Holtzman Jennifer S, Osann Kathryn, Pharar Jessica, Lee Kenneth, Ahn Yeh-Chan, Tucker Travis, Sabet Sharareh, Chen Zhongping, Gukasyan Ripsik, Wilder-Smith Petra
The Herman Ostrow School of Dentistry, University of Southern California, 3305B South Hoover Street, Bldg A, Room 120, Los Angeles, California 90089-71001, USA.
Lasers Surg Med. 2010 Oct;42(8):752-9. doi: 10.1002/lsm.20963.
The onset and progression of early tooth decay is often preventable with dental sealants. However, occasionally decay progresses underneath the sealant. Current technology does not permit monitoring of potential lesion progression or arrest. Dental sealants themselves mask the visual cues that identify early tooth decay, and radiographs are not sufficiently sensitive. Therefore, clinicians can be reluctant to use dental sealant. The objective of this ex vivo study was to evaluate the ability of dentists to detect decay beneath commonly used dental sealants using optical coherence tomography (OCT) imaging. STUDY DESIGNS/MATERIALS/METHODS: Forty extracted teeth were divided into equal groups of carious and non-carious teeth, as determined by visual inspection. After radiographs and OCT imaging, teeth were randomly assigned for sealant placement with one of four commonly purchased dental sealants: Clinpro™, Fuji Triage™, Embrace Wet Bond™, and Delton™.Following sealant placement, teeth were radiographed, imaged with OCT, sectioned, examined histologically, and scored as healthy/not healthy. OCT and radiographic images were scored separately. The gold standard was histopathological diagnosis from the serial sections.Cohen's kappa, sensitivity, negative predictive value, and positive predictive value were computed for all measures.
After 90 minutes training, pre-standardized dentists were able to detect tooth decay more accurately using OCT than with visual or radiographic examination. Detection using OCT was somewhat better prior to sealant placement than afterwards. This effect varied in size depending on the type of sealant used. Radiographic diagnosis was also less accurate after sealant placement. Of the four dental sealants, Delton provided excellent positive predictive value and the best post-sealant negative predictive values.
In this ex vivo study, dentists were able to detect tooth decay beneath four commonly used dental sealants based on OCT images. Clinical investigations are now underway to determine the usefulness of this approach in vivo.
早期龋齿的发生和进展通常可用牙科密封剂预防。然而，偶尔龋齿会在密封剂下方发展。当前技术无法监测潜在病变的进展或停滞情况。牙科密封剂本身会掩盖识别早期龋齿的视觉线索，而X光片的敏感度又不够。因此，临床医生可能不愿使用牙科密封剂。这项体外研究的目的是评估牙医使用光学相干断层扫描（OCT）成像检测常用牙科密封剂下方龋齿的能力。
研究设计/材料/方法：通过目视检查将40颗拔除的牙齿分为龋齿组和非龋齿组，每组数量相等。在进行X光片和OCT成像后，牙齿被随机分配使用四种常见购买的牙科密封剂之一进行密封剂放置：Clinpro™、Fuji Triage™、Embrace Wet Bond™和Delton™。
放置密封剂后，对牙齿进行X光片拍摄、OCT成像、切片、组织学检查，并评定为健康/不健康。OCT和X光片图像分别评分。金标准是连续切片的组织病理学诊断。计算所有测量指标的Cohen's kappa、敏感度、阴性预测值和阳性预测值。
经过90分钟的培训，经过预标准化的牙医使用OCT比视觉或X光检查能更准确地检测龋齿。在放置密封剂之前使用OCT检测比之后稍好。这种效果的大小因使用的密封剂类型而异。放置密封剂后X光片诊断也不太准确。在四种牙科密封剂中，Delton具有出色的阳性预测值和最佳的放置密封剂后的阴性预测值。
在这项体外研究中，牙医能够根据OCT图像检测四种常用牙科密封剂下方的龋齿。目前正在进行临床研究以确定这种方法在体内的实用性。
