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Liu XX, Li G. Diagnostic performance of approximal caries in bitewing radiographs from different monitors and room illuminances. Dentomaxillofac Radiol 2025; 54:125-131. [PMID: 39602601 DOI: 10.1093/dmfr/twae061] [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: 07/27/2024] [Revised: 10/12/2024] [Accepted: 11/13/2024] [Indexed: 11/29/2024] Open
Abstract
OBJECTIVE To compare the accuracy, duration, and certainty of diagnosing approximal caries in bitewing radiographs displayed in 3 monitors under 2 luminance conditions. METHODS A total of 39 teeth without evident caries were selected from 11 patients undergoing partial jaw resection. Before the operation, 13 bitewing radiographs were captured by a digital imaging system. Eight observers evaluated the images under dark (9 lux) and bright (200 lux) conditions, using 2 medical-grade monitors and a commercial monitor. Using histological results as the gold standard, the areas under the receiver operating characteristic curves under different conditions were compared using the Z-test. Multivariate analysis of variance was conducted to assess the impact of various factors on diagnostic duration, while ordinal logistic regression was used to examine factors influencing diagnostic certainty level. It was considered significant when P < .05. RESULTS No significant difference was found in the diagnostic accuracy or duration for diagnosis of approximal caries under 2 luminance conditions with the 3 distinct monitors (P > .05). Ambient light, clinical experience, and the pathological grade of approximal caries have influence on the degree of diagnostic confidence (P < .05). CONCLUSIONS Different monitors and ambient luminance didn't influence the diagnostic accuracy or evaluation duration. Ambient luminance, clinical experience, and the depth of caries affect the degree of diagnostic confidence. ADVANCES IN KNOWLEDGE The study employing bitewing radiographs from real patients indicates that ambient luminance, clinical experience, and the depth of caries affect the degree of diagnostic confidence.
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Affiliation(s)
- Xiao-Xuan Liu
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Beijing, 100081, China
- National Center for Stomatology, Beijing, 100081, China
- National Clinical Research Center for Oral Diseases, Beijing, 100081, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, 100081, China
- Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, China
- NHC Key Laboratory of Digital Stomatology, Beijing, 100081, China
- NMPA Key Laboratory for Dental Materials, Beijing, 100081, China
| | - Gang Li
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Beijing, 100081, China
- National Center for Stomatology, Beijing, 100081, China
- National Clinical Research Center for Oral Diseases, Beijing, 100081, China
- National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, 100081, China
- Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, China
- NHC Key Laboratory of Digital Stomatology, Beijing, 100081, China
- NMPA Key Laboratory for Dental Materials, Beijing, 100081, China
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Munhoz EA, Xavier CRG, Salles RP, Capelozza ALA, Bodanezi AV. Convenient model of hard tissue simulation for dental radiographic research and instruction. World J Methodol 2024; 14:88850. [PMID: 38577207 PMCID: PMC10989409 DOI: 10.5662/wjm.v14.i1.88850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/20/2023] [Accepted: 01/19/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The authors describe a technique for building an alternative jawbone phantom using dental gypsum and rice for research and dental radiology instruction. AIM To investigate the potential of an alternative phantom to simulate the trabecular bone aspect of the human maxilla in periapical radiographs. METHODS Half-maxillary phantoms built from gypsum-ground rice were exposed to X-rays, and the resulting images (experimental group) were compared to standardized radiographic images produced from dry human maxillary bone (control group) (n = 7). The images were blindly assessed according to strict criteria by three examiners for the usual trabecular aspects of the surrounding bone, and significant differences between groups and in assessment reliability were compared using Fisher's exact and kappa tests (α = 0.05). RESULTS The differences in the trabecular aspects between groups were not statistically significant. In addition, interobserver agreement among observers was 0.43 and 0.51 for the control and experimental groups, respectively, whereas intraobserver agreement was 0.71 and 0.73, respectively. CONCLUSION The tested phantom seemed to demonstrate potential for trabecular bone image simulation on maxillary periapical radiographs.
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Affiliation(s)
- Etiene Andrade Munhoz
- Department of Dentistry, Health Science Centre, Federal University of Santa Catarina, Florianopolis 88040-379, Brazil
| | - Claudio Roberto Gaiao Xavier
- Department of Stomatology, Radiology and Oral Surgery, School of Dentistry, University of São Paulo, Bauru 17012-901, Brazil
| | - Roberto Ponce Salles
- Department of Stomatology, Radiology and Oral Surgery, School of Dentistry, University of São Paulo, Bauru 17012-901, Brazil
| | - Ana Lúcia Alvares Capelozza
- Department of Stomatology, Radiology and Oral Surgery, School of Dentistry, University of São Paulo, Bauru 17012-901, Brazil
| | - Augusto Vanni Bodanezi
- Department of Dentistry, Health Science Centre, Federal University of Santa Catarina, Florianopolis 88040-379, Brazil
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Altukroni A, Alsaeedi A, Gonzalez-Losada C, Lee JH, Alabudh M, Mirah M, El-Amri S, Ezz El-Deen O. Detection of the pathological exposure of pulp using an artificial intelligence tool: a multicentric study over periapical radiographs. BMC Oral Health 2023; 23:553. [PMID: 37563659 PMCID: PMC10416487 DOI: 10.1186/s12903-023-03251-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Introducing artificial intelligence (AI) into the medical field proved beneficial in automating tasks and streamlining the practitioners' lives. Hence, this study was conducted to design and evaluate an AI tool called Make Sure Caries Detector and Classifier (MSc) for detecting pathological exposure of pulp on digital periapical radiographs and to compare its performance with dentists. METHODS This study was a diagnostic, multi-centric study, with 3461 digital periapical radiographs from three countries and seven centers. MSc was built using Yolov5-x model, and it was used for exposed and unexposed pulp detection. The dataset was split into a train, validate, and test dataset; the ratio was 8-1-1 to prevent overfitting. 345 images with 752 labels were randomly allocated to test MSc. The performance metrics used to test MSc performance included mean average precision (mAP), precision, F1 score, recall, and area under receiver operating characteristic curve (AUC). The metrics used to compare the performance with that of 10 certified dentists were: right diagnosis exposed (RDE), right diagnosis not exposed (RDNE), false diagnosis exposed (FDE), false diagnosis not exposed (FDNE), missed diagnosis (MD), and over diagnosis (OD). RESULTS MSc achieved a performance of more than 90% in all metrics examined: an average precision of 0.928, recall of 0.918, F1-score of 0.922, and AUC of 0.956 (P<.05). The results showed a higher mean of 1.94 for all right (correct) diagnosis parameters in MSc group, while a higher mean of 0.64 for all wrong diagnosis parameters in the dentists group (P<.05). CONCLUSIONS The designed MSc tool proved itself reliable in the detection and differentiating between exposed and unexposed pulp in the internally validated model. It also showed a better performance for the detection of exposed and unexposed pulp when compared to the 10 dentists' consensus.
