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Jones B, Chen T, Michou S, Kilpatrick N, Burgner DP, Vannahme C, Silva M. Diagnostic agreement between visual examination and an automated scanner system with fluorescence for detecting and classifying occlusal carious lesions in primary teeth. J Dent 2024; 149:105279. [PMID: 39121599 DOI: 10.1016/j.jdent.2024.105279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 07/22/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
OBJECTIVES To investigate the in vivo diagnostic agreement between visual examination (VE) using the International Caries Detection and Assessment System (ICDAS) and an automated scanner system for detecting and classifying carious lesions in primary teeth. METHODS 5-year-old children (n = 216) underwent VE and intraoral scanning (TRIOS 4, 3Shape TRIOS A/S, Copenhagen, Denmark). Dental caries experience was recorded for each tooth surface using ICDAS. An automated, fluorescence-based caries scoring system was applied to eligible primary teeth occlusal surfaces on the 3D models using commercially available software. The automated system classified surfaces as sound, initial caries (ICDAS 01/02), or moderate-extensive caries (ICDAS ≥03). The diagnostic agreement was investigated using multi-level modelling and intraclass correlation coefficients. Analyses were repeated at both the initial threshold (ICDAS ≥01) and the moderate-extensive threshold (ICDAS ≥03). RESULTS 213 participants were included in the study, and 1525 primary molar occlusal surfaces were included in the analysis. The odds of detecting caries using the automated system were 46 % lower at the initial disease threshold (OR 0.54, 95 % CI 0.39-0.74) and 70 % lower at the moderate-extensive disease threshold (OR 0.30, 95 % CI 0.16-0.58) compared to VE. The intraclass correlation estimates at the initial and moderate-extensive thresholds were 0.90 (95 % CI 0.70-0.96) and 0.76 (95 % CI 0.22-0.94) respectively. CONCLUSION The automated system is less likely to detect initial lesions and is more likely to underestimate lesion severity relative to visual examination using ICDAS. CLINICAL SIGNIFICANCE Clinically, using the automated tool to replace thorough visual inspection in primary teeth could result in missed opportunities to provide professional or self-care to arrest or reverse early disease. Additionally, it could misclassify moderate lesions as initial caries, potentially leading to complications associated with the delayed management of dental caries.
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Affiliation(s)
- Bree Jones
- Melbourne Dental School, University of Melbourne, 720 Swanston Street, Carlton 3053, VIC, Australia; Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia.
| | - Tong Chen
- Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia; Clinical Epidemiology & Biostatistics Unit, Murdoch Children's Research Institute, Royal Children's Hospital Melbourne 50 Flemington Rd, Parkville, VIC 3052, Australia
| | - Stavroula Michou
- Department of Odontology, School of Dentistry, University of Copenhagen, Nørre Allé 20 DK-2200 Copenhagen, Denmark; 3Shape TRIOS A/S, Copenhagen, Niels Juels Gade 13 1059 København, Denmark
| | - Nicky Kilpatrick
- Melbourne Dental School, University of Melbourne, 720 Swanston Street, Carlton 3053, VIC, Australia; Department of Paediatrics, University of Melbourne, Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia
| | - David P Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia
| | - Christoph Vannahme
- 3Shape TRIOS A/S, Copenhagen, Niels Juels Gade 13 1059 København, Denmark
| | - Mihiri Silva
- Melbourne Dental School, University of Melbourne, 720 Swanston Street, Carlton 3053, VIC, Australia; Murdoch Children's Research Institute, Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia
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Marcondes APM, Campos PHD, Ribeiro CS, Novaes TFD, Lussi A, Diniz MB. Performance of near-infrared light transillumination in the detection of occlusal caries lesions in deciduous teeth. Photodiagnosis Photodyn Ther 2023; 44:103744. [PMID: 37567332 DOI: 10.1016/j.pdpdt.2023.103744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/11/2023] [Accepted: 08/08/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND This 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]). METHODS Fifty-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). RESULTS A 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. CONCLUSIONS NILT technology (DC) and LFpen exhibited similar performance for the detection of occlusal caries lesions in deciduous molars when compared with ICDAS criteria.
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Affiliation(s)
- Ana Paula Marçal Marcondes
- Graduate Program in Dentistry, Cruzeiro do Sul University, Rua Galvão Bueno, 868, Liberdade, São Paulo, SP 01506-000, Brazil
| | - Priscila Hernández de Campos
- Graduate Program in Dentistry, Cruzeiro do Sul University, Rua Galvão Bueno, 868, Liberdade, São Paulo, SP 01506-000, Brazil
| | - Caroline Santos Ribeiro
- Graduate Program in Dentistry, Cruzeiro do Sul University, Rua Galvão Bueno, 868, Liberdade, São Paulo, SP 01506-000, Brazil
| | - Tatiane Fernandes de Novaes
- Graduate Program in Dentistry, Cruzeiro do Sul University, Rua Galvão Bueno, 868, Liberdade, São Paulo, SP 01506-000, Brazil
| | - Adrian Lussi
- Department of Operative Dentistry and Periodontology, Center of Dental Medicine, University of Freiburg, Hugstetter Strasse 55, Freiburg DE-79106, Germany
| | - Michele Baffi Diniz
- Graduate Program in Dentistry, Cruzeiro do Sul University, Rua Galvão Bueno, 868, Liberdade, São Paulo, SP 01506-000, Brazil.
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Kocak-Topbas N, Kamburoğlu K, Ertürk-Avunduk AT, Ozemre MO, Eratam N, Çakmak EE. Clinical Performance of Diagnostic Methods in Third Molar Teeth with Early Occlusal Caries. Diagnostics (Basel) 2023; 13:diagnostics13020284. [PMID: 36673093 PMCID: PMC9858034 DOI: 10.3390/diagnostics13020284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/29/2022] [Accepted: 01/10/2023] [Indexed: 01/14/2023] Open
Abstract
The aim of this study was to compare the diagnostic performance of clinical visual examination (ICDAS II), digital periapical radiography (PR), near infrared light transillumination (NIR-LT), and laser fluorescence (LF) to microcomputed tomography (Micro-CT) which is the reference standard for the detection of non-cavitated occlusal enamel and dentin caries in third molar teeth. Potential participants were consecutively recruited. In this prospective study, 101 third molars of 101 patients were examined; the molars had non-cavitated occlusal caries which required extraction. ICDAS II, PR, NIR-LT and LF examinations were carried out by two blinded examiners. Reference standard was determined by micro-CT imaging seven days after extraction. Accuracy rate, sensitivity, specificity, predictive values and areas under receiver operating characteristic (ROC) curves (Az) were statistically analyzed. Nonparametric variables were subjected to the Kruskal−Wallis Test. Significance level was set as p < 0.05. NIR-LT had the highest sensitivity (99.67−99.67%) and accuracy (78.22−77.23%) for the determination of occlusal enamel caries according to examiners 1 and 2, respectively. LF method had the highest sensitivity (70.83−54.17%) and accuracy (66.34−59.41%) for determining occlusal dentin caries according to examiners 1 and 2, respectively. The ROC curve (Az) value ranged between 0.524 and 0.726 for the different methods tested. Most effective methods for the diagnosis of occlusal enamel and dentin caries were determined to be NIR-LT and LF pen methods, respectively. The present prospective clinical study showed that NIR-LT and LF-Pen were a reliable modality for the detection of occlusal enamel and dentin caries without ionizing radiation.
