Diagnostic Drama. Use of ICDAS II and Fluorescence-Based Intraoral Camera in Early Occlusal Caries Detection: A Clinical Study

Background: Early diagnosis of occlusal caries is of paramount importance for a minimally invasive approach in dentistry. The aim of the present in vivo clinical prospective study was to compare the diagnostic outcomes of visual subjective evaluation between the International Caries Detection and Assessment System (ICDAS-II) and an intraoral fluorescence-based camera (VistaCam iX Proof, Dürr Dental, Bietigheim-Bissingen, Germany) for the detection of pits and fissures in early caries lesions of posterior teeth. Methods: The study included 1011 posterior teeth in 255 patients aged 13–20 years (mean age 16 ± 2.2 years). Two blinded operators evaluated all the occlusal surfaces and the first assigned an ICDAS-II code, while the second assessed the VistaCam score: sound enamel (score 0–1.2); initial enamel decay (score 1.2–1.5); dentine caries (score 1.5–3). Results: Some 283 (28%) of the assessed teeth were ICDAS-II code 0; 334 (33%) code 1; 189 (18.7%) code 2; 176 (17.4%) code 3; and 29 (2.9%) code 4. The level of agreement between the two procedures was expressed by using Cohen’s and Fleiss’ kappa statistics and performing McNemar’s test. VistaCam assessed in 513 (50.7%) sound enamel; in 292 (28.9%) initial enamel decay; and in 206 (20.4%) dentine caries. Conclusions: This comparative study showed a poor agreement between the two diagnostic methods, especially between ICDAS-II 0, 1 and 2 codes and fluorescence assessments.

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SOPROLIFE System: An Accurate Diagnostic Enhancer

The Scientific World JOURNAL ◽

10.1155/2014/924741 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 8

Author(s):

Mona Zeitouny ◽

Mireille Feghali ◽

Assaad Nasr ◽

Philippe Abou-Samra ◽

Nadine Saleh ◽

...

Keyword(s):

Assessment Tool ◽

High Reliability ◽

Intraclass Correlation ◽

High Sensitivity ◽

Assessment System ◽

Diagnostic Methods ◽

Caries Detection ◽

Occlusal Caries ◽

Posterior Teeth ◽

Icdas Ii

Objectives.The aim of this study was to evaluate a light-emitting diode fluorescence tool, the SOPROLIFE light-induced fluorescence evaluator, and compare it to the international caries detection and assessment system-II (ICDAS-II) in the detection of occlusal caries. Methods. A total of 219 permanent posterior teeth in 21 subjects, with age ranging from 15 to 65 years, were examined. An intraclass correlation coefficient (ICC) was computed to assess the reliability between the two diagnostic methods.Results.The results showed a high reliability between the two methods (ICC = 0.92; IC = 0.901–0.940;P<0.001). The SOPROLIFE blue fluorescence mode had a high sensitivity (87%) and a high specificity (99%) when compared to ICDAS-II.Conclusion.Compared to the most used visual method in the diagnosis of occlusal caries lesions, the finding from this study suggests that SOPROLIFE can be used as a reproducible and reliable assessment tool. At a cut-off point, categorizing noncarious lesions and visual change in enamel, SOPROLIFE shows a high sensitivity and specificity. We can conclude that financially ICDAS is better than SOPROLIFE. However SOPROLIFE is easier for clinicians since it is a simple evaluation of images. Finally in terms of efficiency SOPROLIFE is not superior to ICDAS but tends to be equivalent with the same advantages.

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

Revista de Odontologia da UNESP ◽

10.1590/1807-2577.12416 ◽

2017 ◽

Vol 46 (2) ◽

pp. 109-115 ◽

Cited By ~ 2

Author(s):

Cristina Dupim PRESOTO ◽

Tamara Carolina TREVISAN ◽

Maria Costa de ANDRADE ◽

Andrea Abi-Rached DANTAS ◽

Juliana Alvares Duarte Bonini CAMPOS ◽

...

Keyword(s):

Likelihood Ratio ◽

Roc Curve ◽

Digital Images ◽

Assessment System ◽

Caries Detection ◽

Occlusal Caries ◽

Posterior Teeth ◽

Occlusal Surfaces ◽

Discrimination Capacity ◽

Caries Lesions

Abstract Introduction 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 an acceptable discrimination capacity (AUROC=0.78), although it was lower than the others. The positive likelihood ratio for the fluorescence was only 2.32, compared to 20.58 for the intraoral image and 58.11 for the ICDAS. Conclusion Both methods and the ICDAS exhibited an adequate clinical performance, although the ICDAS and intraoral image were more effective than the fluorescence.