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Affiliation(s)
| | - A Alsaeedi
- Department of Computer Science, College of Computer Science and Engineering, Taibah University, Medina, Saudi Arabia
| | - C Gonzalez-Losada
- School of Dentistry, Complutense University of Madrid, Madrid, Spain
| | - J H Lee
- Department of Periodontology, College of Dentistry and Institute of Oral Bioscience, Jeonbuk National University, Jeonju, Korea
| | - M Alabudh
- Ministry of Health, Medina, Saudi Arabia
| | - M Mirah
- Department of Dental Materials, Taibah University, Medina, Saudi Arabia
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Hegde S, Gao J, Vasa R, Cox S. Factors affecting interpretation of dental radiographs. Dentomaxillofac Radiol 2023; 52:20220279. [PMID: 36472942 PMCID: PMC9974235 DOI: 10.1259/dmfr.20220279] [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: 08/24/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To identify the factors influencing errors in the interpretation of dental radiographs. METHODS A protocol was registered on Prospero. All studies published until May 2022 were included in this review. The search of the electronic databases spanned Ovid Medline, PubMed, EMBASE, Web of Science and Scopus. The quality of the studies was assessed using the MMAT tool. Due to the heterogeneity of the included studies, a meta-analysis was not conducted. RESULTS The search yielded 858 articles, of which eight papers met the inclusion and exclusion criteria and were included in the systematic review. These studies assessed the factors influencing the accuracy of the interpretation of dental radiographs. Six factors were identified as being significant that affected the occurrence of interpretation errors. These include clinical experience, clinical knowledge, and technical ability, case complexity, time pressure, location and duration of dental education and training and cognitive load. CONCLUSIONS The occurrence of interpretation errors has not been widely investigated in dentistry. The factors identified in this review are interlinked. Further studies are needed to better understand the extent of the occurrence of interpretive errors and their impact on the practice of dentistry.
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Affiliation(s)
- Shwetha Hegde
- Academic Fellow, Dentomaxillofacial Radiology, Sydney Dental School, University of Sydney, Sydney, Australia
| | - Jinlong Gao
- Senior Lecturer, Sydney Dental School, Institute of Dental Research, Westmead Centre for Oral Health, University of Sydney, Sydney, Australia
| | - Rajesh Vasa
- Head of Translational Research and Development, Applied Artificial Intelligence, Deakin University, Melbourne, Australia
| | - Stephen Cox
- Head of Discipline, Discipline of Oral Surgery, Sydney Dental School, University of Sydney, Sydney, Australia
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Near-Infrared Transillumination for Occlusal Carious Lesion Detection: A Retrospective Reliability Study. Diagnostics (Basel) 2022; 13:diagnostics13010036. [PMID: 36611328 PMCID: PMC9818492 DOI: 10.3390/diagnostics13010036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/24/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022] Open
Abstract
The aim of this study was to assess the reliability of three diagnostic methods (near-infrared transillumination (NIRT), bitewing radiographs (BW), and clinical images (CI)) to detect occlusal carious lesions in a low caries risk population. This retrospective analysis included one hundred and eighty-eight occlusal surfaces, scored as sound surface, early lesion, or distinct lesion. We evaluated the agreement between and within the methods over time. Kappa statistics tested the correlation between the methods. Examiners detected occlusal early lesions more frequently with visual examination and NIRT and the same lesions were confirmed on the 2-year follow-up. Within the limitations of this study, we were able to establish that early occlusal lesions can be detected and monitored over time using NIRT and visual exam, while BW scores showed mostly sound surfaces at both examinations. NIRT combined with clinical examination can be considered appropriate to detect and monitor early enamel caries on the occlusal surface in low caries-risk populations.
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The Diagnostic Relevance and Interfaces Covered by Mach Band Effect in Dentistry: An Analysis of the Literature. Healthcare (Basel) 2022; 10:healthcare10040632. [PMID: 35455810 PMCID: PMC9026821 DOI: 10.3390/healthcare10040632] [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: 03/17/2022] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 12/04/2022] Open
Abstract
This work surveyed how the Mach band effect was mentioned in the dental literature and provided a qualitative assessment of diagnostic relevance and interfaces covered. PubMed, Scopus, and Google Scholar were queried in mid-Jan 2022. The search string was (“mach band effect” OR “mach effect”) AND (dental OR oral OR tooth OR teeth OR maxillofacial OR orofacial). All publications returned by the searches were screened. Exclusion criteria included irrelevance (e.g., dealing with “Mach effect” that was non-radiographic or non-dental) and not written in English. Reference lists of returned publications were manually searched to identify potentially missed papers. For each included publication, the following parameters were recorded: any presentation of radiographic images showing a Mach band effect, direct investigation of the effect, relevance to which structural interfaces, diagnostic relevance, and in which parts of the publication Mach band effect was mentioned. Seventy-seven publications were included and analyzed. The majority of the publications mentioned the Mach band effect in the Discussion section about its diagnostic relevance to caries detection at the enamel-dentinal junction and the interface between restorative material and tooth structure. Eight of them presented radiographic images showing a Mach band effect. Three of them investigated the Mach band effect. Dental publications seldom covered the Mach band effect. When they covered it, most of them only mentioned it in the Discussion section without actually investigating it.
