Bücher K, Galler M, Seitz M, Hickel R, Kunzelmann K-H, Kühnisch J
Oper Dent. 2015 May-Jun;40(3):255-62. doi: 10.2341/13-128-L. Epub 2015 Feb 19.
This in vitro study aimed to evaluate occlusal caries extension in relation to visual and radiographic diagnostic criteria and their clinical value to indicate operative or preventive dental care.
A total of 196 third molars with clinically sound occlusal fissures or noncavitated lesions were collected. Before microcomputed tomography (μCT) investigation, each tooth was examined visually and radiographically. Kühnisch's μCT-based caries-extension index (CE index) was used to determine the caries depth on a numeric scale (0 = sound; 0.01-0.99 = enamel caries; 1.0-1.99 = dentin caries). Sensitivities (SEs), specificities (SPs), and area under the receiver operating characteristic curve (Az value) were also calculated.
Based on μCT data, the following mean CE index values and standard deviations (SDs) were documented according to the visual criteria: sound = 0.6 (0.4); first visible signs = 0.9 (0.4); established lesions = 1.3 (0.3); microcavities = 1.4 (0.2); dentin exposure = 1.5 (0.2); and large cavities = 1.5 (0.3). The radiographic categories according to Marthaler (enamel caries [D0-2], caries in the outer half of dentin [D3], and caries in the inner half of dentin [D4]) were related to CE index values of 0.9 (0.4), 1.4 (0.2) and 1.6 (0.4), respectively. Caries detected visually or radiographically showed an SE of 84% and an SP of 85% (Az = 0.85). When both methods were used to predict dentin involvement simultaneously, SE = 27%, SP = 100%, and Az = 0.63; this combined visual and radiographic approach was associated with a perfect specificity and no false-negative decisions. The proportion of false-positive diagnoses was moderately high, and lesion extension in these cases was mainly limited to the outer 20% of the dentin.
Our results might be useful for differentiating between preventive and operative dental care for pits and fissures.
本体外研究旨在评估咬合面龋损扩展与视觉及影像学诊断标准的关系，以及它们在指导牙科手术或预防性治疗方面的临床价值。
共收集了196颗具有临床完好咬合面裂隙或非龋洞性病变的第三磨牙。在进行微计算机断层扫描（μCT）检查前，对每颗牙齿进行了视觉和影像学检查。基于Kühnisch的μCT龋损扩展指数（CE指数）用于在数字量表上确定龋损深度（0 = 完好；0.01 - 0.99 = 釉质龋；1.0 - 1.99 = 牙本质龋）。还计算了敏感度（SEs）、特异度（SPs）以及受试者工作特征曲线下面积（Az值）。
基于μCT数据，根据视觉标准记录了以下平均CE指数值及标准差（SDs）：完好 = 0.6（0.4）；首次可见迹象 = 0.9（0.4）；已确诊病变 = 1.3（0.3）；微龋洞 = 1.4（0.2）；牙本质暴露 = 1.5（0.2）；大龋洞 = 1.5（0.3）。根据Marthaler的影像学分类（釉质龋[D0 - 2]、牙本质外半层龋[D3]和牙本质内半层龋[D4]）分别对应CE指数值为0.9（0.4）、1.4（0.2）和1.6（0.4）。视觉或影像学检测到的龋损显示敏感度为84%，特异度为85%（Az = 0.85）。当同时使用两种方法预测牙本质受累情况时，敏感度 = 27%，特异度 = 100%，Az = 0.63；这种视觉和影像学相结合的方法具有完美的特异度且无假阴性判断。假阳性诊断比例中等偏高，且这些病例中的病变扩展主要局限于牙本质外层的20%。
我们的结果可能有助于区分窝沟的预防性和手术性牙科治疗。
