Departamento de Ortodontia e Odontopediatria, School of Dentistry, University of São Paulo, Av. Prof. Lineu Prestes 2227, São Paulo, SP, Brazil.
Braz Oral Res. 2010 Jan-Mar;24(1):102-7. doi: 10.1590/s1806-83242010000100017.
Secondary caries has been reported as the main reason for restoration replacement. The aim of this in vitro study was to evaluate the performance of different methods--visual inspection, laser fluorescence (DIAGNOdent), radiography and tactile examination--for secondary caries detection in primary molars restored with amalgam. Fifty-four primary molars were photographed and 73 suspect sites adjacent to amalgam restorations were selected. Two examiners evaluated independently these sites using all methods. Agreement between examiners was assessed by the Kappa test. To validate the methods, a caries-detector dye was used after restoration removal. The best cut-off points for the sample were found by a Receiver Operator Characteristic (ROC) analysis, and the area under the ROC curve (Az), and the sensitivity, specificity and accuracy of the methods were calculated for enamel (D2) and dentine (D3) thresholds. These parameters were found for each method and then compared by the McNemar test. The tactile examination and visual inspection presented the highest inter-examiner agreement for the D2 and D3 thresholds, respectively. The visual inspection also showed better performance than the other methods for both thresholds (Az = 0.861 and Az = 0.841, respectively). In conclusion, the visual inspection presented the best performance for detecting enamel and dentin secondary caries in primary teeth restored with amalgam.
继发龋已被报道为修复体替换的主要原因。本体外研究旨在评估不同方法——肉眼观察、激光荧光（DIAGNOdent）、放射线照相和触诊——在检测用银汞合金修复的乳磨牙继发龋中的性能。对 54 颗乳磨牙进行拍照，并选择 73 个紧邻银汞合金修复体的可疑部位。两名检查者使用所有方法独立评估这些部位。使用 Kappa 检验评估检查者之间的一致性。在修复体去除后，使用龋探测染料验证这些方法。通过接收者操作特征（ROC）分析找到样本的最佳截断点，计算 ROC 曲线下的面积（Az），以及各方法在牙釉质（D2）和牙本质（D3）阈值下的灵敏度、特异性和准确性。为每个方法计算了这些参数，然后通过 McNemar 检验进行比较。对于 D2 和 D3 阈值，触诊和肉眼观察的检查者间一致性最高。肉眼观察在两个阈值下的性能均优于其他方法（Az = 0.861 和 Az = 0.841）。总之，肉眼观察在检测用银汞合金修复的乳磨牙的牙釉质和牙本质继发龋方面表现出最佳性能。
