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Kühnisch J, Aps JK, Splieth C, Lussi A, Jablonski-Momeni A, Mendes FM, Schmalz G, Fontana M, Banerjee A, Ricketts D, Schwendicke F, Douglas G, Campus G, van der Veen M, Opdam N, Doméjean S, Martignon S, Neuhaus KW, Horner K, Huysmans MCD. ORCA-EFCD consensus report on clinical recommendation for caries diagnosis. Paper I: caries lesion detection and depth assessment. Clin Oral Investig 2024; 28:227. [PMID: 38514502 PMCID: PMC10957694 DOI: 10.1007/s00784-024-05597-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES The aim of the present consensus paper was to provide recommendations for clinical practice considering the use of visual examination, dental radiography and adjunct methods for primary caries detection. MATERIALS AND METHODS The executive councils of the European Organisation for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD) nominated ten experts each to join the expert panel. The steering committee formed three work groups that were asked to provide recommendations on (1) caries detection and diagnostic methods, (2) caries activity assessment and (3) forming individualised caries diagnoses. The experts responsible for "caries detection and diagnostic methods" searched and evaluated the relevant literature, drafted this manuscript and made provisional consensus recommendations. These recommendations were discussed and refined during the structured process in the whole work group. Finally, the agreement for each recommendation was determined using an anonymous Delphi survey. RESULTS Recommendations (N = 8) were approved and agreed upon by the whole expert panel: visual examination (N = 3), dental radiography (N = 3) and additional diagnostic methods (N = 2). While the quality of evidence was found to be heterogeneous, all recommendations were agreed upon by the expert panel. CONCLUSION Visual examination is recommended as the first-choice method for the detection and assessment of caries lesions on accessible surfaces. Intraoral radiography, preferably bitewing, is recommended as an additional method. Adjunct, non-ionising radiation methods might also be useful in certain clinical situations. CLINICAL RELEVANCE The expert panel merged evidence from the scientific literature with practical considerations and provided recommendations for their use in daily dental practice.
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Affiliation(s)
- Jan Kühnisch
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians Universität München, Poliklinik für Zahnerhaltung und Parodontologie, Goethestraße 70, 80336, München, Germany.
| | | | - Christian Splieth
- Preventive and Pediatric Dentistry, Center for Oral Health, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Adrian Lussi
- University Hospital for Conservative Dentistry and Periodontology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
| | | | - Fausto M Mendes
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Gottfried Schmalz
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, Ann Arbor, USA
| | - Avijit Banerjee
- Conservative & MI Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - David Ricketts
- Unit of Restorative Dentistry, University of Dundee, Dundee, UK
| | - Falk Schwendicke
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians Universität München, Poliklinik für Zahnerhaltung und Parodontologie, Goethestraße 70, 80336, München, Germany
| | - Gail Douglas
- Department of Dental Public Health, University of Leeds Dental School, Leeds, UK
| | - Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Sassari, Italy
| | - Monique van der Veen
- Departments of Preventive Dentistry and Paediatric Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
- Oral Hygiene School, Inholland University of applied sciences, Amsterdam, The Netherlands
| | - Niek Opdam
- Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sophie Doméjean
- Centre de Recherche en Odontologie Clinique EA 4847, UFR d'Odontologie, Département d'Odontologie Conservatrice, Université Clermont Auvergne, Clermont-Ferrand, France
- Service d'Odontologie, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
| | - Stefania Martignon
- UNICA - Caries Research Unit, Research Department, Universidad El Bosque, Bogotá, Colombia
| | - Klaus W Neuhaus
- Department of Pediatric Oral Health, University Center for Dental Medicine Basel (UZB), University of Basel, Basel, Switzerland
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Keith Horner
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Melo M, Pascual A, Camps I, Ata-Ali F, Ata-Ali J. Impedance Spectroscopy as a Tool for the Detection of Occlusal Noncavitated Carious Lesions. Oper Dent 2022; 47:258-267. [PMID: 35604826 DOI: 10.2341/19-149-c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 11/23/2022]
Abstract
A total 302 teeth (148 molars and 154 premolars) corresponding to 152 patients aged ≥18 years were evaluated for caries using the ICDAS (International Caries Detection and Assessment System), fluorescence (DD, DIAGNOdent) and electrical impedance (IMS, CarieScan PRO) systems. Fissurotomy and intraoral radiographs were used as the gold standard. Accordingly, 27.5% (n=84) of the teeth were classified as sound, while 26.9% (n=81) had enamel involvement and 45.6% (n=138) presented carious lesions reaching the dentin. Sensitivity (Se), specificity (Sp), and the area under the curve (AUC) were, respectively, 90.7%, 87.8%, and 0.954 (IMS); 92.4%, 92.7%, and 0.954 (DD); and 79.0%, 72.3%, and 0.756 (ICDAS). With regard to Se and Sp, there were significant differences between ICDAS and DD (p<0.001) and between ICDAS and IMS (p=0.01), but not between IMS and DD (p=0.07). In relation to AUC, there were significant differences between ICDAS and DD (p<0.001), and between ICDAS and IMS (p<0.001), but not between IMS and DD (p>0.05). The correlations between fissurotomy and each method were 88.7% (IMS), 89.7% (DD), and 77.1% (ICDAS). Within the limitations of this study, clinically, the electrical system is not useful for differentiating between sound teeth and truly incipient caries lesions by itself. The fluorescence or electrical systems are recommended with the ICDAS to detect carious lesions in their early stages.
