Verdonschot E H, Bronkhorst E M, Burgersdijk R C, König K G, Schaeken M J, Truin G J
Department of Cariology and Endodontology, University of Nijmegen, The Netherlands.
Caries Res. 1992;26(1):59-64. doi: 10.1159/000261429.
The objective of this study was to compare the performance in occlusal caries diagnosis of various available diagnostic systems when applied to the same teeth. The sample investigated consisted of 13 children for whom 4 premolar and 19 molar teeth were judged to require a sealant. The indication was based on the criteria 'fissure discoloration', 'enamel decalcification' and 'absence of dentinal decay'. For predefined locations within these occlusal fissures a diagnosis was obtained by the following diagnostic systems: clinical examination, examination on fiber-optic transillumination (FOTI), fissure discoloration, electrical resistance measurement, radiographic examination and ratings of fissure morphology. Tooth material was removed until no (more) carious enamel or dentin was left. Two dentists then jointly decided on the status of decay for each of the defined locations within the fissure. These ratings served as the 'gold standard' diagnoses. The electrical resistance measurement with a sensitivity of 0.96 and a specificity of 0.71 was the only diagnostic tool with acceptable performance. Radiographic diagnosis was characterized by a moderate sensitivity and specificity. All other diagnostic systems had either very low sensitivities or very low specificities, or both. The positive predictive value of FOTI examination and the negative predictive value of the electrical resistance measurements were very high, irrespective of the prevalence of occlusal dentinal decay.
本研究的目的是比较各种现有诊断系统应用于同一颗牙齿时在咬合面龋诊断方面的表现。所调查的样本包括13名儿童，他们的4颗前磨牙和19颗磨牙被判定需要进行窝沟封闭。判断依据是“窝沟变色”“釉质脱矿”和“无牙本质龋”标准。对于这些咬合面窝沟内的预定义位置，通过以下诊断系统进行诊断：临床检查、光纤透照检查（FOTI）、窝沟变色、电阻测量、X线检查以及窝沟形态评级。去除牙齿组织，直至不再有（更多的）龋坏釉质或牙本质残留。然后，两名牙医共同确定窝沟内每个定义位置的龋坏状况。这些评级作为“金标准”诊断。灵敏度为0.96、特异度为0.71的电阻测量是唯一性能可接受的诊断工具。X线诊断的特点是灵敏度和特异度中等。所有其他诊断系统的灵敏度或特异度都非常低，或两者都很低。无论咬合面牙本质龋的患病率如何，FOTI检查的阳性预测值和电阻测量的阴性预测值都非常高。