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Affiliation(s)
- Nazan Kocak-Topbas
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Mersin University, Mersin 33343, Turkey
- Correspondence: or ; Tel.: +90-3243610037 (ext. 5603); Fax: +90-3243610092
| | - Kıvanç Kamburoğlu
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara 06110, Turkey
| | | | - Mehmet Ozgur Ozemre
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Mersin University, Mersin 33343, Turkey
| | - Nejlan Eratam
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara 06110, Turkey
| | - Esra Ece Çakmak
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara 06110, Turkey
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Melo M, Pascual A, Camps I, Ata-Ali F, Ata-Ali J. Impedance Spectroscopy as a Tool for the Detection of Occlusal Noncavitated Carious Lesions. Oper Dent 2022; 47:258-267. [PMID: 35604826 DOI: 10.2341/19-149-c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 11/23/2022]
Abstract
A total 302 teeth (148 molars and 154 premolars) corresponding to 152 patients aged ≥18 years were evaluated for caries using the ICDAS (International Caries Detection and Assessment System), fluorescence (DD, DIAGNOdent) and electrical impedance (IMS, CarieScan PRO) systems. Fissurotomy and intraoral radiographs were used as the gold standard. Accordingly, 27.5% (n=84) of the teeth were classified as sound, while 26.9% (n=81) had enamel involvement and 45.6% (n=138) presented carious lesions reaching the dentin. Sensitivity (Se), specificity (Sp), and the area under the curve (AUC) were, respectively, 90.7%, 87.8%, and 0.954 (IMS); 92.4%, 92.7%, and 0.954 (DD); and 79.0%, 72.3%, and 0.756 (ICDAS). With regard to Se and Sp, there were significant differences between ICDAS and DD (p<0.001) and between ICDAS and IMS (p=0.01), but not between IMS and DD (p=0.07). In relation to AUC, there were significant differences between ICDAS and DD (p<0.001), and between ICDAS and IMS (p<0.001), but not between IMS and DD (p>0.05). The correlations between fissurotomy and each method were 88.7% (IMS), 89.7% (DD), and 77.1% (ICDAS). Within the limitations of this study, clinically, the electrical system is not useful for differentiating between sound teeth and truly incipient caries lesions by itself. The fluorescence or electrical systems are recommended with the ICDAS to detect carious lesions in their early stages.
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Affiliation(s)
- M Melo
- María Melo, DDS, MS, PhD, Valencia University Medical and Dental School, University of Valencia, Valencia, Spain
| | - A Pascual
- Agustín Pascual, DDS, MS, PhD, Valencia University Medical and Dental School, University of Valencia, Valencia, Spain
| | - I Camps
- Isabel Camps, DDS, Ms, PhD, Valencia University Medical and Dental School, University of Valencia, Valencia, Spain
| | - F Ata-Ali
- Fadi Ata-Ali, DDS, MS, PhD, private dental practice, Valencia, Spain
| | - J Ata-Ali
- *Javier Ata-Ali, DDS, MS, MPH, PhD, Universidad Europea de Valencia, Faculty of Health Sciences, Department of Dentistry, Public Dental Health Service, Conselleria de Sanitat Universal i Salut Pública, Generalitat Valenciana, Valencia, Spain
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Macey R, Walsh T, Riley P, Glenny AM, Worthington HV, O'Malley L, Clarkson JE, Ricketts D. Visual or visual-tactile examination to detect and inform the diagnosis of enamel caries. Cochrane Database Syst Rev 2021; 6:CD014546. [PMID: 34124773 PMCID: PMC8428329 DOI: 10.1002/14651858.cd014546] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The detection and diagnosis of caries at the initial (non-cavitated) and moderate (enamel) levels of severity is fundamental to achieving and maintaining good oral health and prevention of oral diseases. An increasing array of methods of early caries detection have been proposed that could potentially support traditional methods of detection and diagnosis. Earlier identification of disease could afford patients the opportunity of less invasive treatment with less destruction of tooth tissue, reduce the need for treatment with aerosol-generating procedures, and potentially result in a reduced cost of care to the patient and to healthcare services. OBJECTIVES To determine the diagnostic accuracy of different visual classification systems for the detection and diagnosis of non-cavitated coronal dental caries for different purposes (detection and diagnosis) and in different populations (children or adults). SEARCH METHODS Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 30 April 2020); Embase Ovid (1980 to 30 April 2020); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 30 April 2020); and the World Health Organization International Clinical Trials Registry Platform (to 30 April 2020). We studied reference lists as well as published systematic review articles. SELECTION CRITERIA We included diagnostic accuracy study designs that compared a visual classification system (index test) with a reference standard (histology, excavation, radiographs). This included cross-sectional studies that evaluated the diagnostic accuracy of single index tests and studies that directly compared two or more index tests. Studies reporting at both the patient or tooth surface level were included. In vitro and in vivo studies were considered. Studies that explicitly recruited participants with caries into dentine or frank cavitation were excluded. We also excluded studies that artificially created carious lesions and those that used an index test during the excavation of dental caries to ascertain the optimum depth of excavation. DATA COLLECTION AND ANALYSIS We extracted data independently and in duplicate using a standardised data extraction and quality assessment form based on QUADAS-2 specific to the review context. Estimates of diagnostic accuracy were determined using the bivariate hierarchical method to produce summary points of sensitivity and specificity with 95% confidence intervals (CIs) and regions, and 95% prediction regions. The comparative accuracy of different classification systems was conducted based on indirect comparisons. Potential sources of heterogeneity were pre-specified and explored visually and more formally through meta-regression. MAIN RESULTS We included 71 datasets from 67 studies (48 completed in vitro) reporting a total of 19,590 tooth sites/surfaces. The most frequently reported classification systems were the International Caries Detection and Assessment System (ICDAS) (36 studies) and Ekstrand-Ricketts-Kidd (ERK) (15 studies). In reporting the results, no distinction was made between detection and diagnosis. Only two studies were at low risk of bias across all four domains, and 15 studies were at low concern for applicability across all three domains. The patient selection domain had the highest proportion of high risk of bias studies (49 studies). Four studies were assessed at high risk of bias for the index test domain, nine for the reference standard domain, and seven for the flow and timing domain. Due to the high number of studies on extracted teeth concerns regarding applicability were high for the patient selection and index test domains (49 and 46 studies respectively). Studies were synthesised using a hierarchical bivariate method for meta-analysis. There was substantial variability in the results of the individual studies: sensitivities ranged from 0.16 to 1.00 and specificities from 0 to 1.00. For all visual classification systems the estimated summary sensitivity and specificity point was 0.86 (95% CI 0.80 to 0.90) and 0.77 (95% CI 0.72 to 0.82) respectively, diagnostic odds ratio (DOR) 20.38 (95% CI 14.33 to 28.98). In a cohort of 1000 tooth surfaces with 28% prevalence of enamel caries, this would result in 40 being classified as disease free when enamel caries was truly present (false negatives), and 163 being classified as diseased in the absence of enamel caries (false positives). The addition of test type to the model did not result in any meaningful difference to the sensitivity or specificity estimates (Chi2(4) = 3.78, P = 0.44), nor did the addition of primary or permanent dentition (Chi2(2) = 0.90, P = 0.64). The