Alomari Q D, Qudeimat M A, Khalaf M E, Al-Tarakemah Y
Oper Dent. 2015 May-Jun;40(3):313-21. doi: 10.2341/14-138-L. Epub 2014 Dec 23.
The aim of this laboratory study was to evaluate the effectiveness of incorporating radiographic examination and DIAGNOdent with visual examination for the detection and treatment of noncavitated occluso-dentinal caries. Four examiners examined the occlusal surfaces of 160 extracted posterior teeth. Teeth were examined three times with a one-month interval in between. The first examination was visual (V), the second examination was visual with radiograph (VR), and the third examination was visual with radiograph and DIAGNOdent (VRD). Examiners were asked to detect the presence of caries (if any) and identify the extent of caries (if present; ie, enamel or dentin). The examiners were also asked to choose a treatment for each tooth. The examined teeth were later sectioned, and the presence of caries was charted as 0 = no caries, 1 = caries confined to enamel, 2 = caries in the outer dentin, and 3 = caries in the inner dentin. Sensitivity, specificity, area under the curve (Az values), rank correlation coefficient, interexaminer reproducibility, and McNemar χ(2) tests were calculated. VR had statistically higher specificity and lower sensitivity than V and VRD. The means of Az values ranged from 0.58 to 0.63, with no statistical difference between the three examinations (p>0.05). The means of the rank correlation coefficients with histology for detection of dentinal caries were 0.48, 0.23, and 0.44 using V, VR, and VRD, respectively. Interexaminer reproducibility was best for V alone. The percentages of teeth indicated for restorative treatment were 31%, 33%, and 41% using V, VR, and VRD, respectively. The percentages of teeth correctly treated according to histology were 69.4%, 70.0%, and 67.5% using V, VR, and VRD, respectively. There was no difference in the accuracy of treatment decisions between the three examination points (p>0.05). The addition of radiographs and DIAGNOdent to visual examination did not have a significant effect on the improvement of the detection or treatment decisions of examiners of noncavitated occluso-dentinal carious lesions.
这项实验室研究的目的是评估将X线检查和龋齿诊断仪与视觉检查相结合用于非龋性咬合面牙本质龋检测和治疗的有效性。四名检查者检查了160颗拔除的后牙的咬合面。牙齿每隔一个月检查三次。第一次检查是视觉检查（V），第二次检查是视觉检查加X线片（VR），第三次检查是视觉检查加X线片和龋齿诊断仪（VRD）。要求检查者检测龋齿的存在（如果有）并确定龋齿的范围（如果存在；即釉质或牙本质）。还要求检查者为每颗牙齿选择一种治疗方法。随后将检查过的牙齿进行切片，并将龋齿的存在情况记录为0 = 无龋齿，1 = 龋齿局限于釉质，2 = 外层牙本质龋，3 = 内层牙本质龋。计算敏感性、特异性、曲线下面积（Az值）、等级相关系数、检查者间的可重复性以及McNemar χ(2)检验。VR在统计学上比V和VRD具有更高的特异性和更低的敏感性。Az值的平均值在0.58至0.63之间，三次检查之间无统计学差异（p>0.05）。使用V、VR和VRD检测牙本质龋与组织学的等级相关系数平均值分别为0.48、0.23和0.44。仅视觉检查时检查者间的可重复性最佳。使用V、VR和VRD时，建议进行修复治疗的牙齿百分比分别为31%、33%和41%。根据组织学正确治疗的牙齿百分比使用V、VR和VRD时分别为69.4%、70.0%和67.5%。三个检查点之间治疗决策的准确性没有差异（p>0.05）。在视觉检查中添加X线片和龋齿诊断仪对非龋性咬合面牙本质龋病变检查者的检测或治疗决策的改善没有显著影响。
