Development of a Fluorescence-Based Caries Scoring System for an Intraoral Scanner: An in vitro Study

Accuracy of an intraoral scanner with near-infrared imaging feature in detection of interproximal caries of permanent teeth: An in vivo validation

OBJECTIVE

This study aimed to evaluate the accuracy of an intraoral scanner with near-infrared imaging (NIRI) feature in the diagnosis of interproximal caries and to compare it with the visual-tactile method (VTM), bitewing radiography (BWR), and panoramic radiography (PR).

MATERIALS AND METHODS

Six hundred thirty-nine interproximal surfaces (mesial-distal) of posterior teeth from 22 volunteers were examined. Results were scored by VTM, BWR, PR, and NIRI. Lesions were scored as 0 for no-caries, 1 for early-enamel lesion (EEL), and 2 for lesions involving dentino-enamel junction (DEJ). McNemar, Kappa, and Fleis Kappa tests were used to evaluate the agreement levels. Pearson's Chi-square test was used to determine the matching rates after validation.

RESULTS

A good level of agreement was observed between examination methods (Ƙ = 0.613; p < 0.001). In pairwise comparisons, a moderate agreement was seen between all the methods for lesions with DEJ involvement, while a statistically good agreement was observed between BWR and NIRI (Ƙ = 0.675; p < 0.001). As a result of validation, the accuracy of NIRI for molars was considered 85.2% and 75.7% for premolars in EELs, 85.2% for molars, and 70% for premolars regarding the lesions involving DEJ.

CONCLUSIONS

Intraoral scanners with the NIRI feature may be used for diagnosing interproximal caries, especially for permanent molars.

CLINICAL SIGNIFICANCE

Early detection of proximal caries is one of the most essential topics forming the basis of preventive dentistry. This study investigates a caries diagnostic tool integrated into intraoral scanners to diagnose interproximal caries. A caries diagnostic tool integrated into an intraoral scanner may prevent the harmful effects of ionizing radiation in early caries diagnosis and may improve the patient's oral health status.

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

OBJECTIVE

To assess the agreement in detecting and monitoring occlusal caries over thirty months using conventional visual and radiographic assessment and an intraoral scanner system which supports automated caries scoring.

METHODS

Ninety-one young participants aged 12-19 years were included in the study. All occlusal surfaces were examined visually, radiographically (when indicated), and scanned with the TRIOS 4 intraoral scanner. TRIOS Patient Monitoring software (vers. 2.3, 3Shape TRIOS A/S, Denmark) was used for automated caries detection on the 3D digital models.

RESULTS

Fifty-five of the study participants were re-examined after 30-months. Significant differences regarding caries detection were found between the conventional methods and the automated caries scoring system (p < 0.01), with moderate positive percent agreement (49-61%) and high negative percent agreement (87-98%). All methods reported significant caries progression over the follow-up period (p < 0.01). However, the automated system showed significantly more caries progression than the other methods (p < 0.01).

CONCLUSIONS

The software for automated caries detection and classification showed moderate positive agreement and strong negative agreement with the conventional methods considering both the baseline and the follow-up assessments. The automated caries scoring system detected significantly fewer caries lesions and tended to underestimate the caries severity. All methods indicated significant caries progression over the follow-up period, while the automated system detected more caries progression.

CLINICAL SIGNIFICANCE

The TRIOS system supporting automated occlusal caries detection and classification can assist in detecting and monitoring occlusal caries on permanent teeth as a complementary tool to the conventional methods. However, the operator should be aware that the automated system shows a tendency to underestimate the caries presence and lesion severity.

DIGITAL DENTISTRY AND ITS IMPACT ON ORAL HEALTH-RELATED QUALITY OF LIFE

Over the past 50 years, digitization has gradually taken root in dentistry, starting with computer tomography in the 1970s. The most disruptive events in digital dentistry were the introduction of digital workflow and computer-aided manufacturing, which made new procedures and materials available for dental use. While the conventional lab-based workflow requires light or chemical curing under inconsistent and suboptimal conditions, computer-aided manufacturing allows for industrial-grade material, ensuring consistently high material quality. In addition, many other innovative, less disruptive, but relevant approaches have been developed in digital dentistry. These will have or already impact prevention, diagnosis, and therapy, thus impacting patients' oral health and, consequently, their oral health-related quality of life. Both software and hardware approaches attempt to maintain, restore, or optimize a patient's perceived oral health. This article outlines innovations in dentistry and their potential impact on patients' oral health-related quality of life in prevention and therapy. Furthermore, possible future developments and their potential implications are characterized.