variability of results could not be explained by tooth surface (occlusal or approximal), prevalence of dentinal caries in the sample, nor reference standard. Only one study intentionally included restored teeth in its sample and no studies reported the inclusion of sealants. We rated the certainty of the evidence as low, and downgraded two levels in total for risk of bias due to limitations in the design and conduct of the included studies, indirectness arising from the in vitro studies, and inconsistency of results. AUTHORS' CONCLUSIONS Whilst the confidence intervals for the summary points of the different visual classification systems indicated reasonable performance, they do not reflect the confidence that one can have in the accuracy of assessment using these systems due to the considerable unexplained heterogeneity evident across the studies. The prediction regions in which the sensitivity and specificity of a future study should lie are very broad, an important consideration when interpreting the results of this review. Should treatment be provided as a consequence of a false-positive result then this would be non-invasive, typically the application of fluoride varnish where it was not required, with low potential for an adverse event but healthcare resource and finance costs. Despite the robust methodology applied in this comprehensive review, the results should be interpreted with some caution due to shortcomings in the design and execution of many of the included studies. Studies to determine the diagnostic accuracy of methods to detect and diagnose caries in situ are particularly challenging. Wherever possible future studies should be carried out in a clinical setting, to provide a realistic assessment of performance within the oral cavity with the challenges of plaque, tooth staining, and restorations, and consider methods to minimise bias arising from the use of imperfect reference standards in clinical studies.
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Affiliation(s)
- Richard Macey
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Philip Riley
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Anne-Marie Glenny
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Lucy O'Malley
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Janet E Clarkson
- Division of Oral Health Sciences, Dundee Dental School, University of Dundee, Dundee, UK
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Walsh T, Macey R, Riley P, Glenny AM, Schwendicke F, Worthington HV, Clarkson JE, Ricketts D, Su TL, Sengupta A. Imaging modalities to inform the detection and diagnosis of early caries. Cochrane Database Syst Rev 2021; 3:CD014545. [PMID: 33720395 PMCID: PMC8441255 DOI: 10.1002/14651858.cd014545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The detection and diagnosis of caries at the earliest opportunity is fundamental to the preservation of tooth tissue and maintenance of oral health. Radiographs have traditionally been used to supplement the conventional visual-tactile clinical examination. Accurate, timely detection and diagnosis of early signs of disease could afford patients the opportunity of less invasive treatment with less destruction of tooth tissue, reduce the need for treatment with aerosol-generating procedures, and potentially result in a reduced cost of care to the patient and to healthcare services. OBJECTIVES To determine the diagnostic accuracy of different dental imaging methods to inform the detection and diagnosis of non-cavitated enamel only coronal dental caries. SEARCH METHODS Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 31 December 2018); Embase Ovid (1980 to 31 December 2018); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 31 December 2018); and the World Health Organization International Clinical Trials Registry Platform (to 31 December 2018). We studied reference lists as well as published systematic review articles. SELECTION CRITERIA We included diagnostic accuracy study designs that compared a dental imaging method with a reference standard (histology, excavation, enhanced visual examination), studies that evaluated the diagnostic accuracy of single index tests, and studies that directly compared two or more index tests. Studies reporting at both the patient or tooth surface level were included. In vitro and in vivo studies were eligible for inclusion. Studies that explicitly recruited participants with more advanced lesions that were obviously into dentine or frankly cavitated were excluded. We also excluded studies that artificially created carious lesions and those that used an index test during the excavation of dental caries to ascertain the optimum depth of excavation. DATA COLLECTION AND ANALYSIS Two review authors extracted data independently and in duplicate using a standardised data extraction form and quality assessment based on QUADAS-2 specific to the clinical context. Estimates of diagnostic accuracy were determined using the bivariate hierarchical method to produce summary points of sensitivity and specificity with 95% confidence regions. Comparative accuracy of different radiograph methods was conducted based on indirect and direct comparisons between methods. Potential sources of heterogeneity were pre-specified and explored visually and more formally through meta-regression. MAIN RESULTS We included 104 datasets from 77 studies reporting a total of 15,518 tooth sites or surfaces. The most frequently reported imaging methods were analogue radiographs (55 datasets from 51 studies) and digital radiographs (42 datasets from 40 studies) followed by cone beam computed tomography (CBCT) (7 datasets from 7 studies). Only 17 studies were of an in vivo study design, carried out in a clinical setting. No studies were considered to be at low risk of bias across all four domains but 16 studies were judged to have low concern for applicability across all domains. The patient selection domain had the largest number of studies judged to be at high risk of bias (43 studies); the index test, reference standard, and flow and timing domains were judged to be at high risk of bias in 30, 12, and 7 studies respectively. Studies were synthesised using a hierarchical bivariate method for meta-analysis. There was substantial variability in the results of the individual studies, with sensitivities that ranged from 0 to 0.96 and specificities from 0 to 1.00. For all imaging methods the estimated summary sensitivity and specificity point was 0.47 (95% confidence interval (CI) 0.40 to 0.53) and 0.88 (95% CI 0.84 to 0.92), respectively. In a cohort of 1000 tooth surfaces with a prevalence of enamel caries of 63%, this would result in 337 tooth surfaces being classified as disease free when enamel caries was truly present (false negatives), and 43 tooth surfaces being classified as diseased in the absence of enamel caries (false positives). Meta-regression indicated that measures of accuracy differed according to the imaging method (Chi2(4) = 32.44, P < 0.001), with the highest sensitivity observed for CBCT, and the highest specificity observed for analogue radiographs. None of the specified potential sources of heterogeneity were able to explain the variability in results. No studies included restored teeth in their sample or reported the inclusion of sealants. We rated the certainty of the evidence as low for sensitivity and specificity and downgraded two levels in total for risk of bias due to limitations in the design and conduct of the included studies, indirectness arising from the in vitro studies, and the observed inconsistency of the results. AUTHORS' CONCLUSIONS The design and conduct of studies to determine the diagnostic accuracy of methods to detect and diagnose caries in situ are particularly challenging. Low-certainty evidence suggests that imaging for the detection or diagnosis of early caries may have poor sensitivity but acceptable specificity, resulting in a relatively high number of false-negative results with the potential for early disease to progress. If left untreated, the opportunity to provide professional or self-care practices to arrest or reverse early caries lesions will be missed. The specificity of lesion detection is however relatively high, and one could argue that initiation of non-invasive management (such as the use of topical fluoride), is probably of low risk. CBCT showed superior sensitivity to analogue or digital radiographs but has very limited applicability to the general dental practitioner. However, given the high-radiation dose, and potential for caries-like artefacts from existing restorations, its use cannot be justified in routine caries detection. Nonetheless, if early incidental carious lesions are detected in CBCT scans taken for other purposes, these should be reported. CBCT has the potential to be used as a reference standard in diagnostic studies of this type. Despite the robust methodology applied in this comprehensive review, the results should be interpreted with some caution due to shortcomings in the design and execution of many of the included studies. Future research should evaluate the comparative accuracy of different methods, be undertaken in a clinical setting, and focus on minimising bias arising from the use of imperfect reference standards in clinical studies.
