Clinical relevance of studies on the accuracy of visual inspection for detecting caries lesions: a systematic review

Accuracy of clinical photography for the detection of dental caries: A systematic review and meta-analysis

OBJECTIVE

To evaluate the accuracy of visual caries detection using clinical photographs in comparison with visual clinical intraoral examination for the detection of dental caries.

DATA

This review followed PRISMA-DTA guidelines and was registered in PROSPERO (CRD42024598814). Accuracy parameters of sensitivity, specificity and diagnostic odds ratio (DOR), area under summary receiver operating characteristic curve (AUC), and partial AUC (pAUC) were generated. Risk of bias was assessed using QUADAS-2 tool.

SOURCES

Publications from PubMed, Web of Science, Scopus, and EMBASE databases.

STUDY SELECTION/RESULTS

Eighteen studies including 1300 participants were included in this review. Risks of bias and applicability concerns were frequently encountered in one or more domains. The pooled sensitivity (95 % Confidence Interval, CI), specificity (95 %CI), DOR (95 %CI) and AUC (pAUC) of the visual assessment of clinical photographs were 0.74 (0.70-0.77), 0.95 (0.88-0.98), 52.94 (22.13-126.66), and 0.813 (0.753) for enamel caries; 0.81 (0.75-0.86), 0.98 (0.94-0.99), 142.01 (67.50-298.77), and 0.935 (0.857) for dentine caries; 0.81 (0.70-0.89), 0.99 (0.96-1.00), 245.04 (83.75-716.96), and 0.957 (0.902) for any caries depth. Subgroup analysis suggested that caries depth (enamel caries v.s. dentine caries v.s. any caries depth; p = 0.072), dentition (primary v.s. permanent; p = 0.584 (dentine caries data), p = 0.923 (any caries data)), technology (smartphone camera v.s. intra-oral camera; p = 0.993), and photographer (dental professional v.s. layperson; p = 0.466) did not modify the diagnostic performance.

CONCLUSIONS

Visual assessment of clinical photographs for caries detection demonstrated clinically acceptable accuracy when compared with visual clinical intraoral examination. High specificity values across diagnostic thresholds suggest a high level of accuracy in correctly identifying sound tooth structure.

CLINICAL SIGNIFICANCE

Clinical photography is useful for dental caries detection and can facilitate clinical decision-making.

Teledentistry accuracy for caries diagnosis: a systematic review of in-vivo studies using extra-oral photography methods

BACKGROUND

Dental caries is a global public health concern, and early detection is essential. Traditional methods, particularly visual examination, face access and cost challenges. Teledentistry, as an emerging technology, offers the possibility to overcome such barriers, and it must be given high priority for assessment to optimize the performance of oral healthcare systems. The aim of this study was to systematically review the literature evaluating the diagnostic accuracy of teledentistry using photographs taken by Digital Single Lens Reflex (DSLR) and smartphone cameras against visual clinical examination in either primary or permanent dentition.

METHODS

The review followed PRISMA-DTA guidelines, and the PubMed, Scopus, and Embase databases were searched through December 2022. Original in-vivo studies comparing dental caries diagnosis via images taken by DSLR or smartphone cameras with clinical examination were included. The QUADAS-2 was used to assess the risk of bias and concerns regarding applicability. Meta-analysis was not performed due to heterogeneity among the studies. Therefore, the data were analyzed narratively by the research team.

RESULTS

In the 19 studies included, the sensitivity and specificity ranged from 48 to 98.3% and from 83 to 100%, respectively. The variability in performance was attributed to factors such as study design and diagnostic criteria. Specific tooth surfaces and lesion stages must be considered when interpreting outcomes. Using smartphones for dental photography was common due to the convenience and accessibility of these devices. The employment of mid-level dental providers for remote screening yielded comparable results to those of dentists. Potential bias in patient selection was indicated, suggesting a need for improvements in study design.

CONCLUSION

The diagnostic accuracy of teledentistry for caries detection is comparable to that of traditional clinical examination. The findings establish teledentistry's effectiveness, particularly in lower income settings or areas with access problems. While the results of this review is promising, conducting several more rigorous studies with well-designed methodologies can fully validate the diagnostic accuracy of teledentistry for dental caries to make oral health care provision more efficient and equitable.

REGISTRATION

This study was registered with PROSPERO (CRD42023417437).