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Comparison of Laser Fluorescence and Digital Radiograph with International Caries Detection and Assessment System in Primary Teeth (In-vivo study)

European Scientific Journal ESJ ◽

10.19044/esj.2021.v17n14p24 ◽

2021 ◽

Vol 17 (14) ◽

Author(s):

Rana Kassab ◽

Nayer Abo Elsaad ◽

Shiern Badr

Keyword(s):

Primary Teeth ◽

Clinical Performance ◽

Assessment System ◽

Diagnostic Methods ◽

Caries Detection ◽

Occlusal Caries ◽

Bitewing Radiography ◽

Diagnodent Pen ◽

Icdas Ii ◽

Caries Lesions

Background: There has been an increased incidence of dental caries in children due to recent changes in lifestyle. More sensitive and reproducible diagnostic tools for precise caries detection in children are needed because of the complex occlusal anatomy. Aim: To compare the clinical performance and accuracy of international caries detection and assessment system-II (ICDAS II) versus DIAGNOdent pen and digital bitewing radiograph in the detection of occlusal caries in the primary teeth. Materials and Methods: Fifty children aged 6-11 years were assessed of both gender (29 girls and 21 boys) and 377 occlusal surface of primary teeth were examined by visual ICDAS II, DIAGNOdent pen and digital bitewing radiographic examination at D0 (non caries lesions), D1 (lesions limited to enamel) and D2 (lesions limited to dentin) thresholds. Results: Sensitivity at D0 for ICADS II was 14.23% and 95.95% for DIAGNOdent pen and 87.85% for digital bitewing, radiographs while specificity for both ICADS II and bitewing radiographs were 99.23% but 73.85% for DIAGNOdent pen. At D1, threshold sensitivity of ICADS II and digital bitewing radiographs were higher than DIAGNOdent pen but specificity for bitewing radiographs and DIAGNOdent pen 90.69% - 87.99%. were highly significant than ICADS II At D2, threshold specificity for all diagnostic methods was almost similar with better sensitivity for ICADS II and digital bitewing radiographs. Conclusion: This study showed that ICDAS II, Diagnodent pen, and bitewing radiography are effective for the detection of occlusal caries for primary molars. Digital bitewing radiography correlated stronger with ICDASII than Diagnodent pen and proved to be the best method to detect occlusal lesions within the dentin in primary molars while Diagnodent pen and bitewing radiography are better for detecting enamel caries lesion. In addition, the clinical performance of three diagnostic methods was insufficient to detect occlusal caries lesions separately. Consequently, it is advisable to use a combination of diagnostic methods, especially in unclear cases, as well as in cases of initial lesions and their monitoring.

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The Performance of ICDAS-II Using Low-Powered Magnification with Light-Emitting Diode Headlight and Alternating Current Impedance Spectroscopy Device for Detection of Occlusal Caries on Primary Molars

ISRN Dentistry ◽

10.1155/2013/276070 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Timucin Ari ◽

Nilgun Ari

Keyword(s):

Impedance Spectroscopy ◽

Light Emitting Diode ◽

Clinical Diagnostics ◽

Caries Detection ◽

Primary Molars ◽

Occlusal Caries ◽

Light Emitting ◽

Occlusal Surfaces ◽

Icdas Ii

Early detection of occlusal caries in children is challenging for the dentists, because of the morphology of pit and fissures. The aim of this study was to compare in vitro the diagnostic performance of low-powered magnification with light-emitting diode headlight (LPMLED) using ICDAS-II criteria and AC Impedance Spectroscopy (ACIS) device, on occlusal surfaces of primary molars. The occlusal surfaces of 18 extracted primary molars were examined blindly by two examiners. The teeth were sectioned and examined under light microscopy using Downer’s histological criteria as gold standard. Good to excellent inter- and intraexaminer reproducibility, higher sensitivity, specificity, and AUC values were achieved by LPMLED at D1 threshold. Also the relationship between histology and LPMLED was statistically significant. In conclusion visual aids have the potential to improve the performance of early caries detection and clinical diagnostics in children. Despite its potential, ACIS device should be considered as an adjunct method in detecting caries on primary teeth.

