Clinical Trial of the Canary System for Proximal Caries Detection: A Comparative Study

Background: Detecting initial caries on the proximal surfaces of teeth in an intact dentition is a problem in dental practice since radiograph has been shown to have poor sensitivity with this stage of caries lesions. Hence there is need for an alternative technology. Objectives: The aim of this study was to investigate the efficacy of the Canary System (CS) to detect proximal caries in a clinical setting, comparing it with bitewing radiography (BWR). Methodology: 33 subjects, age 18 years and above, were recruited from a mixed population of low, moderate, and high caries risk patients. BWR and the CS were used to detect proximal caries lesions in these subjects. Teeth were separated by 48 hours insertion of rubber rings, and the proximal surfaces were examined by direct visual examination using the International Caries Detection and Assessment System II (ICDAS-II) scoring system. The Sensitivity (se), specificity (sp), positive (ppv) and negative predictive (npv) values of the CS and BWR in detecting caries on proximal surfaces were calculated by evaluating each method alone against ICDAS-II system (used as bronze standard). The two methods were compared statistically using their Area Under the Receiver Operating Curve (AUC). The sensitivities and specificities were compared using a test of proportions and AUC values were compared using DeLong’s method of nonparametric testing of AUC values. Results: The se, sp, ppv and npv for the CS are 0.92, 0.78, 0.89, 0.84 respectively, and for BWR are 0.67, 0.54, 0.78, and 0.40 respectively. The AUC of the Canary System (0.77) was statistically significantly higher than the AUC of the radiography (0.53, P < .001). Conclusions: This study demonstrated the efficacy of the Canary System in detecting proximal caries lesions to be greater than that of bitewing radiography. Clinical Significance: The Canary System can be a valuable clinical device for detecting and monitoring proximal caries lesions in clinical practice.

Diagnostic validity of early proximal caries detection using near-infrared imaging technology on 3D range data of posterior teeth

Objectives This in vitro study analysed potential of early proximal caries detection using 3D range data of teeth consisting of near-infrared reflection images at 850 nm (NIRR). Materials and methods Two hundred fifty healthy and carious permanent human teeth were arranged pairwise, examined with bitewing radiography (BWR) and NIRR and validated with micro-computed tomography. NIRR findings were evaluated from buccal, lingual and occlusal (trilateral) views according to yes/no decisions about presence of caries. Reliability assessments included kappa statistics and revealed high agreement for both methods. Statistical analysis included cross tabulation and calculation of sensitivity, specificity and AUC. Results Underestimation of caries was 24.8% for NIRR and 26.4% for BWR. Overestimation was 10.4% for occlusal NIRR and 0% for BWR. Trilateral NIRR had overall accuracy of 64.8%, overestimation of 15.6% and underestimation of 19.6%. NIRR and BWR showed high specificity and low sensitivity for proximal caries detection. Conclusions NIRR achieved diagnostic results comparable to BWR. Trilateral NIRR assessments overestimated presence of proximal caries, revealing stronger sensitivity for initial caries detection than BWR. Clinical relevance NIRR provided valid complement to BWR as diagnostic instrument. Investigation from multiple angles did not substantially improve proximal caries detection with NIRR.

Deep learning for early dental caries detection in bitewing radiographs

The early detection of initial dental caries enables preventive treatment, and bitewing radiography is a good diagnostic tool for posterior initial caries. In medical imaging, the utilization of deep learning with convolutional neural networks (CNNs) to process various types of images has been actively researched, with promising performance. In this study, we developed a CNN model using a U-shaped deep CNN (U-Net) for caries detection on bitewing radiographs and investigated whether this model can improve clinicians’ performance. The research complied with relevant ethical regulations. In total, 304 bitewing radiographs were used to train the CNN model and 50 radiographs for performance evaluation. The diagnostic performance of the CNN model on the total test dataset was as follows: precision, 63.29%; recall, 65.02%; and F1-score, 64.14%, showing quite accurate performance. When three dentists detected caries using the results of the CNN model as reference data, the overall diagnostic performance of all three clinicians significantly improved, as shown by an increased sensitivity ratio (D1, 85.34%; D1′, 92.15%; D2, 85.86%; D2′, 93.72%; D3, 69.11%; D3′, 79.06%; p < 0.05). These increases were especially significant (p < 0.05) in the initial and moderate caries subgroups. The deep learning model may help clinicians to diagnose dental caries more accurately.