Assessment of diagnostic accuracy and reliability of reveal fluorescence dental loupes in detecting molar incisor hypomineralization in children

BACKGROUND

Molar-Incisor Hypomineralization (MIH) poses challenges to accurate diagnosis, impacting children's oral health. Traditional methods exhibit limitations, necessitating innovative approaches. This study aimed to evaluate the reliability and diagnostic accuracy Reveal Fluorescence Dental Loupes (RFDLs) for the detection of MIH METHODS: This cross-sectional study, adhering to STRAD guidelines, involved 38 healthy children (age 7-9) with MIH. Ethical approval and informed consent were obtained. Microscope images and Reveal loupes were employed for examinations. Validity was assessed against microscope results, and inter- and intra-examiner reliability were measured using ICC and Kappa coefficients. Sensitivity, specificity, and overall accuracy were calculated, with an AUC-ROC analysis for discriminatory ability.

RESULTS

Intra-examiner reliability scores were excellent (Examiner 1: ICC 0.92, Examiner 2: ICC 0.94). Inter-examiner reliability (Kappa 0.92) indicated almost perfect agreement. Reveal demonstrated high sensitivity (82.61 %) and specificity (92.59 %), with an overall accuracy of 88.70 %. AUC-ROC analysis supported its robust discriminatory ability (AUC: 0.871).

CONCLUSIONS

Reveal Fluorescence Dental Loupes emerged as a promising diagnostic tool for accurate MIH detection, particularly in outreach settings. The study highlights the transformative impact of accessible and reliable diagnostic tools on pediatric oral health outcomes. While acknowledging limitations and the absence of a gold standard, the findings contribute to advancing MIH diagnostic capabilities. Further research in diverse populations is warranted for comprehensive validation.

ORCA-EFCD consensus report on clinical recommendation for caries diagnosis. Paper I: caries lesion detection and depth assessment

OBJECTIVES

The aim of the present consensus paper was to provide recommendations for clinical practice considering the use of visual examination, dental radiography and adjunct methods for primary caries detection.

MATERIALS AND METHODS

The executive councils of the European Organisation for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD) nominated ten experts each to join the expert panel. The steering committee formed three work groups that were asked to provide recommendations on (1) caries detection and diagnostic methods, (2) caries activity assessment and (3) forming individualised caries diagnoses. The experts responsible for "caries detection and diagnostic methods" searched and evaluated the relevant literature, drafted this manuscript and made provisional consensus recommendations. These recommendations were discussed and refined during the structured process in the whole work group. Finally, the agreement for each recommendation was determined using an anonymous Delphi survey.

RESULTS

Recommendations (N = 8) were approved and agreed upon by the whole expert panel: visual examination (N = 3), dental radiography (N = 3) and additional diagnostic methods (N = 2). While the quality of evidence was found to be heterogeneous, all recommendations were agreed upon by the expert panel.

CONCLUSION

Visual examination is recommended as the first-choice method for the detection and assessment of caries lesions on accessible surfaces. Intraoral radiography, preferably bitewing, is recommended as an additional method. Adjunct, non-ionising radiation methods might also be useful in certain clinical situations.

CLINICAL RELEVANCE

The expert panel merged evidence from the scientific literature with practical considerations and provided recommendations for their use in daily dental practice.

STAndard Reporting of CAries Detection and Diagnostic Studies (STARCARDDS)

AIM

The aim of this paper is to present recommendations from an international workshop which evaluated the methodology and reporting of caries diagnostic studies. As a unique feature, this type of studies is focused on caries lesion detection and assessment, and many of them are carried out in vitro, because of the possibility of histological validation of the whole caries spectrum. This feature is not well covered in the existing reporting STARD guideline within the EQUATOR Network.

PARTICIPANTS AND METHODS

An international working group of 13 cariology researchers was formed. The STARD checklist was reviewed and modified for caries detection and diagnosis purposes, in a three-step process of evaluation, consensual modification, and delivery during three 2-day workshops over 18 months. Special attention was paid to reporting requirements of caries studies that solely focus on reliability.

RESULTS

The STARD checklist was modified in 14/30 items, with an emphasis on issues of sample selection (tooth selection in in vitro studies), blinding, and detailed reporting of results.

CONCLUSION

Following STARCARDDS (STAndard Reporting of CAries Detection and Diagnostic Studies) is expected to result in complete reporting of study design and methodology in future caries diagnosis and detection experiments both in vivo and in vitro, thus allowing for better comparability of studies and higher quality of systematic reviews.

CLINICAL RELEVANCE

Standardization of caries diagnostic studies leads to a better comparability among future studies, both in vivo and in vitro.

