicated significant caries progression over the follow-up period, while the automated system detected more caries progression. Clinical significanceThe TRIOS system supporting automated occlusal caries detection and classification can assist in detecting and monitoring occlusal caries on permanent teeth as a complementary tool to the conventional methods. However, the operator should be aware that the automated system shows a tendency to underestimate the caries presence and lesion severity.

Occlusal Caries Detection with Intraoral Scanners in Pediatric Dentistry: A Comparative Clinical Study.

Background: The aim of this clinical study was to compare the occlusal caries detection (OCD) performance of the intraoral scanners (IOSs) Trios 4 (TIO, 3Shape) and Emerald S (EME, Planmeca) and the Diagnocam (DIA, KaVo) with the established visual (WHO) examination (VIS, reference method). Methods: Between 08/2022 and 02/2023, 60 children (mean age 9.6 ± 2.5 years) were examined as part of their regular dental checkups. OCD was performed at the tooth level, separately for primary and permanent unrestored teeth. Furthermore, two thresholds were analyzed: sound versus overall caries (pooled data of enamel and dentin caries, TH1) and pooled data of sound and enamel caries versus dentin caries (TH2). Results: The best agreement with the reference method (reliability) in both dentitions was obtained for DIA (ĸ = 0.829/ĸ = 0.846; primary/permanent teeth), followed by EME (ĸ = 0.827/ĸ = 0.837) and TIO (ĸ = 0.714/ĸ = 0.680). Similar results were shown for the diagnostic quality (sensitivity, specificity and area under the curve of the receiver operating characteristic curve), with higher values for TH1 than for TH2. Both IOSs and the DIA showed worse results than the reference method VIS. Conclusions: Currently, IOS should be used as an additional caries detection tool, especially for visualization, and cannot be recommended as a basic tool for diagnosis or invasive/noninvasive therapy decisions in OCD.

Near-infrared light transillumination for occlusal caries detection in dog teeth: A comparative study

The aim of this study is to compare the effectiveness of visual, radiologic, and near-infrared light transillumination caries detection methods on caries of dog teeth in-vitro. A total of 237 dog molar teeth were evaluated with three different methods; visio-tactile examination with a probe, radiographic assessment, and NIR-LT. Each tooth was evaluated with all of the methods; the absence or presence of occlusal caries was scored as either 0, caries not present, or 1, caries present. All caries detection methods yielded the same outcomes for each tooth. Among all caries detection methods positive Spearman’s rho value (ϱ=1) indicated that there was a strong positive correlation between the caries detection methods. Since NIR-LT is such a comfortable and easy caries diagnosis method, it can be used without sedation, especially in calm dogs.

Evaluation of Reliability and Validity of Occlusal Caries Detection by Direct Visual, Indirect Visual and Fluorescence Camera Using ICDAS II (Codes 0, 1, and 2): An In Vivo Study.

Early detection of carious lesions paves the way for the preservation of tooth structures by remineralization strategies. Visual examination using international caries detection and assessment system (ICDAS) II has been validated with the gold standard of histological classification. A fluorescence camera is yet another diagnostic aid for the early detection of carious lesions based on the autofluorescence of the enamel and dentin. This study was done to evaluate the validity of the fluorescence camera (Soprocare and Acteone) in detecting early carious lesions. A total of 690 occlusal surfaces of non-cavitated premolars and molars were examined by examiners 1 and 2, trained in the ICDAS II grading system. The photographs of the occlusal surface and the fluorescence images, which were taken using a Soprocare (Acetone) intraoral camera, were examined by examiners 3 and 4. The scoring was tabulated and correlated. The κ values for interexaminer reproducibility of indirect visual was 0.841 (good), and his fluorescence camera was 1.00, which is very good. The correlation analysis revealed that there was a higher correlation between direct visual and indirect visual for both examiners when compared to direct and fluorescence cameras. There was a positive relationship between indirect visual and fluorescence cameras for both the experimenter). The indirect visual method for the detection of carries has high sensitivity and specificity irrespective of the examiner. Examination by fluorescence camera has a low sensitivity and high specificity. The specificity of the caries detection method by indirect visual examination based on ICDAS II coding that of the Soprocare fluorescence camera was consistent and reliable, whereas indirect visual examination had a high sensitivity for detecting ICDAS codes 1 and 2. Soprocare showed a very low sensitivity in detecting ICDAS code 1 and 2 lesions. Dhanavel C, Sai CK, Neelamurthy PS, et al. Evaluation of Reliability and Validity of Occlusal Caries Detection by Direct Visual, Indirect Visual and Fluorescence Camera Using ICDAS II (Codes 0, 1, and 2): An In Vivo Study. Int J Clin Pediatr Dent 2023;16(1):74-78.