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Affiliation(s)
- M Melo
- María Melo, DDS, MS, PhD, Valencia University Medical and Dental School, University of Valencia, Valencia, Spain
| | - A Pascual
- Agustín Pascual, DDS, MS, PhD, Valencia University Medical and Dental School, University of Valencia, Valencia, Spain
| | - I Camps
- Isabel Camps, DDS, Ms, PhD, Valencia University Medical and Dental School, University of Valencia, Valencia, Spain
| | - F Ata-Ali
- Fadi Ata-Ali, DDS, MS, PhD, private dental practice, Valencia, Spain
| | - J Ata-Ali
- *Javier Ata-Ali, DDS, MS, MPH, PhD, Universidad Europea de Valencia, Faculty of Health Sciences, Department of Dentistry, Public Dental Health Service, Conselleria de Sanitat Universal i Salut Pública, Generalitat Valenciana, Valencia, Spain
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Jablonski-Momeni A, Korbmacher-Steiner H, Temming A, Wernke P, Heinzel-Gutenbrunner M, Haak R, Krause F. Knowledge of undergraduate dental students regarding management of caries lesions. BDJ Open 2022; 8:9. [PMID: 35365612 PMCID: PMC8976014 DOI: 10.1038/s41405-022-00101-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives Understanding of lifelong control of disease processes associated with caries and its management is an essential part of dental education. This study evaluated the dental students’ knowledge of caries diagnosis and management using the International Caries Classification and Management System (ICCMS). Methods A survey was conducted among undergraduate dental students at two dental schools, attending the sixth (centre 1) and seventh semester (centre 2), respectively. Medical histories, clinical images and radiographs of 12 patients were compiled as anonymous cases. For each case, a specific lesion was to be assessed. In addition, the students should determine the patient’s caries risk and select a treatment option. An expert report (consensus decision) was used as the reference standard. For statistical analysis, kappa statistics and binomial tests were used. Results A total of 46 students participated in this study. The percentage of agreement of responses to the reference was: centre 1: 40.7–51.3%, centre 2: 57.9–67.9%. The corresponding Kappa values were: centre 1: 0.073–0.175, centre 2: 0.315–0.432. Overall, students tended to underestimate the codes compared to the reference standard (p < 0.001). Conclusion Introducing systematic content about caries diagnosis and management such as ICDAS and ICCMS in the learning objectives of undergraduate dental students can be proposed. However, in order to improve diagnosis and enable a more reliable choice of treatment options, attention should also be given to the way they are didactically taught.
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Affiliation(s)
- Anahita Jablonski-Momeni
- Department of Orthodontics, Medical Faculty, Dental School, Philipps-University Marburg, Marburg, Germany.
| | - Heike Korbmacher-Steiner
- Department of Orthodontics, Medical Faculty, Dental School, Philipps-University Marburg, Marburg, Germany
| | - Alexa Temming
- Department of Orthodontics, Medical Faculty, Dental School, Philipps-University Marburg, Marburg, Germany
| | - Pia Wernke
- Department of Orthodontics, Medical Faculty, Dental School, Philipps-University Marburg, Marburg, Germany
| | | | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Felix Krause
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany.,Clinic for Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital RWTH Aachen, Aachen, Germany
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Wang F, Su C, Yang C, von den Hoff JW, Bian Z, Meng L. Validity of near-infrared light transillumination for the assessment of proximal caries in permanent teeth. Aust Dent J 2021; 67:46-54. [PMID: 34689336 DOI: 10.1111/adj.12880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/06/2021] [Accepted: 10/18/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to evaluate the performance of DIAGNOcam (DC) in diagnosing proximal caries and to compare its effectiveness with the International Caries Detection and Assessment System (ICDAS) and bitewing radiography (BWR). METHODS 118 premolars extracted for orthodontic reasons were included and examined using three detection methods and validated by histological sections as the gold standard. The sensitivity, specificity and areas under the ROC curve (Az value) at the outer half enamel (D1), inner half enamel (D2) and dentine (D3) thresholds were compared between different methods. RESULTS At all categories, the specificity of DC was almost as high as ICDAS and BWR. DC showed a significantly higher sensitivity (0.68) than both visual (0.33) and radiographic examination (0.47) at the D1 threshold. DC presented the highest Az value (area under the ROC curve) at the D1 and D2 threshold (0.81, 0.86), while BWR showed the greatest Az values at D3 (0.94). Furthermore, DC had the highest association strength with the gold standard (Spearman's ρ = 0.80). CONCLUSIONS It can be concluded that DC could detect proximal caries effectively and showed comparable or even better performance than ICDAS and BWR.