Systematic review and meta-analysis of diagnostic studies of proximal surface caries

AIM

This systematic review and meta-analysis aimed to assess the diagnostic accuracy and reliability of commonly used caries detection methods for proximal caries diagnostics. Visual examination (VE), bitewing radiography (BWR), laser fluorescence (LF), and fibre-optic transillumination (FOTI) were considered in detail.

MATERIAL AND METHODS

PRISMA guidelines for the reporting of systematic reviews and meta-analyses were applied. The mnemonic PIRDS (problem, index test, reference test, diagnostic and study type) concept was used to guide the literature search. Next, studies that met the inclusion criteria were stepwise selected and evaluated for their quality with a risk of bias (RoB) assessment tool. Studies with low/moderate bias and sufficient reporting were considered for meta-analysis. The pooled sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR), and area under the ROC curve (AUC) were calculated.

RESULTS

From 129 studies meeting the selection criteria, 31 in vitro studies and five clinical studies were finally included in the meta-analysis. The AUC values for in vitro VE amounted to 0.84 (caries detection) and 0.85 (dentin caries detection). BWR ranged in vitro from 0.55 to 0.82 (caries detection) and 0.81-0.92 (dentin caries detection). LF showed higher AUC values for overall caries detection (0.91) and dentin caries detection (0.83) than did other methods. Clinical data are limited.

CONCLUSION

The number of diagnostic studies with low/moderate RoB was found to be low and indicates a need for high-quality, well-designed caries diagnostic studies.

CLINICAL RELEVANCE

BWR and LF showed good diagnostic performance on proximal surfaces. However, because of the low number of includable clinical studies, these data should be interpreted with caution.

Systematic review and meta-analysis of diagnostic methods for occlusal surface caries

AIM

This systematic review and meta-analysis aimed to assess the diagnostic performance of commonly used methods for occlusal caries diagnostics, such as visual examination (VE), bitewing radiography (BW) and laser fluorescence (LF), in relation to their ability to detect (dentin) caries under clinical and laboratory conditions.

MATERIALS AND METHODS

A systematic search of the literature was performed to identify studies meeting the inclusion criteria using the PIRDS concept (N = 1090). A risk of bias (RoB) assessment tool was used for quality evaluation. Reports with low/moderate RoB, well-matching thresholds for index and reference tests and appropriate reporting were included in the meta-analysis (N = 37; 29 in vivo/8 in vitro). The pooled sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR) and areas under ROC curves (AUCs) were computed.

RESULTS

SP ranged from 0.50 (fibre-optic transillumination/caries detection level) to 0.97 (conventional BW/dentine detection level) in vitro. AUCs were typically higher for BW or LF than for VE. The highest AUC of 0.89 was observed for VE at the 1/3 dentin caries detection level; SE (0.70) was registered to be higher than SP (0.47) for VE at the caries detection level in vivo.

CONCLUSION

The number of included studies was found to be low. This underlines the need for high-quality caries diagnostic studies that further provide data in relation to multiple caries thresholds.

CLINICAL RELEVANCE

VE, BW and LF provide acceptable measures for their diagnostic performance on occlusal surfaces, but the results should be interpreted with caution due to the limited data in many categories.

What is the most accurate method for detecting caries lesions? A systematic review

OBJECTIVE

To perform a systematic review and meta-analysis of the performance of different methods for detecting carious lesions in permanent and primary teeth, considering all types of tooth surface.

METHODS

Two reviewers searched PubMed, Embase, Scopus and other sources up to November 2020 to identify published and nonpublished studies in English. We focused on three caries detection methods: visual inspection (VI), radiographic (RX) and fluorescence-based (LF). We included studies investigating at least one of these methods which (a) assessed the accuracy of the method in detecting caries lesions; (b) considered occlusal, proximal or free smooth surfaces in primary or permanent teeth; (c) used a reference standard other than one of the three methods; and (d) reported data on sample size and accuracy. Multilevel analyses, meta-regressions and comparisons of bivariate summary receiver operating characteristics curves were undertaken.

RESULTS

Two hundred and forty manuscripts from 14 129 articles initially identified met the inclusion criteria. VI was better than RX on occlusal surfaces at all caries lesion thresholds and proximal surfaces of permanent teeth only at all lesion thresholds in laboratory setting. LF was slightly better than VI for advanced lesions on occlusal surfaces of permanent teeth in the clinical setting and for all lesions on proximal surfaces of permanent teeth in the laboratory setting. Still, LF was worse than VI for advanced occlusal lesions in permanent teeth in the laboratory setting. Although LF showed slightly better performance than VI with advanced lesions, the latter had significantly higher specificity than other methods in all settings.