Caries Detection in Primary Teeth Using Intraoral Scanners Featuring Fluorescence: Protocol for a Diagnostic Agreement Study

BACKGROUND

Digital methods that enable early caries identification can streamline data collection in research and optimize dental examinations for young children. Intraoral scanners are devices used for creating 3D models of teeth in dentistry and are being rapidly adopted into clinical workflows. Integrating fluorescence technology into scanner hardware can support early caries detection. However, the performance of caries detection methods using 3D models featuring color and fluorescence in primary teeth is unknown.

OBJECTIVE

This study aims to assess the diagnostic agreement between visual examination (VE), on-screen assessment of 3D models in approximate natural colors with and without fluorescence, and application of an automated caries scoring system to the 3D models with fluorescence for caries detection in primary teeth.

METHODS

The study sample will be drawn from eligible participants in a randomized controlled trial at the Royal Children's Hospital, Melbourne, Australia, where a dental assessment was conducted, including VE using the International Caries Detection and Assessment System (ICDAS) and intraoral scan using the TRIOS 4 (3Shape TRIOS A/S). Participant clinical records will be collected, and all records meeting eligibility criteria will be subject to an on-screen assessment of 3D models by 4 dental practitioners. First, all primary tooth surfaces will be examined for caries based on 3D geometry and color, using a merged ICDAS index. Second, the on-screen assessment of 3D models will include fluorescence, where caries will be classified using a merged ICDAS index that has been modified to incorporate fluorescence criteria. After 4 weeks, all examiners will repeat the on-screen assessment for all 3D models. Finally, an automated caries scoring system will be used to classify caries on primary occlusal surfaces. The agreement in the total number of caries detected per person between methods will be assessed using a Bland-Altman analysis and intraclass correlation coefficients. At a tooth surface level, agreement between methods will be estimated using multilevel models to account for the clustering of dental data.

RESULTS

Automated caries scoring of 3D models was completed as of October 2023, with the publication of results expected by July 2024. On-screen assessment has commenced, with the expected completion of scoring and data analysis by March 2024. Results will be disseminated by the end of 2024.

CONCLUSIONS

The study outcomes may inform new practices that use digital models to facilitate dental assessments. Novel approaches that enable remote dental examination without compromising the accuracy of VE have wide applications in the research environment, clinical practice, and the provision of teledentistry.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12622001237774; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384632.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51578.

Performance of the caries diagnosis feature of intraoral scanners and near-infrared imaging technology-A narrative review

PURPOSE

To describe and discuss the benefits and drawbacks of various dental caries diagnostic techniques, including the use of intraoral scanners for caries diagnosis based on near-infrared imaging (NIR) technology.

MATERIAL AND METHODS

A MEDLINE search from 1980-2023 focused on dental caries diagnostic techniques, emphasizing intraoral scanners using NIR technology. Alternative caries detection methods were also evaluated for their advantages and limitations, enabling a comparison with NIR. The review included traditional caries tools, the latest detection methods, and NIR's role in intraoral scanners, drawing from case reports and both in vivo and in vitro studies. Keywords like "caries detection," "intraoral scanners," and "Near Infrared Imaging (NIRI)" guided the search. After screening titles and abstracts for relevance, full texts with valuable insights were thoroughly analyzed. The data was grouped into three: traditional diagnostics, advanced digital methods, and intraoral scanner-based detection.

RESULTS

This comprehensive narrative review described and discussed the current state of dental caries diagnostic methods, given the insufficient number of clinical investigations suitable for a systematic review. Traditional caries diagnosis techniques have shown variable accuracy dependent on a dentist's experience and the potential over-removal of healthy tooth structures. Intraoral scanners have emerged as a novel caries detection method, because of their integration of NIR technology. Various studies have confirmed the efficacy of NIR in detecting interproximal caries and in the early diagnosis of non-cavitated caries. Specifically, intraoral scanners have demonstrated promising results, proving comparable to established diagnostic methods like bitewing radiography. Nevertheless, while the integration of NIR into intraoral scanners seems promising, the technology still faces challenges, notably its accuracy in detecting secondary and subgingival cavities. However, with anticipated integrations of AI, NIR in intraoral scanners could revolutionize early caries detection.