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Basri KN, Yazid F, Megat Abdul Wahab R, Mohd Zain MN, Md Yusof Z, Zoolfakar AS. Chemometrics analysis for the detection of dental caries via UV absorption spectroscopy. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2022; 266:120464. [PMID: 34634732 DOI: 10.1016/j.saa.2021.120464] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
Caries is one of the non-communicable diseases that has a high prevalence trend. The current methods used to detect caries require sophisticated laboratory equipment, professional inspection, and expensive equipment such as X-ray imaging device. A non-invasive and economical method is required to substitute the conventional methods for the detection of caries. UV absorption spectroscopy coupled with chemometrics analysis has emerged as a good potential candidate for such an application. Data preprocessing methods such as mean centre, autoscale and Savitzky-Golay smoothing were implemented to enhance the signal-to-noise ratio of spectra data. Various classification algorithms namely K-nearest neighbours (KNN), logistic regression (LR) and linear discriminant analysis (LDA) were implemented to classify the severity of dental caries into International Caries Detection and Assessment System (ICDAS) scores. The performance of the prediction model was measured and comparatively analysed based on the accuracy, precision, sensitivity, and specificity. The LDA algorithm combined with the Savitzky-Golay preprocessing method had shown the best result with respect to the validation data accuracy, precision, sensitivity and specificity, where each had values of 0.90, 1.00, 0.86 and 1.00 respectively. The area under the curve of the ROC plot computed for the LDA algorithm was 0.95, which indicated that the prediction algorithm was capable of differentiating normal and caries teeth excellently.
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Affiliation(s)
- Katrul Nadia Basri
- School of Electrical Engineering, College of Engineering, Universiti Teknologi MARA, 40450 Shah Alam, Selangor, Malaysia
| | - Farinawati Yazid
- Faculty of Dentistry, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | | | - Mohd Norzaliman Mohd Zain
- Photonics Technology Laboratory, MIMOS Berhad, Technology Park Malaysia, 57000 Kuala Lumpur, Malaysia
| | - Zalhan Md Yusof
- Photonics Technology Laboratory, MIMOS Berhad, Technology Park Malaysia, 57000 Kuala Lumpur, Malaysia
| | - Ahmad Sabirin Zoolfakar
- School of Electrical Engineering, College of Engineering, Universiti Teknologi MARA, 40450 Shah Alam, Selangor, Malaysia.
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Neuhaus KW, Eggmann F, Kühnisch J, Kapor S, Janjic Rankovic M, Schüler I, Krause F, Lussi A, Michou S, Ekstrand K, Huysmans MC. STAndard Reporting of CAries Detection and Diagnostic Studies (STARCARDDS). Clin Oral Investig 2022; 26:1947-1955. [PMID: 34623505 PMCID: PMC8816754 DOI: 10.1007/s00784-021-04173-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 08/31/2021] [Indexed: 12/04/2022]
Abstract
AIM The aim of this paper is to present recommendations from an international workshop which evaluated the methodology and reporting of caries diagnostic studies. As a unique feature, this type of studies is focused on caries lesion detection and assessment, and many of them are carried out in vitro, because of the possibility of histological validation of the whole caries spectrum. This feature is not well covered in the existing reporting STARD guideline within the EQUATOR Network. PARTICIPANTS AND METHODS An international working group of 13 cariology researchers was formed. The STARD checklist was reviewed and modified for caries detection and diagnosis purposes, in a three-step process of evaluation, consensual modification, and delivery during three 2-day workshops over 18 months. Special attention was paid to reporting requirements of caries studies that solely focus on reliability. RESULTS The STARD checklist was modified in 14/30 items, with an emphasis on issues of sample selection (tooth selection in in vitro studies), blinding, and detailed reporting of results. CONCLUSION Following STARCARDDS (STAndard Reporting of CAries Detection and Diagnostic Studies) is expected to result in complete reporting of study design and methodology in future caries diagnosis and detection experiments both in vivo and in vitro, thus allowing for better comparability of studies and higher quality of systematic reviews. CLINICAL RELEVANCE Standardization of caries diagnostic studies leads to a better comparability among future studies, both in vivo and in vitro.
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Affiliation(s)
- Klaus W Neuhaus
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, Mattenstrasse 40, 4058, Basel, CH, Switzerland.
- Department of Dermatology, Inselspital - Bern University Hospital, Bern, Switzerland.