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Affiliation(s)
- Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Richard Macey
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Philip Riley
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Anne-Marie Glenny
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Heatlh Research Services, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Janet E Clarkson
- Division of Oral Health Sciences, Dundee Dental School, University of Dundee, Dundee, UK
| | | | - Ting-Li Su
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Anita Sengupta
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Macey R, Walsh T, Riley P, Glenny AM, Worthington HV, Fee PA, Clarkson JE, Ricketts D. Fluorescence devices for the detection of dental caries. Cochrane Database Syst Rev 2020; 12:CD013811. [PMID: 33319353 PMCID: PMC8677328 DOI: 10.1002/14651858.cd013811] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Caries is one of the most prevalent and preventable conditions worldwide. If identified early enough then non-invasive techniques can be applied, and therefore this review focusses on early caries involving the enamel surface of the tooth. The cornerstone of caries detection is a visual and tactile dental examination, however alternative methods of detection are available, and these include fluorescence-based devices. There are three categories of fluorescence-based device each primarily defined by the different wavelengths they exploit; we have labelled these groups as red, blue, and green fluorescence. These devices could support the visual examination for the detection and diagnosis of caries at an early stage of decay. OBJECTIVES Our primary objectives were to estimate the diagnostic test accuracy of fluorescence-based devices for the detection and diagnosis of enamel caries in children or adults. We planned to investigate the following potential sources of heterogeneity: tooth surface (occlusal, proximal, smooth surface or adjacent to a restoration); single point measurement devices versus imaging or surface assessment devices; and the prevalence of more severe disease in each study sample, at the level of caries into dentine. SEARCH METHODS Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 30 May 2019); Embase Ovid (1980 to 30 May 2019); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 30 May 2019); and the World Health Organization International Clinical Trials Registry Platform (to 30 May 2019). We studied reference lists as well as published systematic review articles. SELECTION CRITERIA We included diagnostic accuracy study designs that compared a fluorescence-based device with a reference standard. This included prospective studies that evaluated the diagnostic accuracy of single index tests and studies that directly compared two or more index tests. Studies that explicitly recruited participants with caries into dentine or frank cavitation were excluded. DATA COLLECTION AND ANALYSIS Two review authors extracted data independently using a piloted study data extraction form based on the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Sensitivity and specificity with 95% confidence intervals (CIs) were reported for each study. This information has been displayed as coupled forest plots and summary receiver operating characteristic (SROC) plots, displaying the sensitivity-specificity points for each study. We estimated diagnostic accuracy using hierarchical summary receiver operating characteristic (HSROC) methods. We reported sensitivities at fixed values of specificity (median 0.78, upper quartile 0.90). MAIN RESULTS We included a total of 133 studies, 55 did not report data in the 2 x 2 format and could not be included in the meta-analysis. 79 studies which provided 114 datasets and evaluated 21,283 tooth surfaces were included in the meta-analysis. There was a high risk of bias for the participant selection domain. The index test, reference standard, and flow and timing domains all showed a high proportion of studies to be at low risk of bias. Concerns regarding the applicability of the evidence were high or unclear for all domains, the highest proportion being seen in participant selection. Selective participant recruitment, poorly defined diagnostic thresholds, and in vitro studies being non-generalisable to the clinical scenario of a routine dental examination were the main reasons for these findings. The dominance of in vitro studies also means that the information on how the results of these devices are used to support diagnosis, as opposed to pure detection, was extremely limited. There was substantial variability in the results which could not be explained by the different devices or dentition or other sources of heterogeneity that we investigated. The diagnostic odds ratio (DOR) was 14.12 (95% CI 11.17 to 17.84). The estimated sensitivity, at a fixed median specificity of 0.78, was 0.70 (95% CI 0.64 to 0.75). In a hypothetical cohort of 1000 tooth sites or surfaces, with a prevalence of enamel caries of 57%, obtained from the included studies, the estimated sensitivity of 0.70 and specificity of 0.78 would result in 171 missed tooth sites or surfaces with enamel caries (false negatives) and 95 incorrectly classed as having early caries (false positives). We used meta-regression to compare the accuracy of the different devices for red fluorescence (84 datasets, 14,514 tooth sites), blue fluorescence (21 datasets, 3429 tooth sites), and green fluorescence (9 datasets, 3340 tooth sites) devices. Initially, we allowed threshold, shape, and accuracy to vary according to device type by including covariates in the model. Allowing consistency of shape, removal of the covariates for accuracy had only a negligible effect (Chi2 = 3.91, degrees of freedom (df) = 2, P = 0.14). Despite the relatively large volume of evidence we rated the certainty of the evidence as low, downgraded two levels in total, for risk of bias due to limitations in the design and conduct of the included studies, indirectness arising from the high number of in vitro studies, and inconsistency due to the substantial variability of results. AUTHORS' CONCLUSIONS There is considerable variation in the performance of these fluorescence-based devices that could not be explained by the different wavelengths of the devices assessed, participant, or study characteristics. Blue and green fluorescence-based devices appeared to outperform red fluorescence-based devices but this difference was not supported by the results of a formal statistical comparison. The evidence base was considerable, but we were only able to include 79 studies out of 133 in the meta-analysis as estimates of sensitivity or specificity values or both could not be extracted or derived. In terms of applicability, any future studies should be carried out in a clinical setting, where difficulties of caries assessment within the oral cavity include plaque, staining, and restorations. Other considerations include the potential of fluorescence devices to be used in combination with other technologies and comparative diagnostic accuracy studies.