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Affiliation(s)
- F Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory for Oral Biomedicine of Ministry of Education (KLOBM), School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - C Su
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory for Oral Biomedicine of Ministry of Education (KLOBM), School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - C Yang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory for Oral Biomedicine of Ministry of Education (KLOBM), School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - J W von den Hoff
- Department of Orthodontics and Craniofacial Biology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Z Bian
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory for Oral Biomedicine of Ministry of Education (KLOBM), School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - L Meng
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory for Oral Biomedicine of Ministry of Education (KLOBM), School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
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Thomas N, Kay E, Witton R, Quinn C. Comparison of a full arch digital photographic assessment of caries prevalence in 5-year-old children to an established visual assessment method: a cross-sectional study. BDJ Open 2021; 7:32. [PMID: 34433801 PMCID: PMC8387399 DOI: 10.1038/s41405-021-00087-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Digital epidemiology in dental disease screening has a number of advantages which warrant further exploration. Aim This study aimed to test the examination accuracy of digital images to evaluate child oral health by comparing the new method to a gold standard method. It also investigated the levels of diagnostic accuracy between different examiners, including dental care professionals and a lay examiner, when quantifying dental disease using images. Methods A calibrated dental examiner inspected forty 5-year-olds. In addition, three sets of digital images were taken per child. These images were assessed by six examiners. Sensitivity and specificity of caries diagnosis and inter-examiner reliability were calculated to compare the caries scores derived from examination of the images to those of the gold standard examinations. Results The mean values for sensitivity and specificity scores were 48.0% and 99.1%, respectively. The mean value for kappa showed moderate agreement between 0.43 and 0.73 (0.57). Mean values for agreement using intra-class coefficients were excellent (0.78) and good (0.73) for dt and dmft, respectively. No statistical difference in the validity of the caries scores was shown between the different image assessors. Conclusions These data demonstrate the feasibility of using digital images to screen child oral health and for nondental professionals to be recruited to carry out digital epidemiology for the oral health surveillance of children.
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Affiliation(s)
- Nicole Thomas
- Faculty of Health, University of Plymouth, Plymouth, UK.
| | - Elizabeth Kay
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Robert Witton
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Cath Quinn
- Faculty of Health, University of Plymouth, Plymouth, UK
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Duong DL, Kabir MH, Kuo RF. Automated caries detection with smartphone color photography using machine learning. Health Informatics J 2021; 27:14604582211007530. [PMID: 33863251 DOI: 10.1177/14604582211007530] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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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Affiliation(s)
| | | | - Rong Fu Kuo
- Department of Biomedical Engineering, National Cheng Kung University.,Medical Device Innovation Center, National Cheng Kung University
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Alkahtani A, Anderson P, Baysan A. The performance of SoproLIFE for early detection of coronal caries using the International Caries Classification and Management System - A preliminary laboratory-based study. Photodiagnosis Photodyn Ther 2021; 35:102422. [PMID: 34214688 DOI: 10.1016/j.pdpdt.2021.102422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/06/2021] [Accepted: 06/24/2021] [Indexed: 10/21/2022]
Abstract
The aim of this laboratory-based study is to evaluate performance of the Light-Induced Fluorescence Evaluator (SoproLIFE) for early detection of coronal caries and to validate the findings using the International Caries Classification and Management System (ICCMS). A total of 56 freshly extracted teeth with coronal carious lesions were included. 74 regions of interest were identified. Visual assessments with International Caries Detection and Assessment Systems (ICDAS), radiographic information and SoproLIFE images were used to classify each region of interest according to the ICCMS as a reference standard. SoproLIFE specificity and sensitivity were calculated at the sound-enamel and dentine lesion levels. Inter and intra reproducibility of ICDAS were analysed and showed a moderate agreement (0.52) and (0.58) respectively. At the sound-initial caries level, the sensitivity and specificity for the SoproLIFE were 90.0%, 95.8% respectively, whilst for the dentine caries level, sensitivity was 100% with specificity of 53.8%. A low proportion of teeth with dental caries were classified as caries-free using the SoproLIFE (false negative=10%). As a conclusion, the performance of SoproLIFE was promising in distinguishing between early enamel carious lesions and sound surfaces. This detection tool could be suggested to be used with ICCMS to assist in the clinical decision-making process.
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Affiliation(s)
- Ashwaq Alkahtani
- Centre for Oral Bioengineering, Institute of Dentistry, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Turner St, Whitechapel, E1 1FR London, UK.