| | - Florin Eggmann
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, Mattenstrasse 40, 4058, Basel, CH, Switzerland
| | - Jan Kühnisch
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany
| | - Svetlana Kapor
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany
| | - Mila Janjic Rankovic
- Department of Orthodontics and Dentofacial Orthopedics , University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ina Schüler
- Department of Orthodontics, Section of Preventive and Paediatric Dentistry , University Hospital, Jena, Germany
| | - Felix Krause
- Department Clinic for Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital RWTH Aachen, Aachen, Germany
| | - Adrian Lussi
- Department of Operative Dentistry and Periodontology, Faculty of Dentistry, University Medical Centre, Freiburg, Germany
- School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Stavroula Michou
- Department of Odontology, University Copenhagen, Copenhagen, Denmark
| | - Kim Ekstrand
- Department of Odontology, University Copenhagen, Copenhagen, Denmark
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Walsh T, Macey R, Riley P, Glenny AM, Schwendicke F, Worthington HV, Clarkson JE, Ricketts D, Su TL, Sengupta A. Imaging modalities to inform the detection and diagnosis of early caries. Cochrane Database Syst Rev 2021; 3:CD014545. [PMID: 33720395 PMCID: PMC8441255 DOI: 10.1002/14651858.cd014545] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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 earliest opportunity is fundamental to the preservation of tooth tissue and maintenance of oral health. Radiographs have traditionally been used to supplement the conventional visual-tactile clinical examination. Accurate, timely detection and diagnosis of early signs 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 dental imaging methods to inform the detection and diagnosis of non-cavitated enamel only coronal dental caries. SEARCH METHODS Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 31 December 2018); Embase Ovid (1980 to 31 December 2018); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 31 December 2018); and the World Health Organization International Clinical Trials Registry Platform (to 31 December 2018). We studied reference lists as well as published systematic review articles. SELECTION CRITERIA We included diagnostic accuracy study designs that compared a dental imaging method with a reference standard (histology, excavation, enhanced visual examination), 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 eligible for inclusion. Studies that explicitly recruited participants with more advanced lesions that were obviously into dentine or frankly cavitated 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 Two review authors extracted data independently and in duplicate using a standardised data extraction form and quality assessment based on QUADAS-2 specific to the clinical context. Estimates of diagnostic accuracy were determined using the bivariate hierarchical method to produce summary points of sensitivity and specificity with 95% confidence regions. Comparative accuracy of different radiograph methods was conducted based on indirect and direct comparisons between methods. Potential sources of heterogeneity were pre-specified and explored visually and more formally through meta-regression. MAIN RESULTS We included 104 datasets from 77 studies reporting a total of 15,518 tooth sites or surfaces. The most frequently reported imaging methods were analogue radiographs (55 datasets from 51 studies) and digital radiographs (42 datasets from 40 studies) followed by cone beam computed tomography (CBCT) (7 datasets from 7 studies). Only 17 studies were of an in vivo study design, carried out in a clinical setting. No studies were considered to be at low risk of bias across all four domains but 16 studies were judged to have low concern for applicability across all domains. The patient selection domain had the largest number of studies judged to be at high risk of bias (43 studies); the index test, reference standard, and flow and timing domains were judged to be at high risk of bias in 30, 12, and 7 studies respectively. Studies were synthesised using a hierarchical bivariate method for meta-analysis. There was substantial variability in the results of the individual studies, with sensitivities that ranged from 0 to 0.96 and specificities from 0 to 1.00. For all imaging methods the estimated summary sensitivity and specificity point was 0.47 (95% confidence interval (CI) 0.40 to 0.53) and 0.88 (95% CI 0.84 to 0.92), respectively. In a cohort of 1000 tooth surfaces with a prevalence of enamel caries of 63%, this would result in 337 tooth surfaces being classified as disease free when enamel caries was truly present (false negatives), and 43 tooth surfaces being classified as diseased in the absence of enamel caries (false positives). Meta-regression indicated that measures of accuracy differed according to the imaging method (Chi2(4) = 32.44, P < 0.001), with the highest sensitivity observed for CBCT, and the highest specificity observed for analogue radiographs. None of the specified potential sources of heterogeneity were able to explain the variability in results. No studies included restored teeth in their sample or reported the inclusion of sealants. We rated the certainty of the evidence as low for sensitivity and specificity 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 the observed inconsistency of the results. AUTHORS' CONCLUSIONS The design and conduct of studies to determine the diagnostic accuracy of methods to detect and diagnose caries in situ are particularly challenging. Low-certainty evidence suggests that imaging for the detection or diagnosis of early caries may have poor sensitivity but acceptable specificity, resulting in a relatively high number of false-negative results with the potential for early disease to progress. If left untreated, the opportunity to provide professional or self-care practices to arrest or reverse early caries lesions will be missed. The specificity of lesion detection is however relatively high, and one could argue that initiation of non-invasive management (such as the use of topical fluoride), is probably of low risk. CBCT showed superior sensitivity to analogue or digital radiographs but has very limited applicability to the general dental practitioner. However, given the high-radiation dose, and potential for caries-like artefacts from existing restorations, its use cannot be justified in routine caries detection. Nonetheless, if early incidental carious lesions are detected in CBCT scans taken for other purposes, these should be reported. CBCT has the potential to be used as a reference standard in diagnostic studies of this type. 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. Future research should evaluate the comparative accuracy of different methods, be undertaken in a clinical setting, and focus on minimising bias arising from the use of imperfect reference standards in clinical studies.
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Affiliation(s)
- Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Richard Macey
- 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
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Heatlh Research Services, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - 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
| | - Janet E Clarkson
- Division of Oral Health Sciences, Dundee Dental School, University of Dundee, Dundee, UK
| | | | - Ting-Li Su
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Anita Sengupta
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Mupparapu M, DeLaura TL, Dimitrova BL, Lo AD, Singer SR. Evaluation of diagnostic radiology acumen between 2 groups of clinical dental students. J Dent Educ 2021; 85:669-678. [PMID: 33502762 DOI: 10.1002/jdd.12537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/10/2020] [Accepted: 12/04/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate and distinguish if an additional year of clinical experience increases the cognitive ability of dental students to accurately assess and interpret dental radiographs. METHODS Radiological acuity was assessed between two groups of clinical dental students at Penn Dental Medicine (PDM). Group 1 was composed of 147 third-year dental students (D3), group 2 was composed of 145 fourth-year dental students (D4). A 65-question test comprising the length and breadth of radiographic anatomy and pathology was administered to both D3 and D4 students. The test was designed to test the participants' knowledge of radiographic technique, anatomy, and differential diagnosis. The null hypothesis was that there would be no significant differences between the two groups. RESULTS STATA 15 software (StataCorp LLC, College Station, TX, USA) was used to statistically analyze the findings. Although, the mean correct score for group 1 was higher (60/65) than group 2 (59/65), there was no statistically significant difference between the performance of the groups. On average, group 1 outperformed the clinically more experienced group 2 on an individual question basis. The average overall number of correctly answered items compared to incorrectly answered items reflected this difference. CONCLUSION(S) An additional year of clinical dental education does not appear to correlate with any higher radiographic acumen. This may be due to tapering exposure to unique pathology and findings, as more routine findings are encountered daily and classroom instruction during the fourth year of dental school is limited. Early incorporation of new radiographic education tools that are clinically oriented may be one method to increase retention of knowledge accumulated in the initial didactic years of dental education.