CONCLUSIONS

Intraoral scanners with NIR technology offer non-destructive imaging, real-time lesion visuals, and enhanced patient communication. Although comparable to bitewing radiography in some studies, a universally accepted diagnostic tool is lacking. Future research should compare them with existing methods, focusing on clinical outcomes, cost-effectiveness, and patient acceptance.

Knowledge and attitudes toward evidence-based cariology and restorative dentistry among Egyptian dental practitioners: a cross-sectional survey

BACKGROUND

This is the first study to assess Egyptian dental practitioners' knowledge about conservative caries management approaches and investigate whether this knowledge transfers into clinical practice and the barriers to translating research into evidence-based practice.

METHODS

A sample of dental practitioners was surveyed using an online questionnaire. Convenience and snowball sampling were used to collect data from February to June 2022. We included graduated dentists from Egyptian universities who practiced in Egypt. Data were analyzed with descriptive statistics, and the associations between variables were checked using Kruskal Wallis and Chi-Square tests.

RESULTS

This study included 396 participants from throughout Egypt. There were significant correlations between specialty and participants' knowledge and behaviors toward evidence-based caries management (p = 0.002) and between specialization and tools used to detect carious lesions (p < 0.001). Most participants (59.1%) used G.V Black's classification, and (80.8%) removed caries based on the feature of dentin hardness and color, whereas (67%) removed caries until hard dentine remained. The participants' primary hurdle to staying up-to-date was their belief that the newly gained information would not be clinically applicable due to a lack of equipment or working in low-economic areas. Patient-related barriers were the major obstacles for participants in implementing evidence-based practice.

CONCLUSION

Egyptian dentists did not fully embrace minimal invasive approaches for caries management, and practitioners' experiences continue to shape decision-making. It emphasizes the imperative to practically educate dentists using effective knowledge translation dissemination to promote evidence adoption in daily practice and advocate value-based dental care to address the economic crisis's impact on Egypt's healthcare.

Diagnostic Applications of Intraoral Scanners: A Systematic Review

In addition to their recognized value for obtaining 3D digital dental models, intraoral scanners (IOSs) have recently been proven to be promising tools for oral health diagnostics. In this work, the most recent literature on IOSs was reviewed with a focus on their applications as detection systems of oral cavity pathologies. Those applications of IOSs falling in the general area of detection systems for oral health diagnostics (e.g., caries, dental wear, periodontal diseases, oral cancer) were included, while excluding those works mainly focused on 3D dental model reconstruction for implantology, orthodontics, or prosthodontics. Three major scientific databases, namely Scopus, PubMed, and Web of Science, were searched and explored by three independent reviewers. The synthesis and analysis of the studies was carried out by considering the type and technical features of the IOS, the study objectives, and the specific diagnostic applications. From the synthesis of the twenty-five included studies, the main diagnostic fields where IOS technology applies were highlighted, ranging from the detection of tooth wear and caries to the diagnosis of plaques, periodontal defects, and other complications. This shows how additional diagnostic information can be obtained by combining the IOS technology with other radiographic techniques. Despite some promising results, the clinical evidence regarding the use of IOSs as oral health probes is still limited, and further efforts are needed to validate the diagnostic potential of IOSs over conventional tools.

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

OBJECTIVES

To evaluate the diagnostic performance of visual caries assessment on 3D dental models obtained using an intraoral scanner and to compare it with the performance of the clinical visual inspection.

METHODS

Fifty-three permanent posterior teeth scheduled for extraction were randomly selected and included in this study. One to three independent examination sites on the occlusal surface of each tooth were clinically inspected using International Caries Detection and Assessment System (ICDAS) criteria. Afterwards, the examined teeth were scanned intraorally with a 3D intraoral scanner (TRIOS 4, 3Shape TRIOS A/S, Copenhagen, Denmark) using white and blue-violet light (415 nm wavelength) to capture the colour and fluorescence signal from the tissues. Six months after the clinical examination, the same examiner conducted the on-screen assessment of the obtained 3D digital dental models at the selected examination sites using modified ICDAS criteria. Both tooth colour and fluorescence texture with high resolution were assessed. Lastly, an independent examiner conducted the histological examination of all teeth after extraction. Using histology as the reference test, Sensitivity (SE), Specificity (SP), Accuracy (ACC), area under the Receiver Operating Characteristic (ROC) curve, and Spearman's correlation coefficient were calculated for the clinical and on-screen ICDAS assessments.