CONCLUSION

Visual caries detection alone is adequate for most patients in daily clinical practice regardless of tooth type or surface.

What diagnostic strategy performs better for caries lesion detection on proximal surfaces of adolescents?

OBJECTIVE

To evaluate the performance of visual inspection alone and associated to radiographic and laser fluorescence (LF) methods in detecting non-evident caries lesions at adolescents' proximal surfaces.

MATERIALS AND METHODS

Adolescents (12 to 17 years old) were assessed for the presence of caries lesions through visual inspection, radiographic examination, and LF method (DIAGNOdent pen), at non-cavitated (NC) and cavitated lesion (CAV) thresholds. Temporary separation with orthodontic rubbers followed by direct visual inspection was the reference standard method. Two examiners conducted the examinations, and the first examiner reassessed around 20% of the sample, to evaluate inter- and intra-examiner reproducibility, respectively. Sensitivity, specificity, accuracy, and utility values were calculated for the methods alone and combined with visual inspection using two different strategies: simultaneous and sequential combination.

RESULTS

A total of 834 proximal surfaces (51 adolescents) were included. Visual inspection presented higher reproducibility values (higher than 0.98). Moreover, visual inspection presented higher sensitivity (around 0.51) than those obtained with other diagnostic strategies (varying from 0.09 to 0.20) at the NC threshold. For CAV, visual inspection presented higher specificity (0.996) than the sequential association with adjunct methods (around 0.97), but with lower sensitivity. Accuracy and utility values for combined strategies were similar or lower than those achieved with the visual inspection performed alone.

CONCLUSION

Visual inspection alone performs better for detecting caries lesions in premolars and molars of adolescents than other diagnostic strategies.

CLINICAL RELEVANCE

The best diagnostic strategy for caries detection of proximal caries lesions in adolescents is the visual inspection alone.

Study protocol for a diagnostic randomized clinical trial to evaluate the effect of the use of two clinical criteria in the assessment of caries lesions around restorations in adults: the Caries Cognition and Identification in Adults (CaCIA) trial

Background

The assessment of restored teeth in dentistry remains a challenge, mainly related to the detection of caries around restorations. There is a diversity of clinical criteria available to assess the caries lesions, resulting in differences in the dentists’ diagnosis and treatment decisions. In addition, there is a lack of evidence regarding the best criteria to detect caries lesions around the restorations. Thus, the present protocol aims to evaluate the effect of using 2 visual criteria to assess restored teeth on the outcomes related to oral health in adults.

Methods

The design protocol of the Caries Cognition and Identification in Adults trial correspond to a triple-blind randomized, controlled clinical trial with parallel-groups. Two groups will be compared: patients who will receive the diagnosis and treatment decision according to FDI (World Dental Federation) criteria—FDI group; and patients who will receive diagnosis and treatment decision according to the “Caries Associated with Restorations or Sealants” criteria defined by the International Caries Classification and Management System (ICCMS group). The participants will be followed up after 6, 12, 18, 24, and 60 months, and the restoration failure will be the primary outcome. The analysis will be conducted through Cox regression with shared frailty. The impact of oral health on quality of life and the cost-effectiveness of the methods used will be the secondary outcomes. Two-tailed analyzes will be used, considering a level of significance of 5%.

Discussion

This is the first clinical trial to assess the effect of using two visual methods to detect caries lesions around restorations on the outcomes related to oral health in adults. The findings of this study will define what is the best diagnostic strategy for the assessment of caries around restorations in permanent teeth.

Trial registration NCT03108586 (registered 11 April 2017).

Accuracy of near-infrared light transillumination (NILT) compared to bitewing radiograph for detection of interproximal caries in the permanent dentition: A systematic review and meta-analysis

OBJECTIVE

To evaluate the accuracy of the near-infrared light transillumination (NILT) for the detection of interproximal dental caries in permanent dentition when compared to bitewing X-ray (BW).

DATA

In vivo studies that detected interproximal primary caries in permanent teeth by using NILT and BW were selected. QUADAS-2 was used to assess the risk of bias. Pooled sensitivity and specificity forest plots were calculated, summary receiver operator characteristics (SROC) curves were constructed. The certainty of the evidence was rated using the GRADE system.

SOURCES

Pubmed, Cochrane Library, Web of Science, Scopus, Lilacs/BBO and grey literature databases were surveyed.