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Affiliation(s)
- Richard Macey
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Philip Riley
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Anne-Marie Glenny
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Patrick A Fee
- Dundee Dental School, University of Dundee, Dundee, UK
| | - Janet E Clarkson
- Division of Oral Health Sciences, Dundee Dental School, University of Dundee, Dundee, UK
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Marczuk-Kolada G, Luczaj-Cepowicz E, Obidzinska M, Rozycki J. Performance of ICDAS II and fluorescence methods on detection of occlusal caries—An ex vivo study. Photodiagnosis Photodyn Ther 2020; 29:101609. [DOI: 10.1016/j.pdpdt.2019.101609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 11/25/2022]
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Leal SC, Barros BV, Cabral RN, Ferrari JCL, de Menezes Abreu DM, Ribeiro APD. Dental caries lesions in primary teeth without obvious cavitation: Treatment decision-making process. Int J Paediatr Dent 2019; 29:422-428. [PMID: 30803096 DOI: 10.1111/ipd.12483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 12/18/2018] [Accepted: 02/17/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Dental caries diagnosis and management have changed over time. AIM To identify the treatment decision-making process performed by paediatric dentists, after caries detection using CAST instrument (Caries Assessment Spectrum and Treatment), for enamel (CAST 3) and non-cavitated dentin caries lesions (CAST 4) before and after analysing radiographic images. DESIGN Seventy-four paediatric dentists were invited to participate. Twelve clinical cases were presented online, and treatment decisions before and after the analysis of bitewing radiographs were evaluated. RESULTS Sixty-one specialists answered the questionnaire. The necessity for radiographs was significantly associated with the presence and depth of the caries lesion (P < 0.0001). CAST 3 lesions were preferentially monitored before and after the radiographic assessment. For CAST 4 lesions limited to the outer half of dentin, treatments indicated before and after radiographic analysis were sealant (33%) and restoration (40%). For the lesions in the inner half of dentin, restoration was the most cited before (45%) and after (84%) radiographs. The radiographic depth was the only significant independent variable when "change in the treatment option" was analysed by the regression model (P < 0.001). CONCLUSIONS Enamel lesions were treated through less invasive treatments. Radiographs influenced the decision, especially for the lesions that involved the inner half of dentin.
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Affiliation(s)
- Soraya Coelho Leal
- Faculty of Health Science, Department of Dentistry, University of Brasilia, Brasília, Brazil
| | | | - Renata Nunes Cabral
- Faculty of Health Science, Department of Dentistry, University of Brasilia, Brasília, Brazil
| | | | | | - Ana Paula Dias Ribeiro
- Department of Restorative Dental Sciences, College of Dentistry, University of Florida, Gainesville, Florida
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Diagnostic validity of the use of ICDAS II and DIAGNOdent pen verified by micro-computed tomography for the detection of occlusal caries lesions—an in vitro evaluation. Lasers Med Sci 2019; 34:1655-1663. [DOI: 10.1007/s10103-019-02762-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/26/2019] [Indexed: 10/26/2022]
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11
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Performance of light-emitting diode device in detecting occlusal caries in the primary molars. Lasers Med Sci 2019; 34:1235-1241. [DOI: 10.1007/s10103-019-02717-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
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Ekstrand K, Gimenez T, Ferreira F, Mendes F, Braga M. The International Caries Detection and Assessment System – ICDAS: A Systematic Review. Caries Res 2018. [DOI: 10.1159/000486429] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The aims of this study were: (1) to evaluate the overall reproducibility and accuracy of the International Caries Detection and Assessment System (ICDAS) for assessing coronal caries lesions, and (2) to investigate the use of systems associated with the ICDAS for activity assessment of coronal caries lesions. Specific search strategies were adopted to identify studies published up to 2016. For the first objective, we selected studies that assessed primary coronal caries lesions using the ICDAS as a reference standard. A total of 54 studies were included. Meta-analyses summarized the results concerning reproducibility and accuracy (correlation with histology, summary ROC curves [SROC], and diagnostic odds ratio [DOR]). The latter 2 were expressed at D1/D3 levels. The heterogeneity of the studies was also assessed. Reproducibility values (pooled) were > 0.65. The ICDAS mostly presented a good overall performance as most areas under SROC were > 0.75 at D1 and > 0.90 at D3; DOR ≥6. For the second objective, we selected studies investigating activity assessment associated with the ICDAS. The meta-analyses pooled results based on the same methodology and parameters as above. Longitudinal findings regarding caries progression were described to estimate the validity of these systems. On average, the systems for activity assessment of caries lesions showed moderate values concerning reproducibility and overall performance. Active caries lesions were more prone to progress than inactive ones after 2 years. In conclusion, the ICDAS presented a substantial level of reproducibility and accuracy for assessing primary coronal caries lesions. Additional systems associated with the ICDAS that classify caries lesion activity can be useful as they are moderately reproducible and accurate.