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Affiliation(s)
- Mel Mupparapu
- Department of Oral Medicine, Penn Dental Medicine, Philadelphia, Pennsylvania, USA
| | - Taylor L DeLaura
- Oral and Maxillofacial Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Angela D Lo
- University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA
| | - Steven R Singer
- Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Newark, New Jersey, USA
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Castner N, Appel T, Eder T, Richter J, Scheiter K, Keutel C, Hüttig F, Duchowski A, Kasneci E. Pupil diameter differentiates expertise in dental radiography visual search. PLoS One 2020; 15:e0223941. [PMID: 32469952 PMCID: PMC7259659 DOI: 10.1371/journal.pone.0223941] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 05/13/2020] [Indexed: 01/22/2023] Open
Abstract
Expert behavior is characterized by rapid information processing abilities, dependent on more structured schemata in long-term memory designated for their domain-specific tasks. From this understanding, expertise can effectively reduce cognitive load on a domain-specific task. However, certain tasks could still evoke different gradations of load even for an expert, e.g., when having to detect subtle anomalies in dental radiographs. Our aim was to measure pupil diameter response to anomalies of varying levels of difficulty in expert and student dentists’ visual examination of panoramic radiographs. We found that students’ pupil diameter dilated significantly from baseline compared to experts, but anomaly difficulty had no effect on pupillary response. In contrast, experts’ pupil diameter responded to varying levels of anomaly difficulty, where more difficult anomalies evoked greater pupil dilation from baseline. Experts thus showed proportional pupillary response indicative of increasing cognitive load with increasingly difficult anomalies, whereas students showed pupillary response indicative of higher cognitive load for all anomalies when compared to experts.
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Affiliation(s)
- Nora Castner
- Human-Computer Interaction, Institute of Computer Science, University Tübingen, Tübingen, Germany
- * E-mail:
| | - Tobias Appel
- Human-Computer Interaction, Institute of Computer Science, University Tübingen, Tübingen, Germany
| | - Thérése Eder
- Multiple Representations Lab, Leibniz-Institut für Wissensmedien, Tübingen, Germany
| | - Juliane Richter
- Multiple Representations Lab, Leibniz-Institut für Wissensmedien, Tübingen, Germany
| | - Katharina Scheiter
- Multiple Representations Lab, Leibniz-Institut für Wissensmedien, Tübingen, Germany
- University Tübingen, Tübingen, Germany
| | - Constanze Keutel
- Department of Oral- and Maxillofacial Radiology, University Clinic for Dentistry, Oral Medicine, and Maxillofacial Surgery, University of Tübingen, Tübingen, Germany
| | - Fabian Hüttig
- Department of Prosthodontics, University Clinic for Dentistry, Oral Medicine, and Maxillofacial Surgery, University of Tübingen, Tübingen, Germany
| | - Andrew Duchowski
- Visual Computing, Clemson University, Clemson, South Carolina, United States of America
| | - Enkelejda Kasneci
- Human-Computer Interaction, Institute of Computer Science, University Tübingen, Tübingen, Germany
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Stratigaki E, Jost FN, Kühnisch J, Litzenburger F, Lussi A, Neuhaus KW. Clinical validation of near-infrared light transillumination for early proximal caries detection using a composite reference standard. J Dent 2020; 103S:100025. [PMID: 34059307 DOI: 10.1016/j.jjodo.2020.100025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/20/2020] [Accepted: 08/23/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The aim of this in vivo prospective clinical study was to validate a near-infrared light transillumination (NILT) device for the detection of proximal caries lesions and compare it to the established diagnostic method of bitewing radiography (BWR). MATERIALS AND METHODS A total of 116 interproximal posterior teeth/surfaces without gross cavitation were included and assessed with BWR and NILT. After clinical examination, the teeth with sound surfaces or non-cavitated caries lesions were separated with the use of an orthodontic separation rubber for 24h. Upon removal of the separator a silicon impression was obtained and the teeth surfaces were directly investigated. Intra- and inter-examiner reproducibility, sensitivities (SE) and specificities (SP) as well as the area under ROC curves (AUC) were calculated. RESULTS The SE of NILT was 0.92 in D1 lesions and 1.00 in D2 and D3 lesions, respectively. BWR showed SE values of 0.81 in D1 lesions, 0.74 in D2 and 1.00 in D3 lesions, respectively. However, NILT showed lower values of SP (D1 0.38, D2 0.42 and D3 0.99) compared to BWR (D1 0.65, D2 0.88, D3 1.00). Intra-examiner reproducibility increased for both examiners from the initial examination (0.68 and 0.62) to the recall appointment (0.89 and 0.76) respectively. CONCLUSION The performance of NILT in detection of enamel caries was comparable to BWR. NILT could be considered as a useful and reliable tool in clinical practice. However, monitoring of enamel lesions might not be accurate, since a low specificity of NILT at D1,2 level and a tendency to false positive ratings have been shown. Therefore, it is recommended that treatment decisions should not be based on NILT alone. CLINICAL RELEVANCE This study might indicate that NILT can be used for routine patient screening but the use of BWR is still important for treatment decisions.
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Affiliation(s)
- Eirini Stratigaki
- Department of Pediatric Oral Health and Orthodontics, University Center for Dental Medicine, UZB, University of Basel, Switzerland.