STUDY SELECTION

From 1594 retrieved articles, 13 studies were included. Six studies had a low risk of bias and a low level of concern regarding applicability. Four studies had an unclear risk of bias, while three presented a high risk of bias. The meta-analysis of six studies demonstrated that NILT presented good overall accuracy. Of 6110 teeth, 92.3 % (5639) were accurately classified (776 as true positive and 4863 as true negative). The pooled sensitivity was 0.97 (0.96 to 0.98; p = 0.0000; I² = 93.2 %) with moderate certainty of evidence, and the pooled specificity was 0.91 (0.91 to 0.92; p = 0.0000; I² = 98.3 %) with high certainty of evidence. Symmetric (0.9837) and asymmetric (0.9836) SROC showed a high discrimination and determination effect of NILT.

CONCLUSION

The current literature, with moderate certainty and a middling quality of evidence, demonstrates that NILT presents a reasonably comparable accuracy to that of BW for detecting interproximal carious lesions in the permanent dentition.

CLINICAL SIGNIFICANCE

Since NILT presented good overall accuracy for the detection of interproximal primary caries, it could be routinely used in dental check-ups, especially in high-risk caries populations and in patients where the use of radiation should be reduced, like pregnant women or children.

Clinical accuracy data presented as natural frequencies improve dentists' caries diagnostic inference: Evidence from a randomized controlled trial

BACKGROUND

The authors assessed whether dentists' diagnostic inferences differ when test accuracy information is communicated using natural frequencies versus conditional probabilities.

METHODS

A parallel, randomized controlled trial with dentists was carried out in Rio de Janeiro, Brazil. The dentists received a question on the probability of a patient having interproximal caries, given a positive bite-wing radiograph. This question was asked using information that was formulated into either natural frequencies or conditional probabilities.

RESULTS

Only 14 (13.9%) of the dentists gave the correct answer; 13 in the natural frequencies group, and 1 in the conditional probabilities group (P < .001). There were 7 nearly correct answers in the natural frequencies group and none in the conditional probabilities group (P = .005).

CONCLUSIONS

Representing diagnostic test accuracy in natural frequencies substantially helped dentists make diagnostic inferences. Nearly twice as many dentists overestimated the presence of interproximal caries when given information in conditional probabilities.

PRACTICAL IMPLICATIONS

Our study findings show information shared using natural frequencies may be more accurately interpreted by dentists than that based on conditional probabilities. Patients will probably receive different standards of care depending on the format in which dentists receive diagnostic test accuracy information.

In vivo validity of proximal caries detection in primary teeth, with histological validation

BACKGROUND

Detection and diagnosis of proximal caries in primary molars are challenging.

AIM

The aim of this in vivo study was to assess the validity and reproducibility of four methods of proximal caries detection in primary molar teeth.

DESIGN

Eighty-two children (5-10 years) were recruited. Initially, 1030 proximal surfaces were examined using meticulous visual examination (ICDAS) (VE1), bitewing radiographs (RE), and a laser fluorescence pen device (LF1). Temporary tooth separation (TTS) was achieved for 447 surfaces, and these were re-examined visually (VE2) and using the LF pen (LF2). Three hundred and fifty-six teeth (542 surfaces) were subsequently extracted and provided histological validation.

RESULTS

At D₁ (enamel and dentine caries) diagnostic threshold, the sensitivity of VE1, RE, VE2, LF1, and LF2 examination was 0.52, 0.14, 0.75, 0.58, and 0.60 and the specificity values were 0.89, 0.97, 0.88, 0.85, and 0.77, respectively. At D₃ (dentine caries) threshold, the sensitivity values were 0.42, 0.71, 0.49, 0.63, and 0.65, respectively, whereas specificity was 0.93 for VE1 and VE2, and 0.98, 0.87, and 0.88 for RE, LF1, and LF2 examinations, respectively. ROC analysis showed radiographic examination to be superior at D₃ .

CONCLUSION

Meticulous caries diagnosis (ICDAS) should be supported by radiographs for detection of dentinal proximal caries in primary molars.

Impact of the radiographic method on treatment decisions related to dental caries in primary molars: a before-after study

OBJECTIVES

To evaluate the impact of radiographic examination on changes of treatment decision related to dental caries compared to decisions guided by visual inspection alone in primary molars.

