Automated caries detection in vivo using a 3D intraoral scanner

Abstract

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

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

“…The Trios 4 (version 20.1.4, 3Shape) uses fluorescence technology with blue-violet light of a wavelength of 415 nm to detect fluorescence changes between sound and demineralized tooth surfaces [ 32 ]. In this study, occlusal and proximal caries lesions were examined.…”

“…Although the potential benefit of intraoral scanners in this regard is mentioned in the literature [ 5 ], only three studies related to caries diagnostic methods have been published. Two studies investigated an experimental caries diagnostic tool integrated in the Trios 3 (3Shape), which is not commercially available, regarding occlusal caries diagnostics in vitro and in vivo [ 31 , 32 ]. The third clinical study compared the iTero Element 5D to established bitewing radiography showing a higher sensitivity for the detection of early proximal caries lesions with intraoral scanners [ 33 ].…”

Gingival shape analysis using surface curvature estimation of the intraoral scans

“…The benefit of intraoral scanning as a diagnostic tool may present an added value to the clinical workflow either in terms of evaluation of disease presence or progression [ 52 , 53 ]. Despite significant investment in money, intraoral scanners are increasingly present and used in dental practices [ 54 ].…”

Effect of defect size and tooth anatomy in the measurements of a 3D patient monitoring tool

“…A previous in vivo study performed an in vitro validation to assess four different algorithms implemented in the IOS system for automated caries detection. Similar to the present study, the authors used the TPM tool for that [ 29 ]. According to their findings, the IOs system exhibits promising performance for clinical application on occlusal changes detection and different approaches can be investigated for possible optimization of the system [ 29 ].…”

“…Different techniques have been purposed in literature such as intraoral inspection with visual scales [ 27 , 28 ] or extraoral evaluation on stone casts models. However, these methods are not qualitative, poorly accurate and subjective [ 19 , 29 , 30 ]. The digital profilometry could be an alternative to measure occlusal wear, but is not fully accessible with extensive time demanding and high costs, being mainly used in research [ 17 ].…”