| | - Fabian N Jost
- Department of Restorative, Preventive, and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Jan Kühnisch
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians University of Munich, Germany
| | - Friederike Litzenburger
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians University of Munich, Germany
| | - Adrian Lussi
- School of Dental Medicine, University of Bern, Switzerland; Department of Operative Dentistry and Periodontology, University Medical Centre, Freiburg, Germany
| | - Klaus W Neuhaus
- Clinic of Periodontology, Endodontology and Cariology, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland; Department of Dermatology, Inselspital, Bern University Hospital, Bern, Switzerland
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Oh HY, Jung HI, Lee JW, de Jong EDJ, Kim BI. Improving the competency of dental hygiene students in detecting dental restorations using quantitative light-induced fluorescence technology. Photodiagnosis Photodyn Ther 2017; 17:245-249. [DOI: 10.1016/j.pdpdt.2016.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/25/2016] [Accepted: 12/29/2016] [Indexed: 11/28/2022]
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Movahhedian N, Adibi S, Tavakoli HS, Baseri H. How does triangular-shaped radiolucency affect caries diagnosis? Oral Radiol 2016. [DOI: 10.1007/s11282-016-0243-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Luz PB, Stringhini CH, Otto BR, Port ALF, Zaleski V, Oliveira RS, Pereira JT, Lussi A, Rodrigues JA. Performance of undergraduate dental students on ICDAS clinical caries detection after different learning strategies. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2015; 19:235-241. [PMID: 25495379 DOI: 10.1111/eje.12131] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/17/2014] [Indexed: 06/04/2023]
Abstract
AIM This study aimed to evaluate the effect of a digital learning tool on undergraduate dental students' performance in detecting dental caries using ICDAS. METHODS An experimental digital learning tool (DLT) was created using digital photographs of sound and carious teeth. Thirty-nine students were divided into three groups (n = 13) and each assessed 12 randomly allocated patients before and after learning strategies: G1, ICDAS e-learning program; G2, ICDAS e-learning program plus DLT; G3, no learning strategy. Students (n = 32) reassessed patients 2 weeks after training. RESULTS Comparing before and after the learning strategies, any difference in the values of specificity and area under the ROC curve for all groups was found. Sensitivity was statistically significantly higher for G1 and G2. Comparing the groups, G2 showed a significant increase in sensitivity at the D2 and D3 thresholds. Spearman's correlations with the gold standard before and after the learning strategy were 0.60 and 0.61 for G1, 0.57 and 0.63 for G2, and 0.54 and 0.54 for G3, respectively. The Wilcoxon test showed a statistically significant difference between the values obtained before and after learning strategies for G1 and G2. CONCLUSIONS Use of the DLT after the ICDAS e-learning program tended to increase the sensitivity of ICDAS used by undergraduate dental students. The DLT appeared to improve dental students' ability to use ICDAS.
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Affiliation(s)
- P B Luz
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - C H Stringhini
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - B R Otto
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - A L F Port
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - V Zaleski
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - R S Oliveira
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - J T Pereira
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - A Lussi
- Department of Preventive, Restorative and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - J A Rodrigues
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Bussaneli DG, Boldieri T, Diniz MB, Rivera LML, Santos-Pinto L, Cordeiro RDCL. Influence of professional experience on detection and treatment decision of occlusal caries lesions in primary teeth. Int J Paediatr Dent 2015; 25:418-27. [PMID: 25511642 DOI: 10.1111/ipd.12148] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the influence of examiner's clinical experience on detection and treatment decision of caries lesions in primary molars. DESIGN Three experienced dentists (Group A) and three undergraduate students (Group B) used the International Caries Detection and Assessment System (ICDAS) criteria and bitewing radiographs (BW) to perform examinations twice in 77 primary molars that presented a sound or carious occlusal surface. For the treatment decision (TD), the examiners attributed scores, analyzing the teeth in conjunction with the radiographs. The presence and the depth of lesion were validated histologically, and reproducibility was evaluated. The sensitivity, specificity, accuracy, and area under the ROC curve values were calculated for ICDAS and BW. The associations between ICDAS, BW, and TD were analyzed by means of contingency tables. RESULTS Interexaminer agreement for ICDAS, BW, and TD were excellent for Group B and moderate for Group A. The two groups presented similar and satisfactory performance for caries lesion detection using ICDAS and BW. In the treatment decision, Group A was shown to have a less invasive approach than Group B. CONCLUSION The examiner's experience was not determinant for the clinical and radiographic detection of occlusal lesions in primary teeth but influenced the treatment decision of initial lesions.
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Affiliation(s)
- Diego Girotto Bussaneli
- Department of Pediatric Dentistry and Orthodontics, Araraquara School of Dentistry, UNESP-Univ Estadual Paulista, Araraquara, SP, Brazil
| | - Thalita Boldieri
- Department of Pediatric Dentistry and Orthodontics, Araraquara School of Dentistry, UNESP-Univ Estadual Paulista, Araraquara, SP, Brazil
| | - Michele Baffi Diniz
- Department of Pediatric Dentistry, School of Dentistry, UNICSUL - Cruzeiro do Sul University, São Paulo, SP, Brazil
| | - Luciana Monti Lima Rivera
- Department of Pediatric Dentistry, School of Dentistry, USC - Sagrado Coração Univesity, Bauru, SP, Brazil
| | - Lourdes Santos-Pinto
- Department of Pediatric Dentistry and Orthodontics, Araraquara School of Dentistry, UNESP-Univ Estadual Paulista, Araraquara, SP, Brazil
| | - Rita De Cássia Loiola Cordeiro
- Department of Pediatric Dentistry and Orthodontics, Araraquara School of Dentistry, UNESP-Univ Estadual Paulista, Araraquara, SP, Brazil
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Neuhaus KW, Jost F, Perrin P, Lussi A. Impact of different magnification levels on visual caries detection with ICDAS. J Dent 2015; 43:1559-64. [PMID: 26366524 DOI: 10.1016/j.jdent.2015.09.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 09/02/2015] [Accepted: 09/04/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The aim of this in vitro study was to examine the effect of different levels of magnification on the accuracy and reliability of visual caries detection using ICDAS criteria. METHODS Occlusal surfaces of 100 extracted molars were assessed by 14 examiners (3rd and the 4th year dental students and dentists) using no magnification aids, a 2.5× Galilean loupe, a 4.5× Keplerian loupe, or a surgical microscope with 10× magnification. The assessments were repeated on a different day. Sensitivity, specificity, AUC and reliabilities were calculated according to the gold standard of histology. RESULTS We found that with increasing magnification, the number of surfaces rated as "sound" (ICDAS code 0) decreased, while the number of surfaces with a localized enamel breakdown (ICDAS code 3) increased. While the sensitivities increased, the values of the specificities decreased to an unacceptably low level irrespective of the clinical experience of the examiners. CONCLUSIONS ICDAS seems to be optimized for natural vision up to 2.0× magnification and not for high magnifications. The use of powerful magnification in visual caries detection involves the risk of unnecessary and premature invasive treatment. CLINICAL SIGNIFICANCE This paper discusses when it does and does not make sense to use magnification devices for visual caries detection using ICDAS criteria. Strong magnifications should be refrained from for this purpose.