RESULTS

The ACC values of the evaluated methods varied between 0.59-0.79 for initial caries lesions and 0.77-0.99 for moderate-extensive caries lesions. Apart from SE values corresponding to caries in the inner half of enamel, no significant difference was observed between clinical visual inspection and on-screen assessment. In addition, no difference was found in the assessment of 3D models with tooth colour alone or supplemented with fluorescence for all the evaluated diagnostic measures.

CONCLUSIONS

On-screen visual assessment of 3D digital dental models with tooth colour or fluorescence showed a similar diagnostic performance to the clinical visual inspection when detecting and classifying occlusal caries lesions on permanent teeth.

CLINICAL SIGNIFICANCE

3D intraoral scanning can aid the detection and classification of occlusal caries as part of patient screening and can potentially be used in remote caries assessment for clinical and research purposes.

Accuracy and precision of intraoral scanners for shade matching: A systematic review

STATEMENT OF PROBLEM

The use of intraoral scanners is rising in prosthetic dentistry; however, systematic analysis of their accuracy and precision for shade matching is scarce.

PURPOSE

The purpose of this systematic review was to evaluate the accuracy and precision of intraoral scanners for shade matching.

MATERIAL AND METHODS

In addition to a manual search, an electronic systematic search was conducted on MEDLINE/PubMed, EMBASE, Web of Science, Cochrane, and Scopus databases. English-language original studies published between January 1, 2010 and March 1, 2022 with intraoral or digital scanners were chosen based on the keywords of tooth color or shade selection or determination, color or shade matching, accuracy, validity, or trueness, and precision, repeatability, or reproducibility as inclusive criteria. Two reviewers independently performed the literature search, selected the studies, collected the data from the studies included, and evaluated the quality of the studies included using a quality assessment method and the Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies. A third reviewer resolved disagreements.

RESULTS

A total of 17 articles concerning the shade matching accuracy and precision of intraoral scanners were selected and reviewed. Among them, 4 articles evaluated only accuracy, 4 articles assessed only precision, and 9 articles investigated both accuracy and precision. Ten articles reported low levels of shade matching accuracy for intraoral scanners, while 11 articles reported high levels of shade matching precision for intraoral scanners.

CONCLUSIONS

Based on the current literature, intraoral scanners show acceptable precision but unacceptable accuracy for shade matching.

Expert consensus on dental caries management

Dental Caries is a kind of chronic oral disease that greatly threaten human being's health. Though dentists and researchers struggled for decades to combat this oral disease, the incidence and prevalence of dental caries remain quite high. Therefore, improving the disease management is a key issue for the whole population and life cycle management of dental caries. So clinical difficulty assessment system of caries prevention and management is established based on dental caries diagnosis and classification. Dentists should perform oral examination and establish dental records at each visit. When treatment plan is made on the base of caries risk assessment and carious lesion activity, we need to work out patient‑centered and personalized treatment planning to regain oral microecological balance, to control caries progression and to restore the structure and function of the carious teeth. And the follow-up visits are made based on personalized caries management. This expert consensus mainly discusses caries risk assessment, caries treatment difficulty assessment and dental caries treatment plan, which are the most important parts of caries management in the whole life cycle.

New Caries Diagnostic Tools in Intraoral Scanners: A Comparative In Vitro Study to Established Methods in Permanent and Primary Teeth