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Iranzo-Cortés JE, Almarche-Tarazona M, Montiel-Company JM, Almerich-Silla JM. Diagnostic validity of ICDAS II, VistaProof and a combination of these two methods. An in vitro study in pre-cavitated lesions. Lasers Surg Med 2017; 50:166-173. [DOI: 10.1002/lsm.22751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 01/10/2023]
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14
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Olivan SRG, Deana AM, Pinto MM, Sfalcin RA, Fernandes KPS, Mesquita-Ferrari RA, Prates RA, Bussadori SK. Diagnosis of occlusal caries lesions in deciduous molars by coherent light scattering pattern speckle. Photodiagnosis Photodyn Ther 2017; 18:221-225. [PMID: 28300725 DOI: 10.1016/j.pdpdt.2017.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/30/2017] [Accepted: 03/09/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study presents the correlation between laser speckle images and detection of incipient caries lesions from changs in the microstructure of the surface of tooth enamel. METHODS We used 30 healthy deciduous molar teeth collected from the Biobank Human Teeth, Faculty of Dentistry, University of São Paulo who had carious lesions induced by the pH cycling method. The samples were evaluated for the diagnosis of caries by two methods ICDAS and speckle pattern of coherent light scattering after 5, 10 and 15days and the results were statistically analyzed using α=0.05 significance level. RESULTS A significant difference was observed between the image of the speckle scattering of healthy and injured areas within the 3 study groups, but not when comparing the three groups, showing us that it is an innovative technique that needs further study, but can be used as a diagnostic method for the detection of early caries lesions. CONCLUSION It can be concluded that the analysis of scattering speckle pattern is a diagnostic technique that provides information on the microstructure of the surface of tooth enamel which has sensitivity for detection of incipient caries lesions.
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Affiliation(s)
- Silvia Regina Garcia Olivan
- Department of Biophotonics Applied to Health Sciences, University Nove de Julho, UNINOVE, São Paulo, Brazil; School of Dentistry, University Nove de Julho, UNINOVE, São Paulo, Brazil
| | - Alessandro Melo Deana
- Department of Biophotonics Applied to Health Sciences, University Nove de Julho, UNINOVE, São Paulo, Brazil
| | | | - Ravana Angelini Sfalcin
- Department of Biophotonics Applied to Health Sciences, University Nove de Julho, UNINOVE, São Paulo, Brazil; School of Dentistry, University Nove de Julho, UNINOVE, São Paulo, Brazil
| | - Kristianne Porta Santos Fernandes
- Department of Biophotonics Applied to Health Sciences, University Nove de Julho, UNINOVE, São Paulo, Brazil; School of Dentistry, University Nove de Julho, UNINOVE, São Paulo, Brazil
| | | | - Renato Araujo Prates
- Department of Biophotonics Applied to Health Sciences, University Nove de Julho, UNINOVE, São Paulo, Brazil; School of Dentistry, University Nove de Julho, UNINOVE, São Paulo, Brazil
| | - Sandra Kalil Bussadori
- Department of Biophotonics Applied to Health Sciences, University Nove de Julho, UNINOVE, São Paulo, Brazil; School of Dentistry, University Nove de Julho, UNINOVE, São Paulo, Brazil.
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Bizhang M, Wollenweber N, Singh-Hüsgen P, Danesh G, Zimmer S. Pen-type laser fluorescence device versus bitewing radiographs for caries detection on approximal surfaces. Head Face Med 2016; 12:30. [PMID: 27809872 PMCID: PMC5095970 DOI: 10.1186/s13005-016-0126-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 10/26/2016] [Indexed: 11/23/2022] Open
Abstract
Background The accurate detection of approximal caries is generally difficult. The aim of this study was to assess the ability of the pen-type laser fluorescence device (LF pen) to detect approximal carious lesions in comparison to bitewing radiographs (BW). Methods Three hundred forty-one tooth surfaces were diagnosed in 20 patients with an average age of 26.70 (±2.82) years. Each test tooth was sequentially assessed by a single calibrated examiner using visual inspection, BW, and the LF pen. Radiographs were used as the gold standard to calculate an appropriate cut-off. Results Sensitivity, specificity and accuracy values for cut-off limits of 15, measured by the LF pen were compared using the chi2 test (McNemar test). For approximal caries at D3 level, the highest values of specificity and sensitivity were observed for the LF pen at a cut-off value of 15 (96.8 and 83.0 %) and for visual inspection (99.3 and 4.3 %). Conclusion Within the limitations of this study, dentin caries on approximal surfaces could be detected equally well by the LF pen as by the bitewing radiographs. Therefore, the LF pen can be recommended as an alternative to radiographs for the detection of approximal caries in a regular dental practice setting. Trial registration DRKS00004817 on DRKS on 12th March 2013.
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Affiliation(s)
- M Bizhang
- Department of Operative and Preventive Dentistry, University Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany.
| | - N Wollenweber
- Department of Operative and Preventive Dentistry, University Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| | - P Singh-Hüsgen
- Department of Operative and Preventive Dentistry and Periodontics, Heinrich-Hein University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - G Danesh
- Department of Orthodontics, University Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
| | - S Zimmer
- Department of Operative and Preventive Dentistry, University Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany
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Jablonski-Momeni A, Heinzel-Gutenbrunner M, Vill G. Use of a fluorescence-based camera for monitoring occlusal surfaces of primary and permanent teeth. Int J Paediatr Dent 2016; 26:448-456. [PMID: 26590509 DOI: 10.1111/ipd.12216] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sound teeth and incipient lesions require regular monitoring to detect possible progression of caries early on. AIM To evaluate the ability of the VistaProof (VP) fluorescence-based camera for monitoring occlusal surfaces. DESIGN A total of 419 posterior teeth (205 primary molars, 145 permanent molars, and 69 premolars) of 35 patients were examined (average age: 9.1 years). The occlusal surfaces were classified visually according to the criteria of the International Caries Detection and Assessment System (ICDAS). VP measurements were performed at baseline (t1), and the examinations were repeated after six (t2) and twelve month (t3). Correlation between methods was calculated using Spearman's rank correlation coefficient (rs ). Wilcoxon test was used to monitor whether VP identified changes as well as ICDAS (α = 0.05). RESULTS Correlations between ICDAS and VP were significantly positive (rs : 0.66-0.73, P < 0.001). No significant differences were found between all times for the ICDAS findings. Significant differences for the VP were ascertained for t1/t2 (P = 0.03). Results based on cluster randomization showed significant differences between ICDAS and VistaProof concerning the absence/presence of changes in the finding (P < 0.0005). CONCLUSION Correlation between ICDAS and VP was strong. The VP supported the findings of visual examination for monitoring occlusal surfaces, although not all changes could be detected with respect to the visual findings.
