Validity and Reproducibility of Different Combinations of Methods for Occlusal Caries Detection: An in vitro Comparison

Abstract

This study assessed the validity and reproducibility of different combinations of occlusal caries detection methods: visual examination (VE), laser fluorescence (LF) and radiographic examination (RE). Intra- and interexaminer reproducibilities were also assessed. Forty-seven extracted human molars were used and 121 sites, either suspected or not to be carious, were chosen. Occlusal surfaces were examined by 8 volunteers, assigned to three groups according to their level of knowledge and clinical experience on dental practice: group I, undergraduate students; group II, postgraduate students; group III, professors. Three combinations of methods were tested: A: VE + LF, B: VE + RE, C: VE + LF + RE. The examiners scored the sites using ranking scales and chose a final score based on their clinical experience. The gold standard was determined by histological examination of the sites. In general, LF and RE yielded poorer results than the combinations of methods. For combination A, group III showed the highest sensitivity, while group II showed the highest specificity. For combination B, group II showed moderate sensitivity whereas groups I and III exhibited low sensitivities; all groups of examiners reached substantial specificity. For combination C, all groups exhibited moderate sensitivity and substantial specificity. Interexaminer reproducibility ranged from fair to moderate for combinations A and C, while for combination B kappa values indicated moderate interexaminer reproducibility. It may be concluded that individual exams presented inferior performance than the conjunction of them. Combination C (VE + LF + RE) resulted in the best accuracy for all groups. The knowledge background of the examiners influenced their ability to detect caries lesions and affected interexaminer reproducibility.

Occlusal Caries Depth Measurements Obtained by Five Different Imaging Modalities

“…In order to overcome difficulties during diagnosis and enable better detection of occlusal caries, authors have recommended that traditional methods like visual examination and probing [3] that may cause enamel defects [4] be combined with other diagnostic aids such as radiography, laser or light fluorescence-based methods, or electrical impedance measurements [5][6][7][8][9]. Conventional intraoral film, solid-state detectors and photostimulable phosphor plates are the most commonly preferred and available modalities for diagnosing occlusal caries in conjunction with visual and clinical examination in routine dental practice.…”

A comparison of the diagnostic accuracy ofin vivoandin vitrophotostimulable phosphor digital images in the detection of occlusal caries lesions

“…23 The ability to detect caries has also been shown to increase with observer experience. 24 Diagnostic accuracy (mean ROC curve area 0.92-0.98) and intraexaminer and interexaminer reproducibility have also been shown to be significantly higher in the detection of occlusal demineralization using the subtraction technique compared with paired digital images viewed side by side, indicating that the subtraction method can be used successfully to monitor occlusal caries. 25 In the present study, only nine patients (15%) experienced notable discomfort (including pain and vomiting) during image exposure.…”

Different methods of dental caries diagnosis in an epidemiological setting

“…Diagnostic decision making is a balancing act 5 . Although there is low strength to the evidence as regards the performance of diagnostic methods 4 , there are positive results described in the literature 2,[6][7]22 about the association of auxiliary resources and adjunct diagnostic methods for identifying initial carious lesions. This trend was evident and was in agreement with the results of this study.…”

“…According to the systematic review of Bader et al 4 , the strength of scientific evidence for adjunct methods of caries detection is poor. However, some studies have presented satisfactory results with the use of auxiliary resources (often low-tech and low-cost actions that improve visual examination as previous tooth brushing and drying or artificial lighting, for example) and adjunct methods (often high-tech devices as fiber-optic transillumination/FOTI, Diagnodent™, Electronic Caries Monitor/ECM or digital radiography, for example) for the detection of caries [5][6] . Apart from adding new diagnostic adjuncts with the aim of designing a more reliable nosological chart, more sensitive diagnostic thresholds recording the presence of initial carious lesions and/or activity have been proposed with some success in the literature 1,3,7 .…”