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Affiliation(s)
- K W Neuhaus
- Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Bern, Switzerland.
| | - F Jost
- Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - P Perrin
- Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - A Lussi
- Department of Preventive, Restorative and Pediatric Dentistry, University of Bern, Bern, Switzerland
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Proximal caries lesion detection in primary teeth: does this justify the association of diagnostic methods? Lasers Med Sci 2015; 30:2239-44. [PMID: 26286856 DOI: 10.1007/s10103-015-1798-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
Abstract
The aim of this clinical study was to evaluate and compare the performance of visual exam with use of the Nyvad criteria (visual examination - (VE)), interproximal radiography (BW), laser fluorescence device (DIAGNOdent Pen-DDPen), and their association in the diagnosis of proximal lesions in primary teeth. For this purpose, 45 children (n = 59 surfaces) of both sexes, aged between 5 and 9 years were selected, who presented healthy primary molars or primary molars with signs suggestive of the presence of caries lesions. The surfaces were clinically evaluated and coded according to the Nyvad criteria and immediately afterwards with the DDPen. Radiographic exam was performed only on the surfaces coded with Nyvad scores 2, 3, 5, or 6. Active caries lesions and/or those with discontinuous surfaces were restored, considering the depth of lesion as reference standard. Sensitivity, specificity, accuracy, and area under ROC curve were calculated for each technique and its associations. Visual exam with Nyvad criteria presented the highest specificity, accuracy, and area under ROC curve values. The DDPen presented the highest sensitivity values. Association with one or more methods resulted in an increase in specificity. The performance of visual, radiographic, and DDpen exams and their associations were good; however, the clinical examination with the Nyvad criteria was sufficient for the diagnosis of interproximal lesions in primary teeth.
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Diniz MB, Cordeiro RCL, Ferreira-Zandona AG. Detection of Caries Around Amalgam Restorations on Approximal Surfaces. Oper Dent 2015; 41:34-43. [PMID: 26237637 DOI: 10.2341/14-048-l] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
To evaluate the in vitro performance of the International Caries Detection and Assessment System (ICDAS) visual examination, bitewing radiography (BW), and the DIAGNOdent 2190, a pen-type laser fluorescence device (LFpen), in detecting caries around amalgam restorations on approximal surfaces. Approximal surfaces (N=136) of permanent posterior teeth (N=110) with Class II amalgam restorations were assessed twice by two experienced examiners using ICDAS, BW, and LFpen. The occurrence of proximal overhangs was also evaluated. The teeth were histologically prepared and assessed for caries extension. Different cutoff limits for the LFpen were used. Intraexaminer and interexaminer reproducibility showed moderate to good agreement for all the methods (weighted κ/intraclass correlation coefficient=0.40 to 0.87). The specificities at D1 (all visible lesions affecting enamel) and D3 (lesions extended into dentin) were, respectively, 0.41 and 0.82 for ICDAS, 0.70 and 0.82 for BW, and 0.77-0.89 and 0.88-0.94 for LFpen. The sensitivities were 0.80 and 0.52 for ICDAS, 0.56 and 0.51 for BW, and 0.04-0.23 and 0.01-0.02 for LFpen at D1 and D3, respectively. At the D1/D3 thresholds, the accuracy and the area under the receiver operating characteristic curve (Az) values were similar and statistically higher for ICDAS (0.65/0.68 and 0.633/0.688) and BW (0.64/0.68 and 0.655/0.719), respectively; whereas, LFpen presented lower accuracy (0.37-0.44/0.49-0.52) and Az (0.390-0.454/0.345-0.395) values. The occurrence of overhangs (26.8%) was shown to be irrelevant in determining the presence of secondary caries. The ICDAS and BW methods presented the best performance in detecting caries lesions affecting enamel and dentin on approximal surfaces of amalgam restorations.
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Krzyżostaniak J, Surdacka A, Kulczyk T, Dyszkiewicz-Konwińska M, Owecka M. Diagnostic accuracy of cone beam computed tomography compared with intraoral radiography for the detection of noncavitated occlusal carious lesions. Caries Res 2014; 48:461-6. [PMID: 24852420 DOI: 10.1159/000358101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 12/17/2013] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to evaluate the accuracy of cone beam computed tomography (CBCT) in the detection of noncavitated occlusal caries lesions and to compare this accuracy with that observed with conventional radiographs. 135 human teeth, 67 premolars and 68 molars with macroscopically intact occlusal surfaces, were examined by two independent observers using the CBCT system: NewTom 3G (Quantitative Radiology) and intraoral conventional film (Kodak Insight). The true lesion diagnosis was established by histological examination. The detection methods were compared by means of sensitivity, specificity, predictive values and accuracy. To assess intra- and interobserver agreement, weighted kappa coefficients were computed. Analyses were performed separately for caries reaching into dentin and for all noncavitated lesions. For the detection of occlusal lesions extending into dentin, sensitivity values were lower for film (0.45) when compared with CBCT (0.51), but the differences were not statistically significant (p > 0.19). For all occlusal lesions sensitivity values were 0.32 and 0.22, respectively, for CBCT and film. The specificity scores were high for both modalities. Interobserver agreement amounted to 0.93 for the CBCT system and to 0.87 for film. It was concluded that the use of the 9-inch field of view NewTom CBCT unit for the diagnosis of noncavitated occlusal caries cannot be recommended.
