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. 2025 Feb 20;25(1):270.
doi: 10.1186/s12903-025-05629-8.

Detection of proximal dental caries in primary teeth with a near-infrared-irradiation-assisted intraoral scanner: an in vitro study

Abeer K Tashkandi  1   2 , Sultan O Jiffri  3 , Rahaf M Albalawi  3 , Sara A Albukhari  3 , Sulafa A Mugharbil  3 , Hanin E Yeslam  4   5
Affiliations

Detection of proximal dental caries in primary teeth with a near-infrared-irradiation-assisted intraoral scanner: an in vitro study

Abeer K Tashkandi et al. BMC Oral Health. .

Abstract

Background: The early detection of dental caries is crucial for successful dental care. New intraoral scanners using near-infrared irradiation (NIRI) technology track preventive lesions without ionizing radiation. This study aimed to evaluate the performance of intraoral scanners (IOSs) in detecting proximal caries in primary posterior teeth, compared to conventional methods such as loupes-assisted clinical exams and bitewing (BW) radiography.

Methods: Fifteen examined tooth surfaces were used to produce a total of 60 scores by a restorative dentistry consultant (RDC). The tooth surfaces were categorized into caries-free (n = 5 × 4 exam methods) and carious (n = 10 × 4 exam methods) subgroups. Artificial caries lesions were created on specified surfaces and mounted on typodont in sets for evaluation using a simplified modified ICDAS visual and BW radiographic examination, DIAGNOcam device, and iTero Element 5D NIRI-assisted IOS. Reference surface scores were recorded. Investigators (RDCs and recent dental graduates (RDGs)) were trained and calibrated. Inter-examiner agreement, agreement with reference, specificity, and sensitivity were checked.

Results: The results showed that the sensitivity and specificity differed between the diagnostic tests. The best agreement of all investigated diagnostic methods with the reference was found using the DIAGNOcam device (ĸ = 0.87) and BW radiography (ĸ = 1.00). High agreement was found for visual examination (by the RDC and RDGs (ĸ ≈ 0.85)) and iTero 5D examination (ĸ = 0.87).

Conclusions: The iTero Element 5D IOS had lower sensitivity and specificity compared to other methods. The potential use of IOSs with NIRI as a substitute for conventional diagnostic methods in primary teeth shows promise but requires further investigation.

Keywords: Artificial caries; Caries detection; DIAGNOcam; Intra-oral scanners; Near infra-red irradiation; Near infra-red transillumination; Preventive; Primary teeth; Proximal lesions; Restorative dentistry; iTero Element 5D.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study received approval from the ethical committee at the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia (IRB# 192–11-23). The study adhered to the principles of the Declaration of Helsinki, and informed consent was obtained from all subjects and/ or their legal guardian(s). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart demonstrating the study design
Fig. 2
Fig. 2
Primary molar embedded in stone and with an exposed artificial dentin lesion
Fig. 3
Fig. 3
Tooth sets mounted on test typodonts for group assignment, scanning, and further diagnostic tests
Fig. 4
Fig. 4
Artificial caries lesion detected on the proximal surface of a primary molar using bitewing (BW) radiography (indicated by the orange arrows): A: Clinical picture; B: BW radiograph
Fig. 5
Fig. 5
Artificial caries lesions detected on the proximal surfaces of primary molars using scanning devices (indicated by the orange arrows): A: Using DIAGNOcam, the lesion appears dark; B: Using iTero Element 5D, the lesion appears white
Fig. 6
Fig. 6
Receiver operating characteristic (ROC) curve analysis the primary proximal surfaces diagnostics for the investigated examination methods at threshold I (sound (0) versus overall artificial caries (pooled data points of enamel (1) and dentin artificial caries (2 and 3))). Where, RDC: restorative dentistry consultant; RDG: recent dental graduate
Fig. 7
Fig. 7
Receiver operating characteristic (ROC) curve analysis the primary proximal surfaces diagnostics for the investigated examination methods at threshold II (pooled sound and enamel (0 and 1) and dentin (Enamel breakdown with shallow dentin involvement) (2) vs. deep dentin artificial caries)). Where, RDC: restorative dentistry consultant
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