Comparison of occlusal caries detection using the ICDAS criteria on extracted teeth or their photographs

Abstract

BackgroundUsing photographs of occlusal surfaces instead of extracted teeth for the detection of caries can be useful in multicenter studies or education. Using a panel of observers, ICDAS scores on teeth or photographs were evaluated against the histological gold standard. The hypothesis was that both outcomes were equivalent.MethodsFour examiners with different experience in ICDAS scored photographs of occlusal surfaces of 100 extracted teeth on a monitor using ICDAS criteria. Two of the examiners had previously scored extracted teeth prior to photography. Digital images of histological sections of the teeth were observed by all examiners and consensus scores were given for each investigation site (gold standard). Kappa statistics and Spearman correlation coefficients as well as repeated measure ANOVA were performed. ROC curves were constructed for each examiner and the areas under the ROC-curves (AUC) of both scoring techniques (extracted teeth, digital images) were compared (α = 0.05).ResultsIntra- and inter-rater kappa for ICDAS on teeth were 0.81–0.94 and on photographs 0.54–0.88, respectively. Correlation with histology was 0.58– 0.61 for the teeth and 0.50–0.62 for the photographs. AUC of ICDAS scores of extracted teeth (mean 0.89) were slightly higher than those for photographs (mean 0.84). However, both AUC values were not statistically significant (p = 0.38).ConclusionUsing photographs to assess occlusal surfaces with the ICDAS criteria was not statistically different from scoring the extracted teeth.

Histologic validation of ICDAS‐II and polarization sensitive optical coherence tomography to detect smooth surface early carious lesions

“…The photographs of carious lesions were used for ICDAS‐II‐SSCm scoring. The effect of photograph on observer's performance had already been examined and showed no significant difference in sound surfaces or those with ICDAS‐II scores 1‐4 . After saving photographs of ICDAS‐II‐SSCm scoring, the first and/or third author (SV& SM) proceeded to other centre for PS‐OCT procedure to reduce overall time consumption to avoid any effect of storing medium.…”

“…The effect of photograph on observer's performance had already been examined and showed no significant difference in sound surfaces or those with ICDAS-II scores 1-4. 26 After saving photographs of ICDAS-II-SSCm scoring, the first and/or third author (SV& SM) proceeded to other centre for PS-OCT procedure to reduce overall time consumption to avoid any effect of storing medium. A bias of perception between the examiners was decreased in the study by using the same laptop with similar contrast and brightness for all the examiners amid scoring.…”

Accuracy of visual and image-based ICDAS criteria compared with a micro-CT gold standard for caries detection on occlusal surfaces

“…This has been also found in other studies, as visual examination presents some difficulties in distinguishing between active caries and non-carious hard tissue defects or inactive lesions. 25,27 Moreover, we also attribute this result to the type of gold standard used in the present study, which evaluated the lesions on a three-dimensional basis and relied on quantitative cutoff mineral density values. Collectively, the low sensitivity values for threshold 2 and low specificity values for threshold 1 found in the present study may emphasize the effect of an alternative micro-CT gold standard.…”

“…One of the main limitations on the more widespread use of ICDAS as a caries scoring system is the difficulty in achieving inter-examiner agreement, since each examiner is expected to have a different interpretation of visual signs based on personal visual acuity, neural signal processing, experience, and education. 25 A previous study found that e-learning sessions on ICDAS along with training sessions performed with instructors on extracted teeth improved the ability of dental students to apply the ICDAS criteria for diagnostic purposes. 29 In this study, calibration with e-learning sessions on ICDAS was performed to check whether a less demanding learning curve could be expected from this scoring system involving relatively experienced dental professionals.…”

“…It was possible to observe that both visual and image-based inspection methods showed excellent sensitivity (0.93 and 0.97, respectively) in distinguishing sound from carious elements (threshold 1: caries presence), thus corroborating the findings of previous studies in which a histological gold standard was used. 4,25 For detection of carious lesions requiring operative treatment, both methods showed poor sensitivity values (0.33 and 0.28, respectively). This may be partly explained by the fact that most accuracy studies testing ICDAS have been designed using stereomicroscopy as a gold standard for caries presence.…”