MATERIALS AND METHODS

A total of 126 children aged 3-6 years who had sought dental assistance were randomly selected and examined by two calibrated examiners using visual inspection. A treatment plan regarding dental caries was generated based on this assessment. The same examiners then evaluated two bitewing radiographs, creating an additional treatment plan guided by concurrent assessment of both visual and radiographic methods. Occlusal and proximal surfaces of primary molars received a treatment decision as follows: (i) no treatment, (ii) non-operative treatment, and (iii) operative treatment. The frequency of changes in the treatment decision after radiographic examination was calculated, with subsequent Poisson multilevel regression analysis to evaluate variables influencing such changes.

RESULTS

Changes from "no treatment" decided with visual inspection to "non-operative treatment" after radiographic evaluation occurred in 52 surfaces (3.2%), and changes to "operative treatment" were observed in 46 dental surfaces (2.8%). Furthermore, 50 surfaces (6.2%) had their treatment decision changed from non-operative to operative treatment after radiographic assessment. In addition, changes were significantly more frequent in children with higher caries experience, on proximal surfaces and in 1st primary molars.

CONCLUSIONS

The impact of radiographic examination on changes in the treatment decision of primary molars made with visual inspection is modest. Changes are more frequent in children with higher caries experience and in proximal surfaces.

CLINICAL RELEVANCE

The benefits of the radiographic method for detecting caries in children, as a protocol in the diagnostic process, seem to be overestimated; the impact of this method on changes in treatment decision made by visual examination alone is low. Radiographs could be, however, useful in particular conditions, such as in children with high caries experience.

Is it feasible to use smartphone images to perform telediagnosis of different stages of occlusal caries lesions?

The purpose of this study was to compare the performance of two different models of smartphone and a conventional camera with that of direct clinical examination in detecting caries lesions at different stages of progression in deciduous molars. The photographic equipment consisted of two smartphones (iPhone and Nexus 4) and a conventional macro camera setup. First, in the laboratory phase of the study, we compared the images of 20 exfoliated primary teeth having caries lesions at different stages. Then, in the clinical phase of the study, the images of 119 primary molars from fifteen children (3 to 6 years old) were used. All of the photographic images were taken using the previously described devices. In both groups, two examiners, blinded to the photographic equipment used, assessed the images independently on a computer screen, and classified them according to the International Caries Detection and Assessment System (ICDAS). The teeth were then examined directly by two other experienced examiners, and the consensus reached was considered the reference standard. Parameters of validity, such as percentage of correct answers, agreement with the reference standard, sensitivity, specificity and inter-examiner agreement (using the weighted kappa test) were calculated. The examiners performed similarly in both in vitro and in vivo studies. Inter-examiner reliability was approximately 0.7 for all the devices in the laboratory setting, and for the macro camera photography system in the clinical setting, but it was approximately 0.9 for the iPhone and Nexus images taken in vivo. With regard to the percentage of correct answers, the highest values were observed for sound and extensive caries lesions in both laboratory and clinical settings. The percentage of correct answers for initial and moderate lesions was particularly low in the clinical evaluation, irrespective of the camera devices used. Therefore, we concluded that photographic diagnosis using smartphone images is feasible and accurate for distinguishing sound tooth surfaces from extensive caries lesions; however, photographic images are not a good method for accurately detecting initial and moderate caries lesions.

Accuracy of pen-type laser fluorescence device and radiographic methods in detecting approximal carious lesions in primary teeth - an in vivo study

BACKGROUND

The diagnosis of approximal lesions is limited due to the difficulty of direct examination of these areas.

AIM

To determine the accuracy of pen-type laser fluorescence (LFpen) device, compared to digital bitewing (BW) radiography, in diagnosing approximal carious lesions in posterior primary teeth at cavitation and non-cavitation thresholds.

DESIGN

A total of 46 children (aged 3-9 years) were assessed and 195 approximal surfaces of 184 primary molars were examined by digital BW and LFpen. Visual-tactile inspection based on the International Caries Detection and Assessment System (ICDAS-II) was used as the reference standard. All examinations were performed by the same examiner. Sensitivity, specificity, and accuracy were calculated. Spearman's correlation coefficients were calculated between LFpen and BW readings and the reference standard.

RESULTS

Sensitivity, specificity and AUC were 81.8, 86.7, and 0.84 for BW and 49.1, 87.9, and 0.69 for LFpen both at non-cavitation thresholds. At cavitation thresholds, BW showed higher specificity (96.0), sensitivity (93.0), and AUC (0.98) than did LFpen (72.0, 86.9, and 0.82, respectively), but a lower correlation was indicated by LFpen readings.