Occlusal caries detection on 3D models obtained with an intraoral scanner. A validation study

ObjectivesTo evaluate the diagnostic performance of visual caries assessment on 3D dental models obtained using an intraoral scanner and to compare it with the performance of the clinical visual inspection. MethodsFifty-three permanent posterior teeth scheduled for extraction were randomly selected and included in this study. One to three independent examination sites on the occlusal surface of each tooth were clinically inspected using International Caries Detection and Assessment System (ICDAS) criteria. Afterwards, the examined teeth were scanned intraorally with a 3D intraoral scanner (TRIOS 4, 3Shape TRIOS A/S, Copenhagen, Denmark) using white and blue-violet light (415 nm wavelength) to capture the colour and fluorescence signal from the tissues. Six months after the clinical examination, the same examiner conducted the on-screen assessment of the obtained 3D digital dental models at the selected examination sites using modified ICDAS criteria. Both tooth colour and fluorescence texture with high resolution were assessed. Lastly, an independent examiner conducted the histological examination of all teeth after extraction. Using histology as the reference test, Sensitivity (SE), Specificity (SP), Accuracy (ACC), area under the Receiver Operating Characteristic (ROC) curve, and Spearman's correlation coefficient were calculated for the clinical and on-screen ICDAS assessments. ResultsThe ACC values of the evaluated methods varied between 0.59-0.79 for initial caries lesions and 0.77-0.99 for moderate-extensive caries lesions. Apart from SE values corresponding to caries in the inner half of enamel, no significant difference was observed between clinical visual inspection and on-screen assessment. In addition, no difference was found in the assessment of 3D models with tooth colour alone or supplemented with fluorescence for all the evaluated diagnostic measures. ConclusionsOn-screen visual assessment of 3D digital dental models with tooth colour or fluorescence showed a similar diagnostic performance to the clinical visual inspection when detecting and classifying occlusal caries lesions on permanent teeth. Clinical significance3D intraoral scanning can aid the detection and classification of occlusal caries as part of patient screening and can potentially be used in remote caries assessment for clinical and research purposes.

Early occlusal caries detection using targeted fluorescent starch nanoparticles

ObjectivesWe have previously shown fluorescent cationic starch nanoparticles (FCSNs) penetrate enamel surface porosity of active carious lesions, potentially aiding their detection. Here, we evaluate the in vitro diagnostic accuracy of FCSNs in detecting occlusal caries compared to histologic reference standard. Methods100 extracted human teeth were selected with sound (50), or either non-cavitated (25) or cavitated (25) lesions. A region of interest (ROI) on the occlusal surface was assessed for fluorescence by two independent examiners, after immersion in FCSN solution, water rinse, and illumination by dental curing lamp viewed through orange UV-filter glasses. ROIs were sectioned and evaluated by histology (Downer Criteria) as a gold standard for caries presence. Cohen's Kappa was determined for inter- and intra-examiner agreement, and sensitivity, specificity, and area under the curve of Receiver Operator Curves (ROCAUC) were calculated. The analysis was repeated for the subset of “early” lesions, defined as being limited to enamel. ResultsFCSN use resulted in substantial inter-user (k=0.74±0.07), and high intra-user agreement (k=0.80±0.06; 0.94±0.03, by examiner). Sensitivity, specificity and ROCAUC for FCSNs were 88.9%; 94.6%; 0.92±0.06 for all, and 76.9%, 94.6%, and 0.86±0.10 for early lesions. In post hoc analysis, sensitivity seemed to be greater with the FCSN than the expert visual exam, particularly for early lesions. Conclusions/Clinical significanceFCSNs are a reproducible and accurate novel technology for occlusal caries detection, with high sensitivity and specificity compared to histology. Future clinical validation is necessary. FCSNs can improve early caries detection and shift treatment towards non-invasive approaches, improving oral health.