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Development of a Fluorescence-Based Caries Scoring System for an Intraoral Scanner: An in vitro Study

Caries Research ◽

10.1159/000509925 ◽

2020 ◽

Vol 54 (4) ◽

pp. 324-335

Author(s):

Stavroula Michou ◽

Ana Raquel Benetti ◽

Christoph Vannahme ◽

Pétur Gordon Hermannsson ◽

Azam Bakhshandeh ◽

...

Keyword(s):

Scoring System ◽

State Of The Art ◽

Assessment System ◽

Detection Methods ◽

Caries Detection ◽

Fluorescence Signal ◽

Radiographic Assessment ◽

Intraoral Scanner ◽

Posterior Teeth ◽

Occlusal Surfaces

Objectives: To develop an automated fluorescence-based caries scoring system for an intraoral scanner and totest the performance of the system compared to state-of-the-art methods. Methods: Seventy-three permanent posterior teeth were scanned with a three-dimensional (3D) intraoral scanner prototype which emitted light at 415 nm. An overlay representing the fluorescence signal from the tissue was mapped onto 3D models of the teeth. Multiple examination sites (n = 139) on the occlusal surfaces were chosen, and their red and green fluorescence signal components were extracted. These components were used to calculate 4 mathematical functions upon which a caries scoring system for the scanner prototype could be based. Visual-tactile (International Caries Detection and Assessment System, ICDAS), radiographic (ICDAS), and histological assessments were conducted on the same examination sites. Results: Most index tests showed significant correlation with histology. The strongest correlation was observed for the visual-tactile examination (rs = 0.80) followed by the scanner supported by the caries classification function that quantifies the overall fluorescence compared to sound surfaces (rs = 0.78). Additionally, this function resulted in the highest intra-examiner reliability (κ = 0.964), and the highest sum of sensitivity (SE) and specificity (SP) (sum SE-SP: 1.60–1.84) at the 2 histological levels where the comparison with visual-tactile assessment was possible (κ = 0.886, sum SE-SP = 1.57–1.81) and at the 3 out of 4 histological levels where the comparison with radiographic assessment was possible (κ = 0.911, sum SE-SP = 1.37–1.78); the only exception was for the lesions in the outer third of dentin, where the radiographic assessment showed the highest sum SE-SP (1.78). Conclusion: A fluorescence-based caries scoring system was developed for the intraoral scanner showing promising performance compared to state-of-the-art caries detection methods. The intraoral scanner accompanied by an automated caries scoring system may improve objective caries detection and increase the efficiency and effectiveness of oral examinations. Furthermore, this device has the potential to support reliable monitoring of early caries lesions.

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Sensitivity and Specificity of Different Diagnostic Methods in Occlusal Caries Detection of Permanent Teeth among Paediatric Patients

Archives of Orofacial Sciences ◽

10.21315/aos2021.16.2.3 ◽

2021 ◽

Vol 16 (2) ◽

pp. 113-126

Author(s):

Ilham Wan Mokhtar ◽

Annapurny Venkiteswaran ◽

Mohd Yusmiaidil Putera Mohd Yusof

Keyword(s):

Sensitivity And Specificity ◽

Near Infrared ◽

Visual Detection ◽

Diagnostic Methods ◽

Infrared Light ◽

Caries Detection ◽

Permanent Teeth ◽

Occlusal Caries ◽

Occlusal Caries Detection ◽

Occlusal Surfaces

Dental caries is a commonly progressive disease that proceeds through various degrees of severity that a dentist can detect. The aims of the in vivo study were to assess the accuracy of the individual model (near-infrared light transillumination [NILT] device, visual and radiographic examinations) in detecting occlusal caries, and to evaluate the performance of visual and NILT device combination for occlusal caries detection in deciding the treatment options. Fifty-two non-cavitated occlusal surfaces from 16 patients were assessed with three different diagnostic devices in random order. Identified lesions were prepared and validated. Logistic regression analysis was performed for each method. The sensitivity and specificity values for each method and the combined models were statistically measured using RStudio version 0.97.551. At the enamel level, visual detection was the most sensitive method (0.88), while NILT was the most specific (0.93). NILT scored the highest for sensitivity (0.93) at the dentine level and visual detection scored the highest for specificity (0.88). Visual detection + NILT model was significantly better (p = 0.04) compared to visual detection or NILT alone (df = 1). The visual-NILT combination is a superior model in detecting occlusal caries on permanent teeth. The model provided surplus value in caries detection hence improving the treatment decision-making in occlusal surfaces.