CONCLUSION

Bitewing had a better diagnostic accuracy and significantly outperformed LFpen in the detection of non-cavitated lesions. Similar results were obtained by the two methods at the cavitation threshold.

Evaluation of occlusal caries detection and assessment by visual inspection, digital bitewing radiography and near-infrared light transillumination

AIM

This study compared the diagnostic outcomes of visual inspection (VI), digital bitewing radiography (BWR), and near-infrared light transillumination (NIR-LT, DIAGNOcam, KaVo, Biberach, Germany) for occlusal caries detection and assessment of posterior teeth.

PARTICIPANTS AND METHODS

This study included 203 patients (mean age 23.0 years). All individuals received a meticulous VI. Additionally, BWR and NIR-LT images were collected. All BWR and NIR-LT images were blindly evaluated for the presence of enamel caries lesions (ECLs) and dentin caries lesions (DCLs). The descriptive statistical analyses included calculation of frequencies, cross tabulations, and pairwise comparisons using Pearson chi-square tests.

RESULTS

The majority of ECLs/DCLs were detected by VI in this low-risk adult population. The additional diagnostic outcomes in terms of ECLs/DCLs amounted to 5.0% (BWR) and 6.8% (NIR-LT). The combined usage of VI/NIR-LT or VI/BWR identified 95.7 and 94.4% of all ECLs/DCLs on occlusal surfaces, respectively.

CONCLUSION

This comparative diagnostic study showed that VI detected the majority of occlusal caries lesions. Both additional methods showed limited benefits. Due to the valuable features of NIR-LT, i.e., X-ray freeness and clinical practicability, this method might be preferred over X-ray-based methods. Nevertheless, BWRs should be prescribed in clinical situations where insufficient fillings or multiple (deep) caries lesions are diagnosed or where there is a need to assess the caries extension in relation to the pulp.

CLINICAL RELEVANCE

VI has to be understood as caries detection method of choice on occlusal surfaces in low-risk adult population which may help to avoid multiple diagnostic testing, overdiagnosis, and overtreatment.

Validity of Digital Imaging of Fiber-Optic Transillumination in Caries Detection on Proximal Tooth Surfaces

OBJECTIVE

The aim of our study was to evaluate the validity of the digital imaging fiber-optic transillumination (DIFOTI) method in comparison with clinical visual examination (CV) and bitewing (BW) radiography on detecting caries lesions on proximal surfaces of teeth.

MATERIALS AND METHODS

Proximal tooth surfaces of premolars and molars (n = 2,103) of 91 voluntary university students aged from 18 to 30 years were examined with CV, BW radiography, and the DIFOTI method.

RESULTS

DIFOTI detected more initial and manifested caries lesions compared with CV and BW. Of the analyzed tooth surfaces, 69.8% were classified as sound by DIFOTI, 80.3% by BW, and 91.6% by CV. Initial caries lesions were found in 21.2% of the surfaces by DIFOTI, in 14.1% by BW, and in 6.2% by CV, whereas the proportions for manifested dental caries lesions were 9.0%, 5.6%, and 2.2%, respectively. The interexaminer agreement regarding the DIFOTI findings between an experienced clinician and a fifth-year dental student was high: κ = 0.67 for initial and κ = 0.91 for manifested caries lesions.

CONCLUSIONS

The noninvasive DIFOTI method seems to offer a potential tool for everyday clinical practice. In clinical use, DIFOTI finds well even initial caries lesions on proximal surfaces, thus providing an instrument for detecting lesions potential for arresting as well as for monitoring the outcome after preventive measures.

Impact of the radiographic examination on diagnosis and treatment decision of caries lesions in primary teeth--the Caries Detection in Children (CARDEC-01) trial: study protocol for a randomized controlled trial

BACKGROUND

Although most clinical guidelines throughout the world indicate that clinicians take two bitewings for detecting caries lesions in primary molars of all children, evidence for this recommendation is essentially based on cross-sectional studies performed in laboratory settings or using convenience samples. The benefits and impact of performing radiographs on diagnosis and treatment decision of caries lesions in primary teeth, mainly considering relevant outcomes for patients, have not been evaluated yet. Thus, the aim of this randomized clinical trial will be to evaluate the impact of performing radiographic examination adjunct to the visual inspection for detecting and making treatment decision regarding caries lesions in primary teeth compared with visual inspection performed alone. We will consider different outcomes related to children's health and welfare.

