Clinical effectiveness of fluorescence, digital images and ICDAS for detecting occlusal caries

Abstract

ResumoIntrodução: A detecção de pequenas lesões de cárie ainda é um desafio para profissionais da Odontologia, que em sua prática clínica dispõem de uma grande variedade de métodos para detectar cáries nas superfícies oclusais. Objetivo: Avaliar clinicamente a efetividade da câmera de fluorescência Vista Proof, da microcâmera intraoral digital Vista Cam e do critério visual ICDAS (International Caries Detection and Assessment System) para detecção de lesões de cárie nas superfícies oclusais. Material e método: Cento e sete dentes posteriores de pacientes adultos foram examinados visualmente e por meio de radiografias digitais por um examinador que os classificou de acordo com a presença ou ausência de cárie. Os dentes foram então avaliados por outro examinador que utilizou o ICDAS, fluorescência e imagens digitais ampliadas. A efetividade dos métodos foi mensurada por meio da sensibilidade, especificidade, razão de verossimilhança positiva e negativa. Para cada método, a curva ROC (Receiver Operating Characteristic) e a área sob a mesma -AUROC (Area Under the ROC curve) foram estimadas. Resultado: Houve excepcional capacidade discriminante para as imagens intraorais (AUROC=0,93) e para o ICDAS (AUROC=0,91), com diferença estatística não significativa entre eles (z=0,35, p=0,73). A fluorescência apresentou capacidade discriminante aceitável (AUROC=0,78), embora tenha sido menor que os outros. A razão de verossimilhança positiva para a fluorescência foi 2,32, comparado a 20,58 para a imagem intraoral e 58,11 para o ICDAS. Conclusão: Ambos os métodos e o ICDAS exibiram um adequado desempenho clínico, sendo que o ICDAS e a imagem intraoral foram mais efetivos que a fluorescência.Descritores: Cárie dentária; efetividade; diagnóstico; fluorescência. AbstractIntroduction: The detection of small caries lesions is still a challenge for dental professionals who in their clinical practice have a wide variety of methods to detect caries on occlusal surfaces. Objective: To clinically assess the effectiveness of the Vista Proof fluorescence camera, the Vista Cam digital intraoral micro camera and the International Caries Detection and Assessment System (ICDAS) visual criterion for detecting caries lesions on occlusal surfaces of permanent teeth. Material and method: One hundred and seven posterior teeth from adult patients were examined visually and by means of digital radiographs by an examiner who rated them according to the presence or absence of occlusal caries. The teeth were then assessed by the other examiner using ICDAS, fluorescence and magnified digital images. The effectiveness of the methods was measured based on sensitivity, specificity, positive and negative likelihood ratio. For each method, the Receiver Operating Characteristic (ROC) curve and the Area Under the ROC curve (AUROC) were estimated. Result: There was exceptional discrimination capacity for the intraoral images (AUROC=.93) and the ICDAS (AUROC=.91), with no significant statistical difference between them (z=.35, p=.73). The fluorescence exhibited a...

Comparison between visual and laser-fluorescence diagnosis of occlusal surfaces of first permanent molars. Literature review and clinical cases

“…Similar results are found in a similar study conducted in 2017, which found a high level of correspondence between the sensitivity and specificity of the two methods of diagnosis: values for Vistacam 0.89 / 0.96 and values for ICDAS 0.84 / 0.99 (9).…”

“…The results after reading and analyzing the articles which met the inclusion criteria show that Vistacam is confirmed to be a reliable but additional diagnostic method, a useful complement to visual diagnosis with ICDAS II system. The intraoral camera enables long-term follow-up of the lesions and improves visual inspection in order to minimize errors during diagnosis, enables long-term follow-up of occlusal surfaces and detection of changes over time (9). Along with these advantages, laser fluorescence diagnostics with Vistacam has its disadvantages as well.…”

“…The Vista Cam iX LEDs emits high-energy blue-violet light at 405 nm on the occlusal tooth area. At this wavelength porphyrins produced by caries-related bacteria, emit red light, containing less energy, in contrast to sound enamel, characterized by green light (8,9,10,11).…”

“…The fluorescence is recorded by the camera, transferred and processed by a software (DBSWIN, Durr) and then stored. As result a digital image show lesions in different colours shades with numerical score between 0 and 3, predicting the extent and depth of carious demineralization.The device is easy to handle in general practice and offer a non-invasive tool for occlusal caries detection (9,10,11,12).…”

Visual and laser-fluorescence diagnosis with Vistacam of first permanent molar before and after silanization

“…Reproducibility and accuracy of ICDAS-II have already shown to be promising for occlusal caries detection (1,3). ICDAS-II is an accessible set of criteria for dentists, researchers and professors and presents acceptable sensitivity and specificity to the detection of occlusal caries ( 4,5,6,7).…”