| | - Paul Anderson
- Dental Physical Sciences Unit, Institute of Dentistry, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Aylin Baysan
- Centre for Oral Bioengineering, Institute of Dentistry, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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Duong DL, Nguyen QDN, Tong MS, Vu MT, Lim JD, Kuo RF. Proof-of-Concept Study on an Automatic Computational System in Detecting and Classifying Occlusal Caries Lesions from Smartphone Color Images of Unrestored Extracted Teeth. Diagnostics (Basel) 2021; 11:diagnostics11071136. [PMID: 34206549 PMCID: PMC8307588 DOI: 10.3390/diagnostics11071136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022] Open
Abstract
Dental caries has been considered the heaviest worldwide oral health burden affecting a significant proportion of the population. To prevent dental caries, an appropriate and accurate early detection method is demanded. This proof-of-concept study aims to develop a two-stage computational system that can detect early occlusal caries from smartphone color images of unrestored extracted teeth according to modified International Caries Detection and Assessment System (ICDAS) criteria (3 classes: Code 0; Code 1-2; Code 3-6): in the first stage, carious lesion areas were identified and extracted from sound tooth regions. Then, five characteristic features of these areas were intendedly selected and calculated to be inputted into the classification stage, where five classifiers (Support Vector Machine, Random Forests, K-Nearest Neighbors, Gradient Boosted Tree, Logistic Regression) were evaluated to determine the best one among them. On a set of 587 smartphone images of extracted teeth, our system achieved accuracy, sensitivity, and specificity that were 87.39%, 89.88%, and 68.86% in the detection stage when compared to modified visual and image-based ICDAS criteria. For the classification stage, the Support Vector Machine model was recorded as the best model with accuracy, sensitivity, and specificity at 88.76%, 92.31%, and 85.21%. As the first step in developing the technology, our present findings confirm the feasibility of using smartphone color images to employ Artificial Intelligence algorithms in caries detection. To improve the performance of the proposed system, there is a need for further development in both in vitro and in vivo modeling. Besides that, an applicable system for accurately taking intra-oral images that can capture entire dental arches including the occlusal surfaces of premolars and molars also needs to be developed.
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Affiliation(s)
- Duc Long Duong
- Department of Biomedical Engineering, National Cheng Kung University, Dasyue Rd, Tainan 701, Taiwan; (Q.D.N.N.); (R.F.K.)
- School of Odonto-Stomatology, Hanoi Medical University, Ton That Tung St, Hanoi City 10000, Vietnam; (M.S.T.); (M.T.V.)
- Correspondence: ; Tel.: +886-968-685-225 or +84-935-759-669
| | - Quoc Duy Nam Nguyen
- Department of Biomedical Engineering, National Cheng Kung University, Dasyue Rd, Tainan 701, Taiwan; (Q.D.N.N.); (R.F.K.)
| | - Minh Son Tong
- School of Odonto-Stomatology, Hanoi Medical University, Ton That Tung St, Hanoi City 10000, Vietnam; (M.S.T.); (M.T.V.)
| | - Manh Tuan Vu
- School of Odonto-Stomatology, Hanoi Medical University, Ton That Tung St, Hanoi City 10000, Vietnam; (M.S.T.); (M.T.V.)
| | - Joseph Dy Lim
- Center of Dentistry, COAHS, University of Makati, J.P. Rizal Ext, Makati, Metro Manila 1215, Philippines;
| | - Rong Fu Kuo
- Department of Biomedical Engineering, National Cheng Kung University, Dasyue Rd, Tainan 701, Taiwan; (Q.D.N.N.); (R.F.K.)
- Medical Device Innovation Center, National Cheng Kung University, Shengli Rd, Tainan 704, Taiwan
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Macey R, Walsh T, Riley P, Glenny AM, Worthington HV, O'Malley L, Clarkson JE, Ricketts D. Visual or visual-tactile examination to detect and inform the diagnosis of enamel caries. Cochrane Database Syst Rev 2021; 6:CD014546. [PMID: 34124773 PMCID: PMC8428329 DOI: 10.1002/14651858.cd014546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The detection and diagnosis of caries at the initial (non-cavitated) and moderate (enamel) levels of severity is fundamental to achieving and maintaining good oral health and prevention of oral diseases. An increasing array of methods of early caries detection have been proposed that could potentially support traditional methods of detection and diagnosis. Earlier identification of disease could afford patients the opportunity of less invasive treatment with less destruction of tooth tissue, reduce the need for treatment with aerosol-generating procedures, and potentially result in a reduced cost of care to the patient and to healthcare services. OBJECTIVES To determine the diagnostic accuracy of different visual classification systems for the detection and diagnosis of non-cavitated coronal dental caries for different purposes (detection and diagnosis) and in different populations (children or adults). SEARCH METHODS Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 30 April 2020); Embase Ovid (1980 to 30 April 2020); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 30 April 2020); and the World Health Organization International Clinical Trials Registry Platform (to 30 April 2020). We studied reference lists as well as published systematic review articles. SELECTION CRITERIA We included diagnostic accuracy study designs that compared a visual classification system (index test) with a reference standard (histology, excavation, radiographs). This included cross-sectional studies that evaluated the diagnostic accuracy of single index tests and studies that directly compared two or more index tests. Studies reporting at both the patient or tooth surface level were included. In vitro and in vivo studies were considered. Studies that explicitly recruited participants with caries into dentine or frank cavitation were excluded. We also excluded studies that artificially created carious lesions and those that used an index test during the