The diagnostic accuracy of a laser fluorescence device and digital radiography in detecting approximal caries lesions in posterior permanent teeth: an in vivo study

Abstract

The aim of this in vivo study was to test the diagnostic accuracy of a pen-type laser fluorescence (LFpen) device in detecting approximal caries lesions, in posterior permanent teeth, at the cavitation and non-cavitation thresholds, and compare it with that of digital bitewing radiography. Thirty patients (aged 18–37), who attended the Faculty of Dentistry at Damascus University for a dental examination, were consecutively screened. Ninety approximal surfaces of posterior permanent teeth without frank cavitations, enamel hypoplasia or restorations were selected and examined using the LFpen (DIAGNOdent pen) and digital bitewing radiography. The reference standard was the visual-tactile inspection, after performing temporary tooth separation, using orthodontic rubber rings, placed for 7 days. The status of included approximal surfaces was recorded as intact/sound, with white/brown spots or cavitated. One trained examiner performed all examinations. There were statistically significant differences in LFpen readings between the three types of approximal surface status (P < 0.001). The optimal cut-off values for detecting approximal caries lesions in posterior permanent teeth were >16 and 8 at the cavitation and non-cavitation thresholds respectively. The sensitivity, specificity and accuracy (measured by the area under the receiver-operating characteristic curve) were 100, 85 and 95 and 92, 90 and 95% at the cavitation and non-cavitation thresholds respectively. The intra-class correlation coefficient for intra-examiner reliability was 0.95. The diagnostic accuracy of the LFpen was significantly higher than that of digital bitewing radiography (P < 0.001). The LFpen’s diagnostic performance was accurate and significantly better than digital bitewing radiography in detecting approximal caries lesions, in posterior permanent teeth.Electronic supplementary materialThe online version of this article (doi:10.1007/s10103-017-2157-2) contains supplementary material, which is available to authorized users.

Accuracy of pen‐type laser fluorescence device and radiographic methods in detecting approximal carious lesions in primary teeth – an in vivo study

“…Such discrepancies could be explained by the subjectivity of the BW examination, which depends on the examiner's experience and skills, in addition to other factors. Furthermore, the use of digital radiography has been reported for permanent teeth, with very few studies on primary teeth. Therefore, the data herein cannot be compared with studies performed with permanent teeth.…”

“…Studies on permanent teeth showed different results when BW and LFpen were compared to those obtained for primary teeth. An in vitro study of permanent teeth revealed that LFpen performed better than the radiographic method. LFpen also presented higher accuracy in detecting both enamel and dentin carious lesions (D1 threshold) than BW for permanent teeth.…”

“…Cost‐effectiveness is closely related to the treatment options offered by different detection methods. Both validity and the specific benefits to different patients should be considered by dentists in the selection of a detection method.…”

“…Thereafter, sensitivity, specificity, accuracy, and the 95%CI were calculated for the LFpen device and digital BW radiography at the cavitation and non‐cavitation thresholds using receiver operating characteristic (ROC) analyses. The estimation of cut‐off values for LFpen was made by allowing for the highest sum of sensitivity and specificity at the cavitation and non‐cavitation thresholds, whereas the cut‐off values for digital BW radiography were based on the radiolucent lesions observed in dentin and enamel at the cavitation and non‐cavitation thresholds, respectively. The accuracy of both diagnostic methods and their P values were calculated using the area under the ROC curve (AUC).…”

“…The estimation of cut‐off values for LFpen was made by allowing for the highest sum of sensitivity and specificity at the cavitation and non‐cavitation thresholds, whereas the cut‐off values for digital BW radiography were based on the radiolucent lesions observed in dentin and enamel at the cavitation and non‐cavitation thresholds, respectively. The accuracy of both diagnostic methods and their P values were calculated using the area under the ROC curve (AUC). The level of significance was set as P < 0.05…”