Department of Pediatric Dentistry, School of Dentistry, University of Athens, Greece.
Oper Dent. 2012 May-Jun;37(3):234-45. doi: 10.2341/10-326-L. Epub 2011 Dec 14.
Current caries diagnostic tools are neither very accurate nor very reliable for the detection of carious lesions of different depths. Thus, the development of new devices and techniques is needed. The aim of this in vitro study was to validate a newer fluorescence device VistaProof (VP), and compare it with DIAGNOdent Pen (DP), direct visual (DV) and indirect visual methods (IDV), with respect to accuracy and reliability for the detection of occlusal caries in permanent teeth.
One hundred seven sites on 41 occlusal surfaces of recently extracted premolars were selected and classified into lesion categories according to Ekstrand's clinical criteria, by direct and indirect visual examination. The fluorescence of the sites was also measured by the two devices, and the teeth were ground through the sites for histological evaluation of their lesion depth. One calibrated examiner of high reliability (intraclass correlation coefficient [ICC]>0.85) made all of the evaluations. Sensitivity, specificity, and accuracy of each detection method were estimated based on histological examination as the reference method, estimated using cutoff limits calculated on the basis of best agreement between the devices' values and histological examination. McNemar tests and receiver operating characteristic (ROC) curve analyses were used to compare the validity measures of all detection methods at α=0.05, while the ICC was used to test the reproducibility of the methods based on a second measurement one week after the first.
There was no statistically significant difference (p>0.05) between the accuracy of DP and VPs for both enamel and dentin lesions. The areas under the ROC curves (AUC) for the two devices were also found not to be different (p>0.05). The reliability of DP was statistically significantly better than VP (p<0.05).
The validity of both fluorescence devices were not found to be significantly different and not better than visual methods for the detection of noncavitated carious lesions.
目前的龋齿诊断工具在检测不同深度的龋齿病变时既不够准确也不够可靠。因此，需要开发新的设备和技术。本体外研究的目的是验证一种较新的荧光设备 VistaProof（VP），并将其与 DIAGNOdent Pen（DP）、直接视觉（DV）和间接视觉方法（IDV）进行比较，以评估其对恒牙窝沟龋的检测准确性和可靠性。
从最近拔出的前磨牙的 41 个咬合面中选择了 107 个部位，并根据 Ekstrand 的临床标准，通过直接和间接视觉检查将这些部位分类为病变类别。还通过两种设备测量了这些部位的荧光强度，并通过对这些部位进行磨片，对其病变深度进行组织学评估。一位高可靠性的校准检查者（组内相关系数[ICC]>0.85）进行了所有评估。基于组织学检查作为参考方法，使用基于设备值与组织学检查之间最佳一致性计算的截断值，估算了每种检测方法的敏感性、特异性和准确性。使用 McNemar 检验和接收者操作特性（ROC）曲线分析比较了所有检测方法的有效性指标，α 值为 0.05，同时使用 ICC 测试了一周后第二次测量时方法的可重复性。
DP 和 VP 在釉质和牙本质病变的准确性方面没有统计学上的显著差异（p>0.05）。还发现这两种设备的 ROC 曲线下面积（AUC）没有差异（p>0.05）。DP 的可靠性在统计学上明显优于 VP（p<0.05）。
两种荧光设备的有效性均未发现明显优于视觉方法，无法检测非龋性龋损。