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Affiliation(s)
- Anahita Jablonski-Momeni
- Dental School, Department of Pediatric and Community Dentistry, Philipps University, Marburg, Germany.
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Melo M, Pascual A, Camps I, Del Campo Á, Ata-Ali J. Caries diagnosis using light fluorescence devices in comparison with traditional visual and tactile evaluation: a prospective study in 152 patients. Odontology 2016; 105:283-290. [PMID: 27655625 DOI: 10.1007/s10266-016-0272-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 08/30/2016] [Indexed: 11/26/2022]
Abstract
The objective of the study was to evaluate the in vivo effectiveness of two fluorescence techniques (DIAGNOdent and VistaProof) and of visual and tactile evaluation in the diagnosis of occlusal caries in permanent teeth. A total of 302 teeth (molars and premolars) from 152 patients were studied. The occlusal surfaces were cleaned using pumice mixed with water, followed by application of the diagnostic methods according to the instructions of the manufacturer, and of the visual and tactile methods according to the recommendations. The true extent of the lesions was determined by fissurotomy. The sensitivity and specificity of visual diagnosis were 79 and 72 %, respectively, versus 53 and 98 % in the case of tactile diagnosis. Teeth with caries lesions exhibited significantly higher DIAGNOdent and VistaProof scores than those without caries. Using the optimum cutoff point of 23.5 obtained in our study for DIAGNOdent, sensitivity and specificity were found to be 92.4 and 92.7 %, respectively, while values of 88.1 and 95.1 % were obtained with a cutoff point of 28.5. Sensitivity in the case of the VistaProof system varied between 92.9 % (cutoff point 1.05) and 85.3 % (cutoff point 1.3), with respective specificity values of 95.8 and 88.6 %. The areas under the curve were 0.756, 0.759, 0.954 and 0.965 for the visual and tactile methods and for DIAGNOdent and VistaProof, respectively. The fluorescence-based techniques showed greater internal and external validity than the visual and tactile methods in diagnosing occlusal caries in permanent teeth. VistaProof is the best method for diagnosing caries in its early stages.
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Affiliation(s)
- María Melo
- Valencia University Medical and Dental School, University of Valencia, Valencia, Spain
| | - Agustín Pascual
- Valencia University Medical and Dental School, University of Valencia, Valencia, Spain
| | - Isabel Camps
- Valencia University Medical and Dental School, University of Valencia, Valencia, Spain
| | | | - Javier Ata-Ali
- European University of Valencia, Valencia, Spain.
- Public Dental Health Service, Arnau de Vilanova Hospital, San Clemente 12, 46015, Valencia, Spain.
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18
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Novaes TF, Moriyama CM, De Benedetto MS, Kohara EK, Braga MM, Mendes FM. Performance of fluorescence-based methods for detecting and quantifying smooth-surface caries lesions in primary teeth: an in vitro study. Int J Paediatr Dent 2016; 26:13-9. [PMID: 25614929 DOI: 10.1111/ipd.12152] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although smooth-surface caries can be subjectively assessed by visual inspection, quantitative methods would improve the monitoring of these lesions. AIM To evaluate the in vitro performance of laser fluorescence devices, namely DIAGNOdent (LF) and DIAGNOdent pen (LFpen), and a fluorescence camera (VistaProof; FC) in the detection and quantification of smooth-surface caries in primary teeth. DESIGN Two examiners evaluated 99 smooth surfaces of 65 extracted primary molars using FC, LF, and LFpen. As a reference standard, the actual and relative lesion depths were determined using stereomicroscopy and polarized light microscopy. Reproducibilities were assessed, and correlation analyses were performed. The sensitivities, specificities, and accuracies of the methods were calculated and compared. RESULTS There was a significant correlation between the values obtained using the fluorescence-based devices and the actual and relative lesion depths, although the correlation coefficient values were not higher than 0.7 (LF, 0.673; LFpen, 0.646; FC, 0.663). The sensitivities of the devices were similar for the detection of enamel caries, although LFpen was superior in detecting dentin lesions. The reliabilities of all methods were moderate to low, with similar accuracies at all depths. CONCLUSION Although the fluorescence-based devices showed similar performance in the detection of enamel and dentin lesions, the reliability of these devices and the correlation of their findings with the actual and relative lesion depths were moderate with regard to smooth-surface caries in primary molars.
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Affiliation(s)
- Tatiane Fernandes Novaes
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.,School of Dentistry, Universidade Cruzeiro do Sul, São Paulo, Brazil
| | - Caroline Moraes Moriyama
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | - Eduardo Kazuo Kohara
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Mariana Minatel Braga
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Fausto Medeiros Mendes
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
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de Azevedo CS, Garbui BU, Martins e Silva C, Simionato Lorenzetti MR, de Freitas AZ, Matos AB. Obtaining artificially caries-affected dentin for in vitro studies. J Contemp Dent Pract 2014; 15:12-19. [PMID: 24939258 DOI: 10.5005/jp-journals-10024-1480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM This study evaluated and improved a protocol for obtaining standard caries-affected dentin (CAD) by Streptococcus mutans biofilm demineralization process. MATERIALS AND METHODS Forty-eight human molars were divided in six experimental groups, according to: period of cariogenic challenge (7, 14 or 21 days) and type of dentin (erupted or unerupted teeth). After complete cariogenic challenge sound and CAD dentin were evaluated by: visual inspection (VI), digital radiography (DR), optical coherence tomography (OCT) and laser fluorescence (LF). RESULTS Visual inspection confirmed the formation of CAD based on tissue yellowing and loss of surface gloss. Digital radiography detected the presence of radiolucent images, suggesting caries. Three calibrated examiners viewed all images obtained by VI and DR and were able to distinguish healthy from CAD. Fisher's exact statistical test (p < 0.05) confirmed no difference between groups by VI (G1/G4: p = 0.6; G2/G5: p = 1; G3/G6: p = 1) or DR (G1/G4: p = 1; G2/G5: p = 1; G3/G6: p = 1). Both LF values and demineralization depth, as determined by OCT, were subjected to ANOVA (p < 0.05). For LF, a statistically significant difference was observed for the type of substrate (p = 0.001). For OCT, no statistically significant differences in the type of substrate (p = 0.163), length of cariogenic challenge (p = 0.512) or interaction between factors (p = 0.148) were observed. Scanning electron micrographs confirmed the presence of CAD; a more uniform demineralization surface was observed in the dentin of unerupted teeth. CONCLUSION This protocol suggests that standard CAD can be obtained in 7 days of cariogenic challenge using unerupted teeth. Clinical significance: With the new perspective on the clinical treatment of caries lesions, bonding is increasingly performed to demineralize CAD, which is susceptible to remineralization. A useful protocol to standardize the production of CAD, by microbiological cariogenic challenge, would be an important contribution to laboratorial test in the field of operative dentistry.
