Pereira Antonio Carlos, Eggertsson Hafsteinn, Martinez-Mier Esperanza Angeles, Mialhe Fábio Luiz, Eckert George Joseph, Zero Domenick Thomas
Departamento de Odontologia Social, Faculdade de Odontologia de Piracicaba, Piracicaba School of Dentistry, FOP/UNICAMP, Piracicaba, São Paulo, Brazil.
Eur J Oral Sci. 2009 Feb;117(1):51-7. doi: 10.1111/j.1600-0722.2008.00586.x.
The aim of this in vitro study was to evaluate whether having results available from multiple detection methods influences dentist's treatment decisions for incipient caries lesions on occlusal surfaces. The occlusal surface of 96 extracted permanent molars without frank cavitation was examined by three examiners initially by visual examination alone, following which they chose one of three treatment options: (i) no treatment, (ii) preventive or non-invasive treatment (sealants), and (iii) invasive treatment. Four weeks later the examiners again selected one of the three treatment options for the surfaces, but this time were able to refer to the results from additional caries-detection methods [bitewing radiographs, electric conductance measurement (ECM), quantitative light fluorescence (QLF), and DIAGNOdent] that had been performed in the interim time. Stereomicroscopy was used to evaluate sensitivity, specificity, accuracy, and area under the Receiver Operating Characteristic (ROC) curve (AUC) for the detection methods at the D1 diagnostic threshold. Slight improvement was obtained in the percentage of sites correctly diagnosed, and in the AUC, when referring to the results obtained from all detection methods compared with visual examination alone. However, a drastic effect on the selection of treatment options was observed by having results available from multiple methods, with the choice of invasive treatment increasing substantially. In conclusion, having data available from multiple methods did not improve the accuracy of examiners in detecting early occlusal caries lesions, but it had a great influence on the number of surfaces indicated for operative treatment. The potential decrease in overall specificity while using multiple methods of detection may be of concern in populations with a low prevalence of occlusal caries lesions.
这项体外研究的目的是评估多种检测方法所得结果是否会影响牙医对咬合面早期龋损的治疗决策。96颗无明显龋洞的拔除恒牙的咬合面最初由三名检查者仅通过视觉检查进行检查，随后他们从三种治疗方案中选择一种：（i）不治疗，（ii）预防性或非侵入性治疗（窝沟封闭），以及（iii）侵入性治疗。四周后，检查者再次为这些表面从三种治疗方案中选择一种，但这次能够参考在此期间进行的其他龋病检测方法[咬合翼片X线片、电导测量（ECM）、定量光导荧光法（QLF）和龋病诊断仪]的结果。使用体视显微镜评估在D1诊断阈值下各检测方法的灵敏度、特异性、准确性和受试者工作特征（ROC）曲线下面积（AUC）。与仅进行视觉检查相比，参考所有检测方法所得结果时，正确诊断部位的百分比和AUC略有改善。然而，观察到多种方法所得结果对治疗方案的选择有显著影响，侵入性治疗的选择大幅增加。总之，多种方法提供的数据并未提高检查者检测早期咬合面龋损的准确性，但对指示进行手术治疗的表面数量有很大影响。在咬合面龋损患病率较低的人群中，使用多种检测方法时总体特异性可能降低，这可能令人担忧。