excavation of dental caries to ascertain the optimum depth of excavation. DATA COLLECTION AND ANALYSIS We extracted data independently and in duplicate using a standardised data extraction and quality assessment form based on QUADAS-2 specific to the review context. Estimates of diagnostic accuracy were determined using the bivariate hierarchical method to produce summary points of sensitivity and specificity with 95% confidence intervals (CIs) and regions, and 95% prediction regions. The comparative accuracy of different classification systems was conducted based on indirect comparisons. Potential sources of heterogeneity were pre-specified and explored visually and more formally through meta-regression. MAIN RESULTS We included 71 datasets from 67 studies (48 completed in vitro) reporting a total of 19,590 tooth sites/surfaces. The most frequently reported classification systems were the International Caries Detection and Assessment System (ICDAS) (36 studies) and Ekstrand-Ricketts-Kidd (ERK) (15 studies). In reporting the results, no distinction was made between detection and diagnosis. Only two studies were at low risk of bias across all four domains, and 15 studies were at low concern for applicability across all three domains. The patient selection domain had the highest proportion of high risk of bias studies (49 studies). Four studies were assessed at high risk of bias for the index test domain, nine for the reference standard domain, and seven for the flow and timing domain. Due to the high number of studies on extracted teeth concerns regarding applicability were high for the patient selection and index test domains (49 and 46 studies respectively). Studies were synthesised using a hierarchical bivariate method for meta-analysis. There was substantial variability in the results of the individual studies: sensitivities ranged from 0.16 to 1.00 and specificities from 0 to 1.00. For all visual classification systems the estimated summary sensitivity and specificity point was 0.86 (95% CI 0.80 to 0.90) and 0.77 (95% CI 0.72 to 0.82) respectively, diagnostic odds ratio (DOR) 20.38 (95% CI 14.33 to 28.98). In a cohort of 1000 tooth surfaces with 28% prevalence of enamel caries, this would result in 40 being classified as disease free when enamel caries was truly present (false negatives), and 163 being classified as diseased in the absence of enamel caries (false positives). The addition of test type to the model did not result in any meaningful difference to the sensitivity or specificity estimates (Chi2(4) = 3.78, P = 0.44), nor did the addition of primary or permanent dentition (Chi2(2) = 0.90, P = 0.64). The variability of results could not be explained by tooth surface (occlusal or approximal), prevalence of dentinal caries in the sample, nor reference standard. Only one study intentionally included restored teeth in its sample and no studies reported the inclusion of sealants. We rated the certainty of the evidence as low, and downgraded two levels in total for risk of bias due to limitations in the design and conduct of the included studies, indirectness arising from the in vitro studies, and inconsistency of results. AUTHORS' CONCLUSIONS Whilst the confidence intervals for the summary points of the different visual classification systems indicated reasonable performance, they do not reflect the confidence that one can have in the accuracy of assessment using these systems due to the considerable unexplained heterogeneity evident across the studies. The prediction regions in which the sensitivity and specificity of a future study should lie are very broad, an important consideration when interpreting the results of this review. Should treatment be provided as a consequence of a false-positive result then this would be non-invasive, typically the application of fluoride varnish where it was not required, with low potential for an adverse event but healthcare resource and finance costs. Despite the robust methodology applied in this comprehensive review, the results should be interpreted with some caution due to shortcomings in the design and execution of many of the included studies. Studies to determine the diagnostic accuracy of methods to detect and diagnose caries in situ are particularly challenging. Wherever possible future studies should be carried out in a clinical setting, to provide a realistic assessment of performance within the oral cavity with the challenges of plaque, tooth staining, and restorations, and consider methods to minimise bias arising from the use of imperfect reference standards in clinical studies.
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Affiliation(s)
- Richard Macey
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Philip Riley
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Anne-Marie Glenny
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Lucy O'Malley
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Janet E Clarkson
- Division of Oral Health Sciences, Dundee Dental School, University of Dundee, Dundee, UK
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10
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Zhang X, Liang Y, Li W, Liu C, Gu D, Sun W, Miao L. Development and evaluation of deep learning for screening dental caries from oral photographs. Oral Dis 2020; 28:173-181. [PMID: 33244805 DOI: 10.1111/odi.13735] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/02/2020] [Accepted: 11/17/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Xuan Zhang
- Department of Periodontology Nanjing Stomatological Hospital Medical School of Nanjing University Nanjing China
| | - Yuan Liang
- University of California Los Angeles CA USA
| | - Wen Li
- Department of Endodontics Nanjing Stomatological Hospital Medical School of Nanjing University Nanjing China
| | - Chao Liu
- Department of Orthodontics Nanjing Stomatological Hospital Medical School of Nanjing University Nanjing China
| | - Deao Gu
- Department of Orthodontics Nanjing Stomatological Hospital Medical School of Nanjing University Nanjing China
| | - Weibin Sun