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Automated caries detection with smartphone color photography using machine learning

Health Informatics Journal ◽

10.1177/14604582211007530 ◽

2021 ◽

Vol 27 (2) ◽

pp. 146045822110075

Author(s):

Duc Long Duong ◽

Malitha Humayun Kabir ◽

Rong Fu Kuo

Keyword(s):

Clinical Decision Making ◽

Clinical Decision ◽

Clinical Diagnostics ◽

Assessment System ◽

Caries Detection ◽

Support Vector ◽

Detection Scheme ◽

Occlusal Surfaces ◽

Icdas Ii ◽

Untreated Caries

Untreated caries is significant problem that affected billion people over the world. Therefore, the appropriate method and accuracy of caries detection in clinical decision-making in dental practices as well as in oral epidemiology or caries research, are required urgently. The aim of this study was to introduce a computational algorithm that can automate recognize carious lesions on tooth occlusal surfaces in smartphone images according to International Caries Detection and Assessment System (ICDAS). From a group of extracted teeth, 620 unrestored molars/premolars were photographed using smartphone. The obtained images were evaluated for caries diagnosis with the ICDAS II codes, and were labeled into three classes: “No Surface Change” ( NSC); “Visually Non-Cavitated” ( VNC); “Cavitated” ( C). Then, a two steps detection scheme using Support Vector Machine (SVM) has been proposed: “ C versus (VNC + NSC)” classification, and “ VNC versus NSC” classification. The accuracy, sensitivity, and specificity of best model were 92.37%, 88.1%, and 96.6% for “ C versus (VNC + NSC),” whereas they were 83.33%, 82.2%, and 66.7% for “ VNC versus NSC.” Although the proposed SVM system required further improvement and verification, with the data only imaged from the smartphone, it performed an auspicious potential for clinical diagnostics with reasonable accuracy and minimal cost.

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Diagnostic Performance of Different Methods in Detecting Incipient Non-Cavitated Occlusal Caries Lesions in Permanent Teeth

Journal of Clinical Pediatric Dentistry ◽

10.17796/1053-4625-43.3.5 ◽

2019 ◽

Vol 43 (3) ◽

pp. 173-179

Author(s):

Murat Ünal ◽

Arzu Koçkanat ◽

Seniha Güler ◽

Esra Gültürk

Keyword(s):

Intraclass Correlation ◽

In Vitro Study ◽

Roc Curves ◽

Caries Detection ◽

Permanent Teeth ◽

Kappa Statistics ◽

Occlusal Caries ◽

Diagnodent Pen ◽

Icdas Ii

Aim: This in vitro study was aimed to investigate the performance of the new caries detection tools on the incipient occlusal caries. Study design: In our study, 100 permanent molar teeth, which were considered to have incipient, enamel caries (D1 and D2 threshold values) according to ICDAS II score. After the visual examination, caries measurements have been applied to all teeth by using DIAGNOdent pen (DP), CarieScan PRO (CP) and SoproLife camera (SC). In addition, in vitro examinations were repeated 2 weeks later. After sectioning and evaluation in stereomicroscope, the lesion depth was determined with histological criteria that are accepted for the gold standard for this research. Sensitivity, specificity, accuracy and area under the ROC curve were calculated at D1 and D2 thresholds. The intra-examiners' reproducibility were analysed using Cohen's kappa statistics and intraclass correlation coefficient (ICC). Results: Intra-examiner repeatability values varied from 0.94 to 0.99 and kappa values ranged from 0.90 to 0.99. While the highest sensitivity and specificity value showed for SC at D1 and D2 thresholds, CP presented the lowest values. The area under ROC curves (Az) varied from 0.70 to 0.99. ICDAS II showed the highest area under ROC curves (Az). Conclusions: ICDAS II, visual diagnostic method by itself is considered to sufficient in order to diagnose incipient occlusal caries. SC may be used as an alternative method for the ICDAS II, since its advantages by displaying caries lesion on the computer monitor, follow-up and motivation of the patients provided.

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Glass Ionomer Sealant versus Fluoride Varnish Application to Prevent Occlusal Caries in Primary Second Molars among Preschool Children: A Randomized Controlled Trial

Caries Research ◽

10.1159/000517390 ◽

2021 ◽

pp. 1-11

Author(s):

Phoebe Pui Ying Lam ◽

Divesh Sardana ◽

Weijia Luo ◽

Manikandan Ekambaram ◽

Gillian Hiu Man Lee ◽

...

