An in vitro Comparison of Detection Methods for Approximal Carious Lesions in Primary Molars

Abstract

Background/Aims: This study aimed to compare and contrast in vitro six methods to determine the most accurate method for detecting approximal carious lesions in primary molars. Methods: Extracted primary molars (n = 140) were stored in 0.02% chlorhexidine solution and mounted in light-cured resin in pairs. The six carious lesion detection methods used by the three examiners to assess approximal carious lesions were visual inspection, digital radiography, two transillumination lights (SDI and NSK), and two laser fluorescence instruments (CDD and DDP). Five damaged teeth were discarded. The teeth (n = 135) were sectioned, serially ground, and examined under light microscopy using Downer’s histological (HST) criteria as the gold standard. Intra- and inter-examiner reliability, agreement with HST, specificity, sensitivity, receiver operating characteristic (ROC) curves, and areas under the curve were calculated. Results: This study found visual inspection to be the most accurate method when validated by histology. Transillumination with NSK light had the highest specificity, and digital radiography had the highest sensitivity for detecting enamel and/or dentinal carious lesions. Combining specificity and sensitivity into the area under ROC curves, enamel plus dentinal lesions were detected most accurately by visual inspection followed by digital radiography; dentinal lesions were detected most accurately by digital radiography followed by visual inspection. Conclusions: None of the four newly developed methods can be recommended as suitable replacements for visual inspection and digital radiography in detecting carious lesions on approximal surfaces of primary molars, and further developmental work is needed.

Diagnosis of the early carious lesion

“…However, in primary teeth it is still a reliable method of early detection. 12 The detection of interproximal caries can be improved by the use of transillumination with radiography.…”

“…35 To achieve best results the angulation of the tip should be consistent, and the results should be seen in conjunction with other detection methods, not as a stand-alone gold standard as the sensitivity and specificity of results vary. 12 …”

Dental caries

“…New detection methods, such as the Diagnodent pen, have been developed for this task, however, results of research indicate that these should only be used as adjuncts to traditional methods, such as bitewing radiographs and visual and tactile examination (Chawla et al 2012). New detection methods, such as the Diagnodent pen, have been developed for this task, however, results of research indicate that these should only be used as adjuncts to traditional methods, such as bitewing radiographs and visual and tactile examination (Chawla et al 2012).…”

Pen-type laser fluorescence device versus bitewing radiographs for caries detection on approximal surfaces

“…In vitro and in vivo studies observed no differences between the LF pen and BW performance in detecting approximal caries in primary teeth [11, 23, 24]. In permanent teeth, the LF pen showed better performance compared to radiography [8].…”