The aim of this in vitro study was to systematically investigate new caries diagnostic tools, including three intraoral scanners, and compare them to established diagnostic methods. For a standardized analysis of occlusal and proximal caries lesions, human permanent and primary teeth (n = 64) were embedded in models and investigated in a phantom head using six different caries diagnostic methods: visual examination, bitewing radiography, Diagnocam (KaVo, Biberach, Germany), Trios 4 (3Shape, Copenhagen, Denmark), iTero Element 5D (Align Technology, San José, CA, USA), and Planmeca Emerald S (Planmeca, Helsinki, Finland). The diagnostic methods were investigated and compared to reference µ-CT for permanent and primary teeth separately. For occlusal caries diagnostics in permanent teeth, the best agreement to the reference (reliability) was obtained for Planmeca Emerald S (ĸ = 0.700), whereas in primary teeth, for visual examination (ĸ = 0.927), followed by Trios 4 (ĸ = 0.579). Regarding proximal caries diagnostics, bitewing radiography, as the gold standard, exhibited the highest agreement for permanent (ĸ = 0.643) and primary teeth (ĸ = 0.871). Concerning the analysis of the diagnostic quality (sensitivity and specificity) using receiver operating characteristic (ROC) curve analysis, comparable findings were obtained for area under curve (AUC) values as for reliability. No diagnostic method could be identified that is generally suitable for occlusal and proximal lesions in both dentitions. Overall, caries diagnostics with intraoral scanners seem to be interesting tools that should be further investigated in clinical studies.

Automated caries detection in vivo using a 3D intraoral scanner

The use of 3D intraoral scanners (IOS) and software that can support automated detection and objective monitoring of oral diseases such as caries, tooth wear or periodontal diseases, is increasingly receiving attention from researchers and industry. This study clinically validates an automated caries scoring system for occlusal caries detection and classification, previously defined for an IOS system featuring fluorescence (TRIOS 4, 3Shape TRIOS A/S, Denmark). Four algorithms (ALG1, ALG2, ALG3, ALG4) are assessed for the IOS; the first three are based only on fluorescence information, while ALG4 also takes into account the tooth color information. The diagnostic performance of these automated algorithms is compared with the diagnostic performance of the clinical visual examination, while histological assessment is used as reference. Additionally, possible differences between in vitro and in vivo diagnostic performance of the IOS system are investigated. The algorithms show comparable in vivo diagnostic performance to the visual examination with no significant difference in the area under the ROC curves (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$p>0.05$$\end{document}p>0.05). Only minor differences between their in vitro and in vivo diagnostic performance are noted but no significant differences in the area under the ROC curves, (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$p>0.05$$\end{document}p>0.05). This novel IOS system exhibits encouraging performance for clinical application on occlusal caries detection and classification. Different approaches can be investigated for possible optimization of the system.

Intraoral scanner featuring transillumination for proximal caries detection. An in vitro validation study on permanent posterior teeth

OBJECTIVES

To assess the validity of an intraoral scanner system featuring near-infrared (NIR) transillumination to aid the detection of proximal caries lesions, and to compare the diagnostic performance of this system with that of conventional caries detection methods and with that of an intraoral camera featuring NIR transillumination (DIAGNOcam).

METHODS

Ninety-five permanent posterior teeth were examined using a prototype tip functioning with TRIOS 4 intraoral scanner system (3Shape TRIOS A/S, Denmark) and emitting NIR light, DIAGNOcam, and visual and radiographic examination employing ICDAS criteria. One or two approximal surfaces per tooth, sound or with caries lesions at different stages, were examined (N₁=158). Histological assessment was used as the reference standard.

RESULTS

All methods showed excellent intra-examiner reliability (κ_intra ≥0.80). Two independent examiners assessed the NIR images obtained with both devices. The first examiner, who obtained and assessed the images, showed improved diagnostic performance than the second examiner, who only had access to the images. The inter-examiner agreement between the two examiners assessing the NIR images was substantial (κ_inter 0.57-0.72). The intraoral scanner and DIAGNOcam showed similar diagnostic performance. Regarding initial caries lesions, the NIR image assessment resulted in equal or improved sensitivity (SE 0.50-0.89) compared to radiographic assessment (SE 0.49-0.51) and higher than visual examination (SE 0.28-0.39). Radiographic and NIR image assessment resulted in similar SE in detecting moderate-extensive dentin caries lesions (SE 0.59-0.70), while visual examination showed an inferior value (SE 0.30).

CONCLUSIONS

The intraoral scanner system featuring NIR transillumination and DIAGNOcam showed an overall good diagnostic performance. The conventional caries detection methods showed inferior sensitivity at initial caries lesion stages.

CLINICAL SIGNIFICANCE

Considering the promising diagnostic performance of the intraoral scanner featuring transillumination and the advantages offered by combining the NIR images with the 3D models of the teeth, this system has the potential to contribute towards more reliable caries detection and monitoring in clinical practice without the use of ionizing radiation.