- Department of Periodontology Nanjing Stomatological Hospital Medical School of Nanjing University Nanjing China
| | - Leiying Miao
- Department of Endodontics Nanjing Stomatological Hospital Medical School of Nanjing University Nanjing China
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11
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Wilde S, Campos PH, Marcondes APM, Moura-Netto C, Novaes TF, Lussi A, Diniz MB. Optical magnification has no benefits on the detection of occlusal caries lesions in permanent molars using different visual scoring systems: An in vitro study. J Clin Exp Dent 2020; 12:e479-e487. [PMID: 32509231 PMCID: PMC7263771 DOI: 10.4317/jced.56445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/27/2020] [Indexed: 01/22/2023] Open
Abstract
Background Some studies have addressed the influence of optical magnification on the detection of caries lesions using a visual scoring system. However, there is a lack of research related to the use of the CAST and ADA-CCS visual scoring systems. In addition, the reliability and accuracy of ADA-CCS index in permanent teeth were not studied yet. So, the aim of this study was to evaluate, in vitro, the influence of different levels of optical magnification on the detection of occlusal caries lesions in permanent molars using three visual scoring systems. Material and Methods One occlusal site per tooth was analyzed in 120 extracted permanent molars. Two trained examiners inspected the teeth using ICDAS (International Caries Detection and Assessment System), CAST (Caries Assessment Spectrum and Treatment), and ADA-CCS (American Dental Association-Caries Classification System) visual criteria, twice with each scoring system, with a one-week interval between examinations. The study was conducted in three phases: (A) without optical magnification, (B) using a binocular lens (3.5× magnification), and (C) using an operating microscope (16× magnification). Then, the teeth were sectioned longitudinally through the center of the selected site and the section with the more severe lesion was histological evaluated considering the D1 (lesions in enamel and dentin) and D3 (dentin lesions) thresholds. Results Kappa values for intra- and inter-examiner reproducibility were good to excellent for all systems. At the D1 threshold, sensitivity, accuracy, and area under the ROC curve were high for ICDAS and CAST in all phases. However, this was not the case for the ADA-CCS in phase C (<0.05). At the D3 diagnostic threshold, there was no significant difference between the visual scoring systems during the study phases (>0.05). Conclusions The magnification does not improve the accuracy of the visual scoring systems in the detection of occlusal caries lesions in permanent molars. Key words:Dental caries, caries detection, permanent teeth, visual examination, magnification.
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Affiliation(s)
- Sabrina Wilde
- School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | - Cacio Moura-Netto
- Faculty of Dental Medicine, Center for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, Viseu, Portugal
| | | | - Adrian Lussi
- Center for Dental Medicine, Medical Center, University of Freiburg - Freiburg, Germany
| | - Michele-Baffi Diniz
- Post-graduate Program in Dentistry, Cruzeiro do Sul University - São Paulo, SP, Brazil
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12
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Moutselos K, Berdouses E, Oulis C, Maglogiannis I. Recognizing Occlusal Caries in Dental Intraoral Images Using Deep Learning. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:1617-1620. [PMID: 31946206 DOI: 10.1109/embc.2019.8856553] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Based on an image dataset of 88 in-vivo dental images taken with an intra-oral camera, we show that a Deep Learning model (Mask R-CNN) can detect and classify dental caries on occlusal surfaces across the whole 7-class ICDAS (International Caries Detection and Assessment System) scale. This is accomplished without any image pre-processing method and by utilizing superpixels segmentation for the experts' annotations and the evaluation of the classifier. In the proposed methodology, transfer learning and data augmentation are employed during the training of the model. The paper discusses technical details, provides initial results and denotes points for further improvement by fine-tuning the classifier along with an extended dataset.
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13
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Digital photography vs. clinical assessment of resin composite restorations. Odontology 2020; 109:184-192. [PMID: 32274674 DOI: 10.1007/s10266-020-00511-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 03/24/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE To compare direct clinical and indirect digital photographic assessment of resin composite restorations. Ninety-two posterior resin composite restorations were classified using World Dental Federation (FDI) criteria by two different clinical examiners (C1 and C2). In the same appointment of clinical assessment, intraoral high-quality digital photographs were taken and posteriorly two different digital examiners (D1 and D2) classified the images of each restoration. Restorations of each patient were assessed once by C1 and C2 independently. D1 and D2 assessed the digital images from different locations and in different time. Data were analyzed using the Cohen's kappa coefficient, Kruskal-Wallis non-parametric test and Dunn's multiple shared test, with 95% confidence. Agreement levels varied from very good (0.81-1.00) to fair (0.21-0.40). Statistically significant differences (p < 0.05) between assessments were found for surface lustre, staining, color match and translucency, esthetic anatomical form, fracture of material and retention and marginal adaptation. The classification of the resin composite restorations varied significantly according to clinical or high-quality digital photographic assessments. Overall, clinical assessment detected more demand for repair or replacement.
