Comparison of laser fluorescence devices for detection of caries in primary teeth

Abstract

The aim of this in vivo study was to evaluate the performance of fluorescence-based devices in detecting occlusal caries lesions in primary molars compared with conventional methods. Two examiners assessed 44 occlusal surfaces of first and second primary molars in 20 patients using two fluorescence devices: DIAGNOdent (LF) and DIAGNOdent pen (LFpen). Teeth were also assessed by visual examination and bitewing radiograph. Histological examination served as the gold standard after extraction. By using the McNemar test, the sensitivity, specificity, accuracy, and area under the receiver operating curve were calculated as outer enamel (D1), inner enamel (D2) and dentine caries (D3) lesion thresholds. The intra- and inter-examiner reproducibility were calculated using the Cohen's unweighted kappa statistics. At the D1 threshold, the LFpen sensitivity was statistically higher than LF and radiographic examination (P < 0.001), whereas there was no statistically significant difference among the groups at the D2 and D3 thresholds (P > 0.05). All methods demonstrated the highest sensitivity values at D3. At the D1 and D2 thresholds, there were no significant differences between the LFpen specificity and the other methods. All methods presented similar performance in detecting all lesions considering the area under the receiver operating curve. The LFpen showed better performance than LF. Furthermore, visual examination and the LFpen device seem to be sufficient for detection of occlusal caries in primary molars.

Validation of DIAGNOdent laser fluorescence and the International Caries Detection and Assessment System (ICDAS) in diagnosis of occlusal caries in permanent teeth: an in vivo study

“…This was a consecutive sample and could have included selection bias. The final sample size (43 teeth) was similar to that of previous validation studies with primary molars . The histological examination of 43 occlusal sites showed a predominance of lesions involving the inner half of the enamel to the outer third of the dentine; an equal number of healthy sites and lesions involving the outer half of the enamel; and a low frequency of deep dentine lesions.…”

“…From the clinical standpoint, the ideal diagnostic test should have a balance between sensitivity and specificity, and the area under the ROC curve should be close to 1. However, these conditions are difficult to achieve with the methods available . A higher value for specificity of a diagnostic test is particularly relevant when caries prevalence is low and the value of low‐specificity adjunct methods for caries detection (X‐rays and DIAGNOdent) is questionable, especially in deciduous teeth, in comparison with visual inspection alone .…”

“…The results of previous in vivo validation studies of the DIAGNOdent device show great variation. However, they seem to agree that DIAGNOdent has utility as an aid in the diagnosis of caries in permanent and primary teeth (). The accuracy of visual examinations using Ekstrand 's criteria and the DIAGNOdent did not differ, and a study with primary teeth did not find utility of laser fluorescence .…”

“…This reference standard system has limitations, as specificity for healthy tooth sites cannot be evaluated and false‐negative results can impair the validity of the studies . Except for a study on primary teeth , DIAGNOdent studies performed in vivo have presented the results for only two thresholds for investigation of the sensitivity, specificity, accuracy, and area under the receiver–operating characteristics (ROC) curve.…”

Qual a melhor estratégia de diagnóstico para detecção de lesões de cárie em superfícies oclusais e proximais de adolescentes?

“…A novidade do dispositivo foi a presença de duas pontas de safira específicas para superfície oclusal e superfície proximal. Estudos têm demonstrado bom desempenho do aparelho na detecção de lesões de cárie em superfícies lisas (Aljehani et al, 2007;De Benedetto et al, 2011;Moriyama et al, 2014;Diniz et al, 2015;Novaes et al, 2016) e oclusais Hellwig, 2006;Rodrigues et al, 2008;Matos et al, 2011;Diniz et al, 2012;Cinar et al, 2013). Para as superfícies proximais, estudos in vitro revelaram que o desempenho do método de fluorescência a laser foi superior ao exame radiográfico (Lussi et al, 2006a;De Souza et al, 2014) em dentes permanentes.…”