METHODS/DESIGN

To reach this objective, 250 children ages 3 to 6 years who sought dental treatment in our dental school will be randomly allocated in two groups according to the diagnostic strategy used for caries detection: visual inspection performed alone or visual inspection associated to radiographic examination. Two trained and calibrated examiners will carry out the examinations and elaborate the treatment decision plan. Then, children will be treated and followed up for 2 years, with evaluations after 12 and 24 months after the inclusion of children in the study. Children will also return after 6 and 18 months to reinforce the preventive orientations. Primary outcome will be the number of dental surfaces in need of dental treatment at the follow-up. Secondary outcomes will be the components of the primary outcome separately, as well as, proportion of false-positive results, the oral health-related quality of life, cost-efficacy, cost-adjusted life years, and number of new lesions in the first permanent molars.

DISCUSSION

Our working hypothesis is that radiographic examination would actually exert little influence on patient-centered outcomes, and visual inspection would be enough as diagnostic strategy for caries detection in primary teeth.

TRIAL REGISTRATION

NCT02078453. Registered 4 March 2015.

In vitro performance of QLF system and conventional methods for detection of occlusal caries around tooth-colored restorations in primary molars

BACKGROUND

Secondary caries is the main reason for restoration replacement, and therefore, an accurate detection of this type of condition is fundamental.

AIM

To compare in vitro the performance of different conventional and quantitative light-induced fluorescence-based (QLF) methods in detecting occlusal caries around resin composite restorations in primary molars.

DESIGN

Two examiners evaluated independently 42 sites adjacent to tooth-colored restorations using visual inspection (ICDAS-CARS), radiographic examination, and QLF. Histological examination was used as reference standard method. Area under the ROC curve (Az), sensitivity, specificity, and accuracy of the methods were calculated at enamel (D1) and dentin caries (D3) lesions thresholds. Intra- and interexaminer reproducibility were calculated using intraclass correlation coefficient (ICC) and kappa statistics.

RESULTS

There was no difference among the methods considering Az at D1 threshold. Visual inspection, radiograph, and QLF (scores) methods presented similar sensitivities and significantly higher than those obtained with the QLF (∆F%). At D3 threshold, there were no differences among the methods regarding sensitivities, specificities, and accuracy, except for the examiner 2 with the QLF (∆F%) who achieved a very low sensitivity value.

CONCLUSION

Conventional methods are similar to QLF methods for detecting caries around tooth-colored restorations in primary teeth.

Visual Inspection Displays Good Accuracy for Detecting Caries Lesions

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Visual inspection for caries detection: a systematic review and meta-analysis. Gimenez T, Piovesan C, Braga MM, Raggio DP, Deery C, Ricketts DN, Ekstrand DR, Mendes FM. J Dent Res 2015;94(7):895-904.

REVIEWER

Svante Twetman, DDS, PhD, Odont Dr

PURPOSE/QUESTION

To evaluate the overall accuracy of visual methods for detecting caries lesions.

SOURCE OF FUNDING

Brazilian government (Process 2012/17888-1).

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis of data

LEVEL OF EVIDENCE

Level 1: Good-quality, patient-oriented evidence

STRENGTH OF RECOMMENDATION GRADE

Grade A: Consistent, good-quality patient-oriented evidence.

Visual Inspection for Caries Detection

We aimed to perform a systematic review including a meta-analysis to evaluate the overall accuracy of visual methods for detecting carious lesions and to identify possible sources of heterogeneity among the studies included. Two reviewers searched PubMed, Embase, Scopus, and other sources through July 2014 to identify published and nonpublished studies in English. Studies of visual inspection were included that 1) assessed accuracy of the method in detecting caries lesions; 2) were performed on occlusal, proximal, or free smooth surfaces in primary or permanent teeth; 3) had a reference standard; and 4) reported sufficient data about sample size and accuracy of methods. The data were used to calculate the pooled sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristics curve. Heterogeneity of the studies was also assessed. A total of 102 manuscripts (from 5,808 articles initially identified) and 1 abstract (from 168) met the inclusion criteria. In general, the analysis demonstrated that the visual method had good accuracy for detecting caries lesions. Although laboratory and clinical studies have presented similar accuracy, clinically obtained specificity was higher. We also observed moderate to high heterogeneity and evidence of publication bias in most papers. Moreover, studies employing widely recognized visual scoring systems presented significantly better accuracy as compared to studies that used their own criteria. In conclusion, visual caries detection method has good overall performance. Furthermore, although the identified studies had high heterogeneity and risk of bias, the use of detailed and validated indices seems to improve the accuracy of the method.