Performance of Different Methods for Detection of Incipient Occlusal Caries Lesions: An In Vitro Study

Abstract

Objective: The aim of this in vitro study was to evaluate the diagnostic performance of visual inspection (VI), laser fluorescence (LF pen), fluorescence camera (FC), and alternating current impedance spectroscopy technique (ACIST) for detection of incipient occlusal caries lesions. Histology was used as the gold standard to determine the interexaminer reliability of the methods, among three examiners with different levels of experiences (Examiner 1: 5 years; examiner 2: 10 years; and examiner 3: 25 years).

Materials and methods: One hundred two molar teeth were selected. The occlusal surfaces of teeth were evaluated with VI, LF pen, FC, and ACIST devices independently by three examiners. Diagnostic performances of methods were evaluated with binormal receiver-operating characteristics analysis. Interexaminer agreement of detection methods was assessed using Cohen's kappa coefficient values (p < 0.001).

Results: Incipient enamel lesions were determined more successfully with VI by all examiners. All detection methods were presented with statistically acceptable interexaminer agreement (p < 0.001). For D₂ and D₃ thresholds, FC for examiner 1, VI for examiner 2, and both VI and FC for examiner 3 demonstrated statistically high sensitivity and specificity (p < 0.05).

Conclusions: It can be concluded that diagnostic performance of the methods was insufficient for detecting incipient occlusal caries lesions by itself. Performance can be improved by using them with VI as a traditional caries detection method.

Keywords: ROC curve; detection methods; laser fluorescence; occlusal caries.