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Affiliation(s)
| | - Bruna Uglik Garbui
- BDS, Department of Operative Dentistry, University of São Paulo São Paulo, Brazil
| | | | | | | | - Adriana Bona Matos
- Full Professor, Department of Operative Dentistry, University of São Paulo São Paulo, Brazil
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Piovesan C, Moro BL, Lara JS, Ardenghi TM, Guedes RS, Haddad AE, Braga MM, Mendes FM. Laboratorial training of examiners for using a visual caries detection system in epidemiological surveys. BMC Oral Health 2013; 13:49. [PMID: 24090355 PMCID: PMC3851947 DOI: 10.1186/1472-6831-13-49] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 09/24/2013] [Indexed: 11/30/2022] Open
Abstract
Background In epidemiological surveys, a good reliability among the examiners regarding the caries detection method is essential. However, training and calibrating those examiners is an arduous task because it involves several patients who are examined many times. To facilitate this step, we aimed to propose a laboratory methodology to simulate the examinations performed to detect caries lesions using the International Caries Detection and Assessment System (ICDAS) in epidemiological surveys. Methods A benchmark examiner conducted all training sessions. A total of 67 exfoliated primary teeth, varying from sound to extensive cavitated, were set in seven arch models to simulate complete mouths in primary dentition. Sixteen examiners (graduate students) evaluated all surfaces of the teeth under illumination using buccal mirrors and ball-ended probe in two occasions, using only coronal primary caries scores of the ICDAS. As reference standard, two different examiners assessed the proximal surfaces by direct visual inspection, classifying them in sound, with non-cavitated or with cavitated lesions. After, teeth were sectioned in the bucco-lingual direction, and the examiners assessed the sections in stereomicroscope, classifying the occlusal and smooth surfaces according to lesion depth. Inter-examiner reproducibility was evaluated using weighted kappa. Sensitivities and specificities were calculated at two thresholds: all lesions and advanced lesions (cavitated lesions in proximal surfaces and lesions reaching the dentine in occlusal and smooth surfaces). Results Regarding the reproducibility, the mean (range) of kappa values was 0.781 (0.529–0.927) for occlusal surfaces, 0.568 (0.191–0.881) for smooth surfaces, and 0.844 (0.698–0.971) for proximal surfaces. Considering all lesions, sensitivity and specificity mean values were respectively 0.724 and 0.844 for occlusal, 0.635 and 0.943 for smooth and 0.658 and 0.927 for proximal surfaces. For detecting advanced lesions, sensitivities and specificities were 0.563 and 0.920 for occlusal, 0.670 and 0.985 for smooth, and 0.838 and 0.985 for proximal surfaces. Conclusion The methodology purposed for training and calibration of several examiners designated for epidemiological surveys of dental caries in preschool children using the ICDAS is feasible, permitting the assessment of reliability and accuracy of the examiners previously to the survey´s development.
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Affiliation(s)
- Chaiana Piovesan
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Av, Lineu Prestes, 2227, São Paulo, SP 05508-000, Brazil.
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An in vivo and in vitro investigation of the use of ICDAS, DIAGNOdent pen and CarieScan PRO for the detection and assessment of occlusal caries in primary molar teeth. Clin Oral Investig 2013; 18:737-44. [PMID: 23793456 DOI: 10.1007/s00784-013-1021-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 06/12/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the in vivo and in vitro validity of International Caries Detection and Assessment System (ICDAS), DIAGNOdent pen and CarieScan PRO in the detection and assessment of occlusal caries in primary teeth. METHODS Sixty-four molars were assessed using all three systems under standardised in vivo conditions. They were then extracted and assessed by two examiners in vitro along with an additional 38 teeth (102 teeth in total from 45 children). Downer's histological scoring criterion was the validation gold standard. Sensitivity, specificity, positive and negative likelihood ratios and area under the receiver-operator curves were calculated for all caries and dentine caries. Repeatability was analysed using Cohen's Kappa and the performance of the systems between in vivo and in vitro settings by the same examiner were compared. RESULTS ICDAS showed the highest validity and repeatability. The DIAGNOdent pen's overall clinical validity was comparable to that of ICDAS, but it demonstrated only moderate repeatability. CarieScan PRO had negligible validity in vivo, and there was no relationship between in vivo and in vitro parameters. CONCLUSIONS The in vivo results of ICDAS and DIAGNOdent pen were satisfactory and comparable to those obtained in vitro, with ICDAS performing better. The CarieScan PRO performed poorly under both conditions. CLINICAL RELEVANCE ICDAS should be the index of choice when detecting and assessing occlusal caries in the primary dentition, and in vitro data can be safely extrapolated in vivo. The DIAGNOdent pen must be employed with caution. Currently, the CarieScan PRO is unsuitable for use in the primary dentition.
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Çınar Ç, Atabek D, Odabaş ME, Ölmez A. Comparison of laser fluorescence devices for detection of caries in primary teeth. Int Dent J 2013; 63:97-102. [DOI: 10.1111/idj.12024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Souza JF, Boldieri T, Diniz MB, Rodrigues JA, Lussi A, Cordeiro RCL. Traditional and novel methods for occlusal caries detection: performance on primary teeth. Lasers Med Sci 2012; 28:287-95. [DOI: 10.1007/s10103-012-1154-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 06/25/2012] [Indexed: 11/29/2022]
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Matos R, Novaes TF, Reyes A, De Benedetto MS, Mendes FM, Braga MM. Influence of cross-infection control methods on performance of pen-type laser fluorescence in detecting occlusal caries lesions in primary teeth. Lasers Med Sci 2012; 28:185-92. [DOI: 10.1007/s10103-012-1092-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 03/30/2012] [Indexed: 11/25/2022]
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