Comparison Between Radiographs, White and Fluorescent Images in the Diagnosis and Treatment Decisions for Occlusal Caries: An Ex Vivo Study

Luciana Pereira da Silva; Luan Ferreira Bastos; Clara Silva Avellar Mascarenhas; Ricardo Tadeu Lopes; Michelle Mikhael Ammari; Luciana Pomarico; Ivete Pomarico Ribeiro de Souza; Maria Augusta Visconti; Aline de Almeida Neves

Authors

Luciana Pereira da Silva
Luan Ferreira Bastos
Clara Silva Avellar Mascarenhas
Ricardo Tadeu Lopes
Michelle Mikhael Ammari
Luciana Pomarico
Ivete Pomarico Ribeiro de Souza
Maria Augusta Visconti
Aline de Almeida Neves

Keywords:

Diagnostic Imaging, Clinical Decision-Making, X-Ray Microtomography, Dental Caries

Abstract

Objective: To compare the agreement of images in white light (WL), fluorescence (FL), and digital radiographs (DR), on the diagnosis and treatment decisions for occlusal caries lesions against a micro-CT gold standard. Material and Methods: Ten extracted third molars, with enamel and/or dentin caries (ICDAS 2-4), were included. Occlusal surface images were acquired with an intraoral camera (SoproLife^®) in WL and FL modes. DR was obtained using an intraoral X-ray and a semi-direct digital system. A total of 780 images were needed, organized in a template, to be later examined by twenty-six dentists invited to compose the study. The Generalized Estimation Equations model was used to compare the proportions of the correct answers between the three methods and the gold standard. When significant, Bonferroni post-hoc test was used to identify differences (α=5%). Results: Most of the examiners were specialists (76.9%) with 14.5 years of experience. All diagnostic methods were similar and showed low agreement (DR 12.7%, WL 16.5%, and FL 16.5%) compared with gold standard caries diagnostic scores. Regarding treatment decisions, mean agreement for all diagnostic methods was higher (43.2%; p<0.001), and among all methods, WL (48.1%) and FL (51.2%) modes performed better than DR (30.4%, p<0.001). Conclusion: SoproLife^® images could help clinicians to propose rational, minimally invasive treatments for occlusal caries lesions.

References

Gimenez T, Piovesan C, Braga MM, Raggio DP, Deery C, Ricketts DN, et al. Visual inspection for caries detection: a systematic review and meta-analysis. J Dent Res 2015; 94(7):895-904. https://doi.org/10.1177/0022034515586763

Gimenez T, Piovesan C, Braga MM, Raggio DP, Deery C, Ricketts DN, et al. Clinical relevance of studies on the accuracy of visual inspection for detecting caries lesions: a systematic review. Caries Res 2015; 49(2):91-8. https://doi.org/10.1159/000365948

Mendes FM, Novaes TF, Matos R, Bittar DG, Piovesan C, Gimenez T, et al. Radiographic and laser fluorescence methods have no benefits for detecting caries in primary teeth. Caries Res 2012; 46(6):536-43. https://doi.org/10.1159/000341189

Kuhnisch J, Ekstrand KR, Pretty I, Twetman S, van Loveren C, Gizani S, et al. Best clinical practice guidance for management of early caries lesions in children and young adults: an EAPD policy document. Eur Arch Paediatr Dent 2016; 17(1):3-12. https://doi.org/10.1007/s40368-015-0218-4

Martignon S, Pitts NB, Goffin G, Mazevet M, Douglas GVA, Newton JT, et al. CariesCare practice guide: consensus on evidence into practice. Br Dent J 2019; 227(5):353-62. https://doi.org/10.1038/s41415-019-0678-8

Pontes LR, Novaes TF, Lara JS, Gimenez T, Moro BL, Camargo LB, et al. Impact of visual inspection and radiographs for caries detection in children through a 2-year randomized clinical trial: the caries detection in children-1 study. J Am Dent Assoc 2020; 151(6):407-15.e1. https://doi.org/10.1016/j.adaj.2020.02.008

American Academy Pediatric Dentistry. Guidelines on prescribing dental radiographs for infants, children, adolescents, and individuals with special health care needs. Pediatr Dent 2017;39(6):205-7.

Schaefer G, Pitchika V, Litzenburger F, Hickel R, Kuhnisch J. Evaluation of occlusal caries detection and assessment by visual inspection, digital bitewing radiography and near-infrared light transillumination. Clin Oral Investig 2018; 22(7):2431-38. https://doi.org/10.1007/s00784-018-2512-0

Macey R, Walsh T, Riley P, Glenny AM, Worthington HV, Fee PA, et al. Fluorescence devices for the detection of dental caries. Cochrane Database Syst Rev 2020; 12(12):CD013811. https://doi.org/10.1002/14651858.CD013811

Terrer E, Koubi S, Dionne A, Weisrock G, Sarraquigne C, Mazuir A, et al. A new concept in restorative dentistry: Light-induced fluorescence evaluator for diagnosis and treatment. Part 1: Diagnosis and treatment of initial occlusal caries. J Contemp Dent Pract 2009; 10(6):E086-94.

Terrer E, Raskin A, Koubi S, Dionne A, Weisrock G, Sarraquigne C, et al. A new concept in restorative dentistry: LIFEDT-light-induced fluorescence evaluator for diagnosis and treatment: part 2 - treatment of dentinal caries. J Contemp Dent Pract 2010; 11(1):E095-102.