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14
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Qudeimat MA, Altarakemah Y, Alomari Q, Alshawaf N, Honkala E. The impact of ICDAS on occlusal caries treatment recommendations for high caries risk patients: an in vitro study. BMC Oral Health 2019; 19:41. [PMID: 30845943 PMCID: PMC6407207 DOI: 10.1186/s12903-019-0730-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 02/25/2019] [Indexed: 11/24/2022] Open
Abstract
Background The diagnostic criteria and tools used in caries lesion detection have been shown to affect the decision-making for caries treatment. Compared to other diagnostic criteria/classifications, ICDAS has been shown to provide a more accurate method for the detection of occlusal caries lesions. The influence of using ICDAS on caries treatment recommendations has received increasing attention in recent years. Therefore, the aim of this study was to assess the impact of ICDAS on dentists’ occlusal caries lesions’ treatment decisions for patients at high risk for caries. Methods Five dentists examined the occlusal surfaces of 270 extracted premolars and permanent molars. For a predetermined clinical scenario, the examiners were asked to indicate their treatment recommendations for each tooth. Four weeks later, all the examiners were trained and calibrated for the use of ICDAS. Then the investigators examined the same 270 teeth independently and indicated their treatment recommendations using the same clinical scenario. Histological validation was used to determine the caries lesions detection performance of the examiners using ICDAS and to assess the relationship between the presence of dentin caries and treatment recommendations for each examiner before and after ICDAS training. Specificity, sensitivity, area under the receiver operating characteristic curve (AUC), and Spearman’s correlation coefficients were calculated. The Wilcoxon two-related sample rank test was used to test for differences between treatment recommendations. Results The strongest correlation for inter-examiner reproducibility was found between the ICDAS D2 cut-off point (ICDAS codes 3–6 as dentin caries) and histologic dentin caries. Treatment recommendations among different examiners before and after ICDAS training demonstrated a statistically significant increase in operative intervention and an increase in the percentage of overtreatment recommendations for two examiners. Conclusions The impact of ICDAS on the examiners’ caries lesion treatment recommendations varied among the dentists in this study. Treatment decision-making can be influenced by the caries lesion’s detection and classification system used.
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Affiliation(s)
- Muawia A Qudeimat
- Department of Developmental and Preventive Sciences, Faculty of Dentistry, Kuwait University, P.O.Box: 24923, Safat-13110, Kuwait, Kuwait.
| | | | - Qasem Alomari
- Department of Restorative Sciences, Kuwait University, Kuwait, Kuwait
| | - Nour Alshawaf
- Department of General Dental Practice, Kuwait University, Kuwait, Kuwait
| | - Eino Honkala
- Institute of Clinical Dentistry, UiT, The Arctic University of Norway, Tromsø, Norway
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Vaswani S, Sharma DS, Mishra S, Sharma S. Histologic validation of ICDAS-II and polarization sensitive optical coherence tomography to detect smooth surface early carious lesions. Int J Paediatr Dent 2018; 29:193-202. [PMID: 30387228 DOI: 10.1111/ipd.12440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 11/27/2022]
Abstract
AIM This in vitro study aimed to histologically validate and compare the methods for detection of smooth surface early carious lesions (ECLs) that is, International caries detection and assessment system for the smooth surface (ICDAS-II-SSC), Polarization sensitive optical coherence tomography (PS-OCT), and radiography. METHODOLOGY PS-OCT images for scores 0-3 of ICDAS-II-SSC were standardized according to ECLs' depth. Preliminary PS-OCT images for ICDAS-II-SSC score-2 of pigmented ECLs showed reduced lesion depth and therefore were dichotomized into scores 2 and 2p for white and pigmented lesions (ICDAS-II-SSCm). ECLs on one hundred freshly extracted teeth were scored by three examiners for ICDAS-II-SSCm, PS-OCT, radiography, and histology. RESULTS Compared to histology, ICDAS-II-SSCm showed a strong positive correlation followed by PS-OCT and radiographic evaluation. ICDAS-II-SSCm had a strong positive correlation with PS-OCT, while both variables had a weak positive correlation with radiography. PS-OCT detected the activity of ECLs by directly relating the image depth of ECLs to their mineral volume content. CONCLUSION The current scope of ICDAS-II should be reviewed since the pigmentation can be misinterpreted as an active lesion. Till then, ICDAS-II-SSC is an effective visual method for early caries detection. PS-OCT has the potential to become a probe with the proper algorithm for diagnostic purposes.
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Affiliation(s)
- Sneha Vaswani
- Department of Pediatric and Preventive dentisty, Modern Dental College & Research Centre, Indore, India
| | - Divya S Sharma
- Department of Pediatric and Preventive dentisty, Modern Dental College & Research Centre, Indore, India
| | - Shikha Mishra
- Department of Pediatric and Preventive dentisty, Modern Dental College & Research Centre, Indore, India
| | - Sanjay Sharma
- Department of Prosthodontics, Crown& Bridge and Implantology, Modern Dental College & Research Centre, Indore, India
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Carvalho RND, Letieri ADS, Vieira TI, Santos TMPD, Lopes RT, Neves ADA, Pomarico L. Accuracy of visual and image-based ICDAS criteria compared with a micro-CT gold standard for caries detection on occlusal surfaces. Braz Oral Res 2018; 32:e60. [PMID: 29995065 DOI: 10.1590/1807-3107bor-2018.vol32.0060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 05/18/2018] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to check the in vitro accuracy of ICDAS criteria on digital images compared to visual examination for the diagnosis of occlusal caries against a micro-CT gold standard. ICDAS was scored in 40 extracted permanent molars by means of visual inspection and stereomicroscopic images. Visual examinations were performed in duplicate and at a one-week interval by three different calibrated examiners. The analysis of digital images by ICDAS criteria was also performed in duplicate, 1 month after visual examinations. The detection methods were compared by means of sensitivity, specificity, area under the curve, predictive positive and negative values, and accuracy for two different thresholds (1- sound vs. carious teeth; 2- tooth requiring operative vs. non-operative treatment). Sensitivity and accuracy values for threshold 1 in the visual ICDAS and image-based ICDAS methods were high for sensitivity (0.93 and 0.97) and for accuracy (0.83 and 0.85), but low for specificity (0.55 for both methods). Specificity values for threshold 2 were 0.77 and 0.82, while sensitivity was 0.33 and 0.28 for each method. Spearman's rank correlation coefficient was 0.53 and 0.43 (p<0.05) for visual and image-based ICDAS compared to the gold standard scores. Both visual and image-based ICDAS scores were similar to each other in terms of diagnostic accuracy when compared to the micro-CT gold standard. Low specificity for the presence of caries and sensitivity for the detection of caries requiring operative treatment were found.
