Clinical validation of near-infrared light transillumination for early proximal caries detection using a composite reference standard.

OBJECTIVES: The aim of this in vivo prospective clinical study was to validate a near-infrared light transillumination (NILT) device for the detection of proximal caries lesions and compare it to the established diagnostic method of bitewing radiography (BWR). MATERIALS AND METHODS: A total of 116 interproximal posterior teeth/surfaces without gross cavitation were included and assessed with BWR and NILT. After clinical examination, the teeth with sound surfaces or non-cavitated caries lesions were separated with the use of an orthodontic separation rubber for 24h. Upon removal of the separator a silicon impression was obtained and the teeth surfaces were directly investigated. Intra- and inter-examiner reproducibility, sensitivities (SE) and specificities (SP) as well as the area under ROC curves (AUC) were calculated. RESULTS: The SE of NILT was 0.92 in D1 lesions and 1.00 in D2 and D3 lesions, respectively. BWR showed SE values of 0.81 in D1 lesions, 0.74 in D2 and 1.00 in D3 lesions, respectively. However, NILT showed lower values of SP (D1 0.38, D2 0.42 and D3 0.99) compared to BWR (D1 0.65, D2 0.88, D3 1.00). Intra-examiner reproducibility increased for both examiners from the initial examination (0.68 and 0.62) to the recall appointment (0.89 and 0.76) respectively. CONCLUSION: The performance of NILT in detection of enamel caries was comparable to BWR. NILT could be considered as a useful and reliable tool in clinical practice. However, monitoring of enamel lesions might not be accurate, since a low specificity of NILT at D1,2 level and a tendency to false positive ratings have been shown. Therefore, it is recommended that treatment decisions should not be based on NILT alone. CLINICAL RELEVANCE: This study might indicate that NILT can be used for routine patient screening but the use of BWR is still important for treatment decisions.

Inter- and intraexaminer reliability of bitewing radiography and near-infrared light transillumination for proximal caries detection and assessment.

OBJECTIVES: The purpose of this in vitro study was to evaluate the inter- and intraexaminer reliability of digital bitewing (DBW) radiography and near-infrared light transillumination (NIRT) for proximal caries detection and assessment in posterior teeth. METHODS: From a pool of 85 patients, 100 corresponding pairs of DBW and NIRT images (~1/3 healthy, ~1/3 with enamel caries and ~1/3 with dentin caries) were chosen. 12 dentists with different professional status and clinical experience repeated the evaluation in two blinded cycles. Two experienced dentists provided a reference diagnosis after analysing all images independently. Statistical analysis included the calculation of simple (κ) and weighted Kappa (wκ) values as a measure of reliability. Logistic regression with a backward elimination model was used to investigate the influence of the diagnostic method, evaluation cycle, type of tooth, and clinical experience on reliability. RESULTS: Altogether, inter- and intraexaminer reliability exhibited good to excellent κ and wκ values for DBW radiography (Inter: κ = 0.60/ 0.63; wκ = 0.74/0.76; Intra: κ = 0.64; wκ = 0.77) and NIRT (Inter: κ = 0.74/0.64; wκ = 0.86/0.82; Intra: κ = 0.68; wκ = 0.84). The backward elimination model revealed NIRT to be significantly more reliable than DBW radiography. CONCLUSIONS: This study revealed a good to excellent inter- and intraexaminer reliability for proximal caries detection using DBW and NIRT images. The logistic regression analysis revealed significantly better reliability for NIRT. Additionally, the first evaluation cycle was more reliable according to the reference diagnoses.

In vitro validation of a hand-held optical reflectometer to measure clinically observed erosive tooth wear.

In this study, we analyzed a newly developed optical reflectometer for measuring erosive tooth wear (ETW) in vitro. Three examiners independently assessed the labial surface of 80 deciduous canines and 75 permanent incisors. One examiner performed visual examinations (BEWE), and the other two used the optical pen-size reflectometer to measure surface reflection intensity (SRI) on the same labial surfaces. The examinations were made in duplicate with at least 1 week interval. Intra- and inter-rater agreements were calculated using weighted kappa analysis for BEWE, and intra-class correlation coefficients (ICC) as well as Bland-Altman plots for SRI. The teeth were separated into without (BEWE 0) or with (BEWE 1-3) ETW, and SRI cut-off points were calculated. Intra-rater agreement for the visual examination was 0.46 and 0.82 for deciduous and permanent teeth, respectively. Inter-rater and intra-rater agreement for SRI were good (ICC > 0.7; p < 0.001). SRI measurements produced high specificity values for deciduous and permanent teeth (≥0.74 and ≥ 0.84, respectively), and lower sensitivity values (≥0.37 and ≥ 0.64, respectively), but permanent teeth had generally higher SRI values (p < 0.05). We observed a significant association between BEWE and SRI (p < 0.05). The optical pen-size reflectometer was able to adequately differentiate ETW on permanent teeth, with highly reliable and reproducible measurements, but ETW on deciduous teeth was less accurately differentiated. The reflectometer is a good candidate for clinical research.