Keyword(s):

Preschool Children ◽

Assessment System ◽

Fluoride Varnish ◽

Caries Detection ◽

Caries Experience ◽

Primary Molars ◽

Glass Ionomer ◽

Occlusal Caries ◽

Occlusal Surfaces ◽

Significant Difference

Fissure sealant is a recommended preventive measure on permanent molars, but its efficacy on primary molars in preschool children is still in doubt. Sodium fluoride varnish (NaFV) enhances remineralization and is effective in preventing caries in smooth surfaces, but limited information is available regarding its use on occlusal surfaces of primary molars. The present study aimed to compare the efficacy of glass ionomer sealant (GIS) versus topical application of 5% NaFV in preventing and arresting occlusal caries in primary second molars among preschool children. One calibrated examiner examined children aged 3–4 years for visible plaque index (VPI), decayed-missing-filled primary surface (dmfs) index, and extent of carious lesions by the International Caries Detection and Assessment System (ICDAS). Subjects with 1 or more primary second molars that were sound or with incipient lesions (ICDAS 0–1), with distinct visual enamel changes (ICDAS 2), or with localized enamel breakdown (ICDAS 3) were recruited. The children were randomly assigned to either NaFV group – application of 5% NaFV at 3-monthly intervals or GIS group – 1 single placement of GIS. A parental questionnaire was used to collect information on the children’s sociodemographic background and oral health-related habits. Two blinded examiners conducted clinical examinations after 6 and 12 months to evaluate the development of occlusal caries and the retention of GIS. Negative binomial regression using generalized estimating equations was employed to adjust for the clustering effect and evaluate the influence of selected variables on the development of occlusal caries into dentin at 12 months. A total of 323 children with 1,159 primary second molars received the respective preventive measures at baseline. At 12 months, 280 children with 989 molars were evaluated. Caries had developed or progressed into dentin in 7.8% and 8.0% of the molars in the NaFV and GIS groups, respectively, with no significant difference between the groups (p = 0.913). The overall retention rates of GIS were 24.6% and 13.5% at 6 and 12 months, respectively. Regression analyses showed only baseline caries experience, and an ICDAS code had a significant association with occlusal caries progression. Quarterly NaFV application and single GIS placement showed similar effectiveness in the prevention of occlusal caries development among preschool children.

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Reliability and validity of ICDAS II coding for occlusal caries using magnification: an in-vitro study

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20172031 ◽

2017 ◽

Vol 3 (6) ◽

pp. 149

Author(s):

Sathyanarayanan R. ◽

Carounanidy Usha ◽

Sudhagar R.

Keyword(s):

Visual Inspection ◽

Characteristic Curve ◽

Randomized Study ◽

Reliability And Validity ◽

Caries Detection ◽

Kappa Statistics ◽

Coding System ◽

Visual Examination ◽

Occlusal Caries ◽

Icdas Ii

Background: Pit and fissure caries presents diagnostic challenges due to its anatomical complexity and fluoride exposure. ICDAS II is a coding system for caries detection using clinical visual inspection. It identifies carious lesions by the change in colour, texture and surface integrity. Magnification might facilitate better detection of the lesions by enhancing the visual acuity. Thus, the objective of this study is to compare the reliability and validity of ICDAS II in detection of occlusal caries, with and without magnification, by using histological standard.Methods: This single blinded, randomized study included 334 unrestored extracted human premolars and molars. Two examiners independently scored pit and fissure caries status using ICDAS II criteria without magnification and later under 6 x magnification using surgical microscope. The samples were sectioned and lesions were scored using the ERK histological criteria, under Stereo microscope. The scores of the examiners were correlated with the histological scoring. Kappa statistics and Spearman correlation coefficients were performed. Optimal sensitivity, specificity of visual and enhanced visual examination was calculated by Receiver Operating Characteristic Curve (ROC). Likelihood ratios (LR) were also calculated. Results: The kappa values for Inter examiner reproducibility of visual and enhanced visual examination under microscope were 0.638-0.694 and for histological examination it was 0.979. Intra examiner reproducibility for visual and enhanced visual examination was 0.665 – 0.594. There was a strong relationship between visual, enhanced visual and histological examinations. Spearman’s correlation coefficient of ICDAS-II visual and enhanced visual examination for each examiner, to ERK histological scores was 0.869-0.848. The sensitivity and LR+ for visual and enhanced visual examination was decreased as the ICDAS score was increased and specificity and LR- increased with increased ICDAS score.Conclusions: Reliability and validity of ICDAS scoring in detecting occlusal caries under magnification did not differ from clinical visual inspection.

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