Diagnostic Validity in Occlusal Caries Detection of ICDAS II, DIAGNOdent, Radiography and a Combination of the Three Methods: An In Vitro Study.

In this study, we compare the efficacy and diagnostic concordance of the ICDAS, the radiographic criterion and the instrument known as the DIAGNOdent fluorescence laser pen on occlusal caries lesions using a histological section as the gold standard. Of 100 teeth that did not present cavitated occlusal lesions or occlusal fillings, 80 were chosen through a randomization program and examined by two previously trained and calibrated researchers. Subsequently, the teeth were sectioned with a diamond disk and observed under an optical microscope. The results were studied for caries with a limit established in enamel and caries with extension to dentin. The intra-examiner (0.821–0.933) and inter-examiner (0.817–0.924) reproducibility obtained for both ICDAS and DIAGNOdent for the diagnosis of borderline enamel caries was high. Similarly, intra-examiner (0.686–1.000) and inter-examiner (0.809–0.944) reproducibility for diagnosis of caries with dentin extension was also high for both methods. The sensitivity obtained was 0.76 (ICDAS), 0.87 (DIAGNOdent) and 0.58 (Rx), whereas the specificity obtained was 0.66 (ICDAS), 0.4 (DIAGNOdent) and 0.77 (Rx) for lesions limited to enamel. For lesions with extension to dentin, the sensitivity obtained was 0.73 (ICDAS), 0.82 (DIAGNOdent) and 0.09 (Rx), and the specificity obtained was 0.79 (ICDAS), 0.52 (DIAGNOdent) and 0.97 (Rx). Sensitivity increases in both cases by combining diagnostic methods. In conclusion, ICDAS and DIAGNOdent are better diagnostic methods than Rx for the detection of occlusal caries, and the combination of these methods helps to obtain a better diagnosis.

Clinical effectiveness of high definition fluorescence camera in detection of initial occlusal caries.

BackgroundAlthough visual inspection is the preferred route in everyday clinical practise for detecting early caries lesions, novel technologies like light fluorescence-based devices (Vista Proof iX HD smart) have been developed to enhance early caries detection. Material and MethodsOcclusal surface of 45 molar and 49 premolar teeth from 34 adult participants who fulfilled the eligibility criteria were examined by two observers using three diagnostic methods. Examination was performed visually using the International Caries Detection and Assessment System (ICDAS-II) followed by Vista Proof. Fissurotomy was applied for histological validation. Intra- and inter-observer agreement were measured for ICDAS-II and light-induced fluorescence camera using Kappa test. The overall diagnostic accuracy parameters, area under the receiver operating characteristic curve (AUC-ROC) and 95% confidence interval (95% CI) of the (AUC) for caries detection by Vista Poof were evaluated. ResultsFor ICDAS-II and Vista Proof methods, there was almost perfect intra- and inter-observer agreement. Based on ICDAS-II as a reference standard 1, Vista Proof showed a low level of agreement in enamel carious lesion detection with low sensitivity value of 48%, high specificity of 100%, and AUC was 0.112, while a high level of agreement in dentin carious lesion detection with high sensitivity value of 100%, low specificity of 48% and AUC was 0.888. Based on fissurotomy as reference standard 2, Vista Proof showed a high level of agreement in dentin carious lesion detection with high sensitivity value of 95% and 0% specificity and AUC was 0.814. ConclusionsQuantitative light-induced fluorescence camera with reference to ICDAS-II is considered as an accurate diagnostic modality for detection of early occlusal caries. Histological findings validate the diagnostic accuracy of the camera in dentin. Key words:Histological validation, Initial caries, ICDAS, Light induced fluorescence, Vista Cam.

Sensitivity and Specificity of Different Diagnostic Methods in Occlusal Caries Detection of Permanent Teeth among Paediatric Patients

Dental caries is a commonly progressive disease that proceeds through various degrees of severity that a dentist can detect. The aims of the in vivo study were to assess the accuracy of the individual model (near-infrared light transillumination [NILT] device, visual and radiographic examinations) in detecting occlusal caries, and to evaluate the performance of visual and NILT device combination for occlusal caries detection in deciding the treatment options. Fifty-two non-cavitated occlusal surfaces from 16 patients were assessed with three different diagnostic devices in random order. Identified lesions were prepared and validated. Logistic regression analysis was performed for each method. The sensitivity and specificity values for each method and the combined models were statistically measured using RStudio version 0.97.551. At the enamel level, visual detection was the most sensitive method (0.88), while NILT was the most specific (0.93). NILT scored the highest for sensitivity (0.93) at the dentine level and visual detection scored the highest for specificity (0.88). Visual detection + NILT model was significantly better (p = 0.04) compared to visual detection or NILT alone (df = 1). The visual-NILT combination is a superior model in detecting occlusal caries on permanent teeth. The model provided surplus value in caries detection hence improving the treatment decision-making in occlusal surfaces.