Conservative treatment of interproximal incipient caries lesions by resin infiltration

Minimally invasive dentistry is based on conservative techniques for the treatment of initial caries lesions, the so-called white spot lesions. One of the conservative maneuvers includes the use of enamel resin infiltrant: a low viscosity material that penetrates the enamel pores to stop lesion progression. Aim: Therefore, this case report aimed to describe the clinical case of a 28-year-old female patient under routine consultation, in which a radiographic examination showed the presence of two incipient caries lesions in the left upper premolars. Methods: The application of a resin infiltrating agent (Icon®, DMG – Hamburg, Germany) was chosen as treatment to stop caries lesions progression. Conclusion: The use of this conservative technique can be considered a promising approach for the prevention of dental tissue wear, and the resin infiltrant is considered an effective material.

ASSESSMENT OF DENTAL CARIOUS LESIONS BY ICDAS II

Introduction. The largest amount of information about the dental caries is provided by the International Caries Detection and Assessment II system (ICDAS II), which is known as evidence-based approach to clinical visual detection of dental caries and enables to detect the stage and depth of carious lesions from the slightest changes in dental enamel to visible cavities affecting dentin. This system has been developed by the group of leading experts in the field of cariology. The results obtained by determining the ICDAS II index contribute to making right clinical decision in the choice of prevention and treatment methods, as well as to predicting the carious progression. The aim of the study is to assess the prevalence and intensity of initial dental caries in people using the ICDAS II index. Materials and methods. A total of 32 patients aged 12 to 25 years were examined. During the dental examination, we assessed the prevalence of dental caries using the ICDAS II. Clinical findings were recorded in oral follow-up charts proposed by the ICDAS Foundation for Epidemiological Studies, which allow us to record dental hard tissue status using six codes: three for assessing carious changes in enamel and three for assessing carious changes in dentine in a sequence of growing severity. Statistical processing of the findings was performed using Student's t-test. Results. Carious lesions were detected in all study participants, their total number was 285, of which 140 (49.1%) had the code 1 and 145 (50.8%) had the code 2 according to the ICDAS II. On average, each of the participants had 9.28 ± 0.67 foci of enamel demineralization. The average number of lesions with codes 1 and 2 by the ICDAS II was respectively 4.54 ± 0.51 and 4.74 ± 0.38 (p> 0.05). The average intensity of dental caries increased with age from 8.29 ± 0.83 in 12-15 year old individuals to 9.39 ± 1.20 in 18-25 year old individuals (p> 0.05), mainly by the growth of the average number of the mean number of caries lesions with the code 1 according to the ICDAS II. Mostly carious lesions are found on the masticatory surfaces, their total number made up 159 (55.7%). 101 (35.4%) caries lesions were found on the vestibular and oral parts of the tooth surfaces, and 25 (8.9%) average lesions were detected on the proximal surfaces. The average intensity of caries detected on the chewing surfaces of the teeth was 5.15 ± 0.49 and was significantly higher than on the vestibular and oral (3.33 ± 0.57, p <0.05) and proximal (0.79 ± 0, 20, p <0.001) surfaces. Conclusion. The obtained results showed a high intensity of carious lesions, with their predominance in the active stages in the two age groups under the study. This proves the appropriateness of using diagnostic ICDAS criteria for early detection of initial caries and its proper treatment.

Diagnostic Value of Fluorescence Methods, Visual Inspection and Photographic Visual Examination in Initial Caries Lesion: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to investigate the efficacy of fluorescence-based methods, visual inspections, and photographic visual examinations in initial caries detection. A literature search was undertaken in the PubMed and Cochrane databases. Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed, and eligible articles published from 1 January 2009 to 30 October 2019 were included if they met the following criteria: they (1) assessed the accuracy of methods of detecting initial tooth caries lesions on occlusal, proximal, or smooth surfaces in both primary and permanent teeth (in clinical); (2) used a reference standard; (3) reported data regarding the sample size, prevalence of initial tooth caries, and accuracy of the methods. Data collection and extraction, quality assessment, and data analysis were conducted according to Cochrane standards Quality Assessment of Diagnostic Accuracy Studies-2. Statistical analyses were performed using Review Manager 5.3 and STATA 14.0. A total of 12 eligible articles were included in the meta-analysis. The results showed that the sensitivity and specificity of fluorescence-based methods were 80% and 80%, respectively; visual inspection was measured at 80% and 75%, respectively; photographic visual examination was measured at 67% and 79%, respectively. We found that the visual method and the fluorescence method were reliable for laboratory use to detect early-stage caries with equivalent accuracy.