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Affiliation(s)
- Raquel Nogueira de Carvalho
- Universidade Federal do Rio de Janeiro - UFRJ, School of Dentistry, Department of Pediatric Dentistry and Orthodontics, Rio de Janeiro, RJ, Brazil
| | - Aline Dos Santos Letieri
- Universidade Federal do Rio de Janeiro - UFRJ, School of Dentistry, Department of Pediatric Dentistry and Orthodontics, Rio de Janeiro, RJ, Brazil
| | - Thiago Isidro Vieira
- Universidade Federal do Rio de Janeiro - UFRJ, School of Dentistry, Department of Pediatric Dentistry and Orthodontics, Rio de Janeiro, RJ, Brazil
| | - Thais Maria Pires Dos Santos
- Universidade Federal do Rio de Janeiro - UFRJ, Laboratory for Nuclear Instrumentation, Rio de Janeiro, RJ, Brazil
| | - Ricardo Tadeu Lopes
- Universidade Federal do Rio de Janeiro - UFRJ, Laboratory for Nuclear Instrumentation, Rio de Janeiro, RJ, Brazil
| | - Aline de Almeida Neves
- Universidade Federal do Rio de Janeiro - UFRJ, School of Dentistry, Department of Pediatric Dentistry and Orthodontics, Rio de Janeiro, RJ, Brazil
| | - Luciana Pomarico
- Universidade Federal do Rio de Janeiro - UFRJ, School of Dentistry, Department of Pediatric Dentistry and Orthodontics, Rio de Janeiro, RJ, Brazil
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Boca C, Truyen B, Henin L, Schulte AG, Stachniss V, De Clerck N, Cornelis J, Bottenberg P. Comparison of micro-CT imaging and histology for approximal caries detection. Sci Rep 2017; 7:6680. [PMID: 28751671 PMCID: PMC5532299 DOI: 10.1038/s41598-017-06735-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/07/2017] [Indexed: 11/21/2022] Open
Abstract
Histological sectioning is a generally accepted in vitro validation method for caries detection techniques. However, it requires cumbersome sample preparation and induces irreversible sample destruction. Micro-Computer Tomography (micro-CT) allows non-destructive imaging of tooth structure. The aim of this study was to compare the performance of histological sectioning and micro-CT imaging in detecting approximal carious lesions. Unlike previous studies, evaluation is objectified by comparing visual appearance of exactly corresponding anatomical regions. Sixty extracted human teeth were scanned with a desktop micro CT system. Axial histological slices were prepared and photographed. Sample preparation, combined with dedicated image processing, ensured selection of identical anatomical regions on radiographic and histological images. Evaluation of the presence and extent of carious lesions was performed by four dentists using custom-designed software. Each section was scored independently (histo or micro CT). Scores of approximal surfaces were retained for further analysis. Spearman’s correlation coefficients (0.738 to 0.829, p < 0.0001) showed a good agreement between signs of carious lesions in the identical region obtained with both methods. Bland-Altman plots showed that 90.76% of the data points were within the limits of agreement. Micro-CT imaging was shown to provide an interesting alternative to histological sectioning as detection method for carious lesions.
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Affiliation(s)
- C Boca
- Department of Electronics and Informatics - ETRO Vrije Universiteit Brussel, Brussels, Belgium.,EXIA, Brussels, Belgium
| | - B Truyen
- Department of Electronics and Informatics - ETRO Vrije Universiteit Brussel, Brussels, Belgium.,EXIA, Brussels, Belgium
| | - L Henin
- Oral Health Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - A G Schulte
- Department of Special Care Dentistry, Universität Witten/Herdecke, Witten, Germany
| | - V Stachniss
- Department of Conservative Dentistry, Universität Marburg, Marburg, Germany
| | - N De Clerck
- Microtomography Research Group, Department of Biomedical Sciences University Antwerp, Antwerp, Belgium
| | - J Cornelis
- Department of Electronics and Informatics - ETRO Vrije Universiteit Brussel, Brussels, Belgium
| | - P Bottenberg
- Oral Health Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
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