Automated caries detection in vivo using a 3D intraoral scanner

The use of 3D intraoral scanners (IOS) and software that can support automated detection and objective monitoring of oral diseases such as caries, tooth wear or periodontal diseases, is increasingly receiving attention from researchers and industry. This study clinically validates an automated caries scoring system for occlusal caries detection and classification, previously defined for an IOS system featuring fluorescence (TRIOS 4, 3Shape TRIOS A/S, Denmark). Four algorithms (ALG1, ALG2, ALG3, ALG4) are assessed for the IOS; the first three are based only on fluorescence information, while ALG4 also takes into account the tooth color information. The diagnostic performance of these automated algorithms is compared with the diagnostic performance of the clinical visual examination, while histological assessment is used as reference. Additionally, possible differences between in vitro and in vivo diagnostic performance of the IOS system are investigated. The algorithms show comparable in vivo diagnostic performance to the visual examination with no significant difference in the area under the ROC curves (p>0.05). Only minor differences between their in vitro and in vivo diagnostic performance are noted but no significant differences in the area under the ROC curves, (p>0.05). This novel IOS system exhibits encouraging performance for clinical application on occlusal caries detection and classification. Different approaches can be investigated for possible optimization of the system.

DETECTION OF PRIMARY OCCLUSAL CARIES USING STATIONARY INTRAORAL TOMOSYNTHESIS: A PILOT STUDY

<h3>BACKGROUND</h3> The implementation of preventive strategies has aided in the noticeable decline of caries prevalence in developed countries. With the reduction of caries prevalence, there is a higher demand for more sensitive and accurate caries detection modalities. In this study we explore the utility of stationary intraoral tomosynthesis (sIOT) in occlusal caries detection. <h3>OBJECTIVE(S)</h3> In this ex vivo diagnostic accuracy study we aim to evaluate the accuracy and assess the sensitivity, specificity, and area under the ROC curve of s-IOT in detecting primary occlusal caries and to compare the results with digital intraoral bitewings, cone beam computed tomography (CBCT), and the histologic standard reference. <h3>STUDY DESIGN</h3> Sixty de-identified extracted human teeth were selected. The teeth selected included unrestored premolar or molar teeth with fully formed roots. The occlusal surfaces exhibited a status that ranged from sound to carious lesions extending into the inner third of the dentin. Teeth with developmental defects such as hypoplasia or fluorosis were excluded from the study. The teeth were coded and randomly mounted using polyvinyl siloxane (PVS) in dental dentoforms and imaged with the 3 imaging modalities (s-IOT, IO bitewings, and CBCT). A reader study was conducted in which 3 calibrated observers were presented with the 3 imaging modalities. A wash-out period of at least 2 weeks was allowed between sessions, with 1 modality displayed per session. The readers were asked to assess their confidence in caries presence using a 5-point Likert scale and to assess caries depth. After imaging, the teeth were sectioned and histologic examination was completed to establish the ground truth reference. <h3>RESULTS</h3> Accuracy, sensitivity, specificity, and area under the ROC curve of the 3 radiographic modalities will be compared with the histologic standard reference. Results are pending final statistical analysis.

Visual Examination, Fluorescence-Aided Caries Excavation (FACE) Technology, Bitewing X-Ray Radiography in the Detection of Occlusal Caries in First Permanent Molars in Children.