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Affiliation(s)
- Joanna Krzyżostaniak
- Department of Conservative Dentistry and Periodontology, Poznan University of Medical Sciences, Poznan, Poland
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Cruz AD, Esteves RG, Poiate IAVP, Portero PP, Almeida SM. Influence of Radiopacity of Dental Composites on the Diagnosis of Secondary Caries: The Correlation Between Objective and Subjective Analyses. Oper Dent 2014; 39:90-7. [DOI: 10.2341/12-377-l] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
This study aimed to objectively evaluate the radiopacity of different dental composites and their subjective influence on diagnosing secondary caries–like lesions and how these results correlate. For objective analysis, three resin specimens (1 mm thick, with a 4-mm internal diameter) were made with four composites: 1) Charisma; 2) Filtek Z250; 3) Prisma AP.H; and 4) Glacier. Three human teeth were selected and then mesio-distally sectioned (1 mm thick) to make the dental specimens. An aluminum (Al) wedge (12 steps, 1 mm thick, 99.8% purity) was used as an internal standard to calculate the radiopacity. For subjective analysis, 20 human teeth were selected and then prepared with a mesio-occluso-distal (MOD) inlay cavity, with half the teeth receiving a round cavity to simulate the carious lesion. The MOD was restored using the composites at four different times. Standardized radiographs were acquired and then digitized (300 dpi and eight-bit TIFF) for both analyses. A histogram objectively measured the pixel intensity values of the images, which were converted into millimeters of Al using linear regressions. Eight observers subjectively evaluated the images using a five-point rating scale to diagnose the caries. The data were statistically analyzed using the Student t-test, the Kappa test, diagnostic testing, and the Pearson correlation coefficient (α=0.05). All materials showed radiopacity values compatible with dental tissues (p>0.05); Glacier was similar to dentin and Prisma AP.H was similar to enamel, while the remaining materials showed a middle radiopacity. Prisma AP.H and Glacier differed (p<0.05) in relation to their accuracy to caries diagnosis, with Glacier having greater accuracy. There was a correlation between objective and subjective analyses with negative linear dependence. An increase in the material's radiopacity could have a subjectively negative influence on the diagnosis of secondary caries; thus, an ideal radiopacity for a dental composite is closer to the dentin image and produces similar attenuation to X-rays than does dentin.
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Affiliation(s)
- AD Cruz
- Adriana Dibo Cruz, DDS, PhD, Dental School of the Fluminense Federal University, Polo of Nova Friburgo, Department of Specific Formation, Area of Dental Radiology, Nova Friburgo, Rio de Janeiro, Brazil
| | - RG Esteves
- Renata Gama Esteves, DDS student, Dental School of the Fluminense Federal University, Polo of Nova Friburgo, Nova Friburgo, Brazil
| | - IAVP Poiate
- Isis Andréa Venturini Pola Poiate, DDS, PhD, Dental School of the Fluminense Federal University, Polo of Nova Friburgo, Department of Specific Formation, Area of Dental Clinic, Nova Friburgo, Rio de Janeiro, Brazil
| | - PP Portero
- Priscila Paiva Portero, Dental School of the Fluminense Federal University, Polo of Nova Friburgo, Department of Specific Formation, Area of Dental Clinic, Nova Friburgo, Rio de Janeiro, Brazil
| | - SM Almeida
- Solange Maria Almeida, DDS, MS, PhD, Dentistry School of Piracicaba, State University of Campinas, Department of Oral Diagnostic, Piracicaba, Brazil
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Affiliation(s)
- DJ Manton
- Elsdon Storey Chair of Child Dental Health; Melbourne Dental School; The University of Melbourne; Victoria
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Schropp L, Alyass NS, Wenzel A, Stavropoulos A. Validity of wax and acrylic as soft-tissue simulation materials used in in vitro radiographic studies. Dentomaxillofac Radiol 2012; 41:686-90. [PMID: 22933536 DOI: 10.1259/dmfr/33467269] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the thickness of wax and acrylic that provides a radiographic density similar to that of the human cheek. METHODS An intraoral film radiograph of the human cheek including a 40×30×3 mm reference aluminium block was recorded under standardized conditions in 61 subjects. Radiographic density was measured by a densitometer in ten randomly selected sites of the film to serve as the gold standard for density values of the cheek soft tissues. Thereafter, the density of series of radiographs of two tissue-simulating materials-wax and acrylic-in systematically increasing thicknesses (wax, 1.5-30 mm; acrylic, 2-40 mm) plus the reference block were measured and compared with the gold-standard values. RESULTS The radiographic density of wax with a thickness of 13-17 mm or acrylic with a thickness of 14.5 mm corresponded to the average density of the human cheek. CONCLUSION The soft tissues of the average human cheek can be simulated with 13-17 mm wax or 14.5 mm acrylic in in vitro radiographic studies.
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Affiliation(s)
- L Schropp
- Prosthetic Dentistry, Department of Dentistry, Aarhus University, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark.
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Souza JF, Boldieri T, Diniz MB, Rodrigues JA, Lussi A, Cordeiro RCL. Traditional and novel methods for occlusal caries detection: performance on primary teeth. Lasers Med Sci 2012; 28:287-95. [DOI: 10.1007/s10103-012-1154-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 06/25/2012] [Indexed: 11/29/2022]
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Moreira PL, Messora MR, Pereira SM, Almeida SMD, Cruz ADD. Diagnosis of secondary caries in esthetic restorations: influence of the incidence vertical angle of the X-ray beam. Braz Dent J 2011; 22:129-33. [PMID: 21537586 DOI: 10.1590/s0103-64402011000200007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 02/07/2011] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the accuracy on the diagnosis of secondary caries-like lesions simulated on esthetic restorations of different materials, changing the incidence vertical angle (IVA) of the x-ray beam. Twenty human teeth received MOD inlay preparations. In the experimental group (n=10), a round cavity was made in the floor of the proximal box to simulate the caries-like lesion. All teeth were restored with 3 composite resins (Charisma, Filtek-Z250 and TPH-Spectrum) at 3 moments. Two radiographic images were acquired with 0º and 10º IVA. Ten observers evaluated the images using a 5-point confidence scale. Intra- and interobserver reliability was analyzed with the Interclass Correlation Coefficient and the diagnostic accuracy was evaluated using the area under the ROC curve (A(z)), Friedman test and Wilcoxon test (α=0.05). Higher accuracy values were obtained with 10º IVA (A(z)=0.66, Filtek-Z250>A(z)=0.56, TPH-Spectrum) compared to 0º (A(z)=0.55, Charisma>A(z)=0.37, TPH-Spectrum), though without statistically significant difference (p>0.05). The detection of secondary caries-like lesions simulated on esthetic restorations of different materials suffered no negative influence by changing the IVA of the x-ray beam.
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