Impact of Scoring Single or Multiple Occlusal Lesions on Estimates of Diagnostic Accuracy of the Visual ICDAS-II System

Abstract

Carious lesions can occur at different sites on the occlusal surfaces of teeth and may differ in appearance and severity. This study aimed to evaluate how estimates of reproducibility and accuracy of ICDAS-II were affected when all lesions on occlusal surfaces, or only a representative lesion, were scored. 100 permanent teeth with 1-4 investigation sites on the occlusal surface were examined visually by four examiners. Serial sections of the teeth were assessed for lesion depth. Intra- and interexaminer reproducibility (weighted kappa values), sensitivity, and specificity were calculated for all investigation sites and for a randomly selected site per tooth. Comparing the kappa values for the whole sample and the independent sites, no effect or only a small effect was found. Comparing the areas under the ROC-curves no effect could be shown. Examining multiple sites on teeth leads to results comparable to when a single independent site is chosen per tooth.

Figure 1

Occlusal view of a molar tooth with three investigation sites and the corresponding histological sections. The length of the embedded coloured foil allows accurate location of the section in the y-axis, using the formula H = 2 (a - ML). The position of the lesion along each section can be then determined by the x-axis coordinate.

Figure 2

Frequency distribution (%) of the differences between the scores in each surface for each examiner when using ICDAS-II and for the consensus histological scores.