To compare the effectiveness of visual examination, radiographic examination and fluorescence-aided caries excavation (FACE) in detecting occlusal caries in first permanent molars in 150 children aged 6-14 years with intact occlusal surface with caries lesions without cavitation, or with darkened or deep fissures that had no clear diagnosis. Two dentists independently performed a visual oral examination, FACE and bitewing radiography. The inter-rater reliability of each detection method was determined and their specificity and sensitivity. All caries detection methods showed high inter-rater reliability with absolute agreement between raters above 90%. Most caries lesions were detected by visual (75.8%) and FACE (79.1%), while only 28.8% of lesions were detected by radiography. Detection by visual examination was strongly correlated with detection by FACE (X2=37.9, Phi=0.498, p<0.001). A lower, yet statistically significant, correlation was found between visual examination and X-ray radiography (X2=5.53, Phi=0.190, p<0.001). FACE had higher sensitivity (87%) and specificity (65%) for detecting occlusal caries in comparison with radiography (60% specificity and 55% sensitivity). Although visual examination remains the best method to detect occlusal caries in young permanent molars in children, FACE is an effective and accurate diagnostic tool that may aid in detection and treatment decisions.

Comparison of Laser Fluorescence and Digital Radiograph with International Caries Detection and Assessment System in Primary Teeth (In-vivo study)

Background: There has been an increased incidence of dental caries in children due to recent changes in lifestyle. More sensitive and reproducible diagnostic tools for precise caries detection in children are needed because of the complex occlusal anatomy. Aim: To compare the clinical performance and accuracy of international caries detection and assessment system-II (ICDAS II) versus DIAGNOdent pen and digital bitewing radiograph in the detection of occlusal caries in the primary teeth. Materials and Methods: Fifty children aged 6-11 years were assessed of both gender (29 girls and 21 boys) and 377 occlusal surface of primary teeth were examined by visual ICDAS II, DIAGNOdent pen and digital bitewing radiographic examination at D0 (non caries lesions), D1 (lesions limited to enamel) and D2 (lesions limited to dentin) thresholds. Results: Sensitivity at D0 for ICADS II was 14.23% and 95.95% for DIAGNOdent pen and 87.85% for digital bitewing, radiographs while specificity for both ICADS II and bitewing radiographs were 99.23% but 73.85% for DIAGNOdent pen. At D1, threshold sensitivity of ICADS II and digital bitewing radiographs were higher than DIAGNOdent pen but specificity for bitewing radiographs and DIAGNOdent pen 90.69% - 87.99%. were highly significant than ICADS II At D2, threshold specificity for all diagnostic methods was almost similar with better sensitivity for ICADS II and digital bitewing radiographs. Conclusion: This study showed that ICDAS II, Diagnodent pen, and bitewing radiography are effective for the detection of occlusal caries for primary molars. Digital bitewing radiography correlated stronger with ICDASII than Diagnodent pen and proved to be the best method to detect occlusal lesions within the dentin in primary molars while Diagnodent pen and bitewing radiography are better for detecting enamel caries lesion. In addition, the clinical performance of three diagnostic methods was insufficient to detect occlusal caries lesions separately. Consequently, it is advisable to use a combination of diagnostic methods, especially in unclear cases, as well as in cases of initial lesions and their monitoring.

Accuracy of the Light-induced Fluorescent Intraoral Camera in Occlusal Caries Detection

This study was conducted to evaluate the accuracy of a light-induced fluorescence intraoral camera vs the visual-tactile assessment method according to the modified International caries detection and assessment system-II (ICDAS-II) criteria clinically in the detection of initial occlusal caries. Occlusal surfaces of 260 molar and premolar teeth from 52 adult participants were examined by two calibrated observers, using two diagnostic methods. Teeth were initially assessed visually according to the criteria of the ICDAS-II, and then by fluorescence camera (Soprolife®). Inter- and intraobserver agreements were measured using Cohen's kappa test. Correlation between methods was calculated using Wilcoxon signed-rank test, and effect size for comparison between the two modalities. The sensitivity, specificity, predictive values, diagnostic accuracy, likelihood ratios (LRs), area under the receiver operating characteristic (ROC) curve (AUC), and 95% confidence interval (95% CI) of the AUC for caries detection by Soprolife® were evaluated. A significant positive correlation was found between the ICDAS-II and camera measurements (p-value <0.001, effect size = 0.572). The sensitivity of Soprolife® was 94.2%, specificity 84.2%, positive predictive value 87.1%, negative predictive value 92.8%, positive LR 6%, negative LR 0.07%, and the diagnostic accuracy 89.5%. AUC was 0.909 with 95% CI (0.863-0.955). There was a perfect intraobserver agreement (kappa = 1.00) for both testing modalities. There was moderate interobserver agreement (kappa = 0.520) with regards to ICDAS, while for Soprolife®, there was substantial interobserver agreement (kappa = 0.798). Soprolife® can be used as a valid and reliable assessment tool for occlusal caries detection. Light-induced fluorescence intraoral camera is an efficient tool in the detection of initial occlusal caries.