Banerjee A. Minimum intervention oral healthcare delivery - is there consensus? Br Dent J 2020; 229(7):393-95. https://doi.org/10.1038/s41415-020-2235-x

Neves AA, Coutinho E, Vivan Cardoso M, Jaecques SV, Van Meerbeek B. Micro-CT based quantitative evaluation of caries excavation. Dent Mater 2010; 26(6):579-88. https://doi.org/10.1016/j.dental.2010.01.012

Oliveira LB, Massignan C, Oenning AC, Rovaris K, Bolan M, Porporatti AL, et al. Validity of micro-CT for in vitro caries detection: A systematic review and meta-analysis. Dentomaxillofac Radiol 2020; 49(7):20190347. https://doi.org/10.1259/dmfr.20190347

de Sousa FB, da Silva PF, Chaves AM. Stereomicroscopy has low accuracy for detecting the depth of carious lesion in dentine. Eur J Oral Sci 2017; 125(3):229-31. https://doi.org/10.1111/eos.12350

Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, et al. Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. BMJ 2003; 326(7379):41-4. https://doi.org/10.1136/bmj.326.7379.41

Abramson JH. WINPEPI updated: Computer programs for epidemiologists, and their teaching potential. Epidemiol Perspect Innov 2011; 8(1):1. https://doi.org/10.1186/1742-5573-8-1

Carvalho RN, Letieri AD, Vieira TI, Santos T, Lopes RT, Neves AA, et al. Accuracy of visual and image-based ICDAS criteria compared with a micro-CT gold standard for caries detection on occlusal surfaces. Braz Oral Res 2018; 32:e60. https://doi.org/10.1590/1807-3107bor-2018.vol32.0060

Ismail AI, Sohn W, Tellez M, Amaya A, Sen A, Hasson H, et al. The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries. Community Dent Oral Epidemiol 2007; 35(3):170-8. https://doi.org/10.1111/j.1600-0528.2007.00347.x

Drancourt N, Roger-Leroi V, Pereira B, Munoz-Sanchez ML, Linas N, Vendittelli F, et al. Validity of Soprolife camera and Calcivis device in caries lesion activity assessment. Br Dent J 2020. https://doi.org/10.1038/s41415-020-2316-x

Banerjee A, Frencken JE, Schwendicke F, Innes NPT. Contemporary operative caries management: consensus recommendations on minimally invasive caries removal. Br Dent J 2017; 223(3):215-22. https://doi.org/10.1038/sj.bdj.2017.672

Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics 1986; 42(1):121-30.

Guimarães LS, Hirakata VN. Use of the generalized estimating equation model in longitudinal data analysis. Rev HCPA 2012; 32(4):503-11.

Soviero VM, Leal SC, Silva RC, Azevedo RB. Validity of MicroCT for in vitro detection of proximal carious lesions in primary molars. J Dent 2012; 40(1):35-40. https://doi.org/10.1016/j.jdent.2011.09.002

Ozkan G, Kanli A, Baseren NM, Arslan U, Tatar I. Validation of micro-computed tomography for occlusal caries detection: an in vitro study. Braz Oral Res 2015; 29(1):S1806-83242015000100309. https://doi.org/10.1590/1807-3107BOR-2015.vol29.0132

Gimenez T, Braga MM, Raggio DP, Deery C, Ricketts DN, Mendes FM. Fluorescence-based methods for detecting caries lesions: systematic review, meta-analysis and sources of heterogeneity. PLoS One 2013; 8(4):e60421. https://doi.org/10.1371/journal.pone.0060421

Muller-Bolla M, Joseph C, Pisapia M, Tramini P, Velly AM, Tassery H. Performance of a recent light fluorescence device for detection of occlusal carious lesions in children and adolescents. Eur Arch Paediatr Dent 2017; 18(3):187-95. https://doi.org/10.1007/s40368-017-0285-9

Terrer E, Slimani A, Giraudeau N, Levallois B, Tramini P, Bonte E, et al. Performance of Fluorescence-based Systems in Early Caries Detection: A Public Health Issue. J Contemp Dent Pract 2019; 20(10):1126-31.

Domejean S, Rongier J, Muller-Bolla M. Detection of occlusal carious lesion using the SoproLife® camera: a systematic review. J Contemp Dent Pract 2016; 17(9):774-79. https://doi.org/10.5005/jp-journals-10024-1928

Boye U, Foster GR, Pretty IA, Tickle M. The views of examiners on the use of intra-oral photographs to detect dental caries in epidemiological studies. Community Dent Health 2013; 30(1):34-8.

Kohara EK, Abdala CG, Novaes TF, Braga MM, Haddad AE, Mendes FM. Is it feasible to use smartphone images to perform telediagnosis of different stages of occlusal caries lesions? PLoS One 2018; 13(9):e0202116. https://doi.org/10.1371/journal.pone.0202116

Kidd EA, Fejerskov O. What constitutes dental caries? Histopathology of carious enamel and dentin related to the action of cariogenic biofilms. J Dent Res 2004; 83 Spec No C:C35-8. https://doi.org/10.1177/154405910408301s07

Thylstrup A, Bruun C, Holmen L. In vivo caries models: Mechanisms for caries initiation and arrestment. Adv Dent Res 1994; 8(2):144-57. https://doi.org/10.1177/08959374940080020401