Association Between Visual Inspection, Caries Activity Status, and Radiography with Treatment Decisions on Approximal Caries in Primary Molars

Abstract

Purpose: The purpose of this study was to evaluate the in vivo performance of the International Caries Detection and Assessment System (ICDAS), Lesion Activity Assessment (LAA), and bitewing radiographs (BW) in detecting carious lesions on approximal surfaces of primary teeth and determine their association with treatment decisions (TDs).

Methods: Eighty-nine primary molars (166 approximal surfaces) in 56 eight- to 12-year-old children were clinically evaluated by a single examiner before and after temporary tooth separation. After exfoliation/ extraction, the teeth were histologically analyzed for caries depth and activity.

Results: Sensitivities for ICDAS and ICDAS-LAA were higher after tooth separation, while specificities were lower (P<0.05). The sensitivity and specificity values for BW were 0.49 and 0.79, respectively. The strongest correlations were found between ICDAS and BW before and after tooth separation, and between ICDAS and ICDAS-LAA and ICDAS and TDs before tooth separation (P<0.05).

Conclusions: The International Caries Detection and Assessment System assessment after tooth separation presented better clinical performance than bitewing radiography for the detection of approximal carious lesions in primary molars. There was a high correlation between treatment decisions based on ICDAS, ICDAS-Lesion Activity Assessment, and bitewing radiography, highlighting the functional similarity of these tools in the clinical decision-making process.