Comparison of novel and established caries diagnostic methods: a clinical study on occlusal surfaces

BackgroundThe purpose of this prospective clinical diagnostic study with validation was to compare the diagnostic accuracy of near-infrared transillumination (NIRT), laser fluorescence measurement (LF), alternating current impedance spectroscopy (ACIS) and their combinations as adjunct methods to visual examination (VE) for occlusal caries detection using a hybrid reference standard.MethodsNinety-six first and second non-cavitated permanent molars from 76 individuals (mean age 24.2) were investigated using (VE) (ICDAS) and bitewing radiography (BWR), as well as NIRT, LF and ACIS. The findings of BWR and NIRT were evaluated by two examiners while the other examinations were conducted by one calibrated dentist. The hybrid reference standard consisted of non-operative validation based on the results of VE and BWR and operative validation. Statistical analysis included cross-tabulations, calculation of sensitivity, specificity and area under the receiver operating characteristic curve at three diagnostic thresholds: caries in general, enamel caries and dentin caries.ResultsNIRT, LF and ACIS exhibited high sensitivity for caries in general [1.00 (1.00–1.00), 0.77 (0.65–0.88), 0.75 (0.63–0.87)) and for dentin caries (0.97 (0.91–1.03), 0.76 (0.76–0.90), 0.64 (0.47–0.80)]. Sensitivity values for enamel caries were weak (0.21, 0.11, 0.37). Specificity values did not fall below 0.65 (NIRT) for all categories and methods, except for NIRT at the caries detection threshold (0.27). A combination of LF and ACIS with VE improved the diagnostic performance at the overall and the enamel caries threshold. The other methods showed fair to excellent discrimination at the overall caries threshold (NIRT 0.64, LF 0.89 and ACIS 0.86) and acceptable discrimination at the dentin caries threshold (NIRT 0.82, LF 0.81 and ACIS 0.79). AUROC for enamel caries exhibited the weakest discrimination. Accuracy was 65.6% for VE, 69.8% for BWR, 50.0% for NIRT, 53.1% for LF and 74.0% for ACIS. Reliability assessment for BWR and NIRT showed at least substantial agreements for all analyses.ConclusionsThe methods, NIRT, LF and ACIS, revealed different potential but no impeccable performance for occlusal caries detection. All are suitable instruments to detect hidden carious lesion in dentin. As auxiliaries to VE, LF and ACIS showed an increase in diagnostic performance.

Detection of Dental Caries and Cracks with Quantitative Light-Induced Fluorescence in Comparison to Radiographic and Visual Examination: A Retrospective Case Study.

The aim of this study was to present an optimal diagnostic protocol by comparing and analyzing a conventional examination and the quantitative light-induced fluorescence (QLF) technique. Selected were 297 teeth of 153 patients to take QLF images and bitewing radiographs. Occlusal dental caries, proximal dental caries and cracks were evaluated and scored using QLF, X-ray and/or visual criteria. The sensitivity, specificity, and area under the curve (AUC) of a receiver operating characteristic analysis were calculated. Two fluorescence parameters (|ΔFmax| and ΔRmax) were utilized to evaluate the fluorescence pattern according to the severity of lesions based on QLF or X-ray criteria. QLF showed higher scores for detecting occlusal dental caries and cracks than the conventional method. ΔRmax increased more clearly than ΔFmax did with occlusal dental caries. The |ΔFmax| values of occlusal dental caries, proximal dental caries and cracks showed good AUC levels (0.84, 0.81 and 0.83, respectively). The ΔRmax of occlusal dental caries showed the highest AUC (0.91) and the ΔRmax of proximal dental caries showed a fail level (0.59) compared to bitewing radiographs. The QLF image could visualize and estimate the degree of occlusal dental caries or cracks. Consequently, the QLF technique may be an adjunct tool to conventional methods for the detection of occlusal caries and peripheral cracks.