Thompson Van P, Schenkel Andrew B, Penugonda Bapanaiah, Wolff Mark S, Zeller Gregory G, Wu Hongyu, Vena Don, Grill Ashley C, Curro Frederick A
Gen Dent. 2016 May-Jun;64(3):20-7.
The International Caries Detection and Assessment System (ICDAS II) and the Caries Classification System (CCS) are caries stage description systems proposed for adoption into clinical practice. This pilot study investigated clinicians' training in and use of these systems for detection of early caries and recommendations for individual tooth treatment. Patient participants (N = 8) with a range of noncavitated lesions (CCS ranks 2 and 4 and ICDAS II ranks 2-4) identified by a team of calibrated examiners were recruited from the New York University College of Dentistry clinic. Eighteen dentists-8 from the Practitioners Engaged in Applied Research and Learning (PEARL) Network and 10 recruited from the Academy of General Dentistry-were randomly assigned to 1 of 3 groups: 5 dentists used only visual-tactile (VT) examination, 7 were trained in the ICDAS II, and 6 were trained in the CCS. Lesion stage for each tooth was determined by the ICDAS II and CCS groups, and recommended treatment was decided by all groups. Teeth were assessed both with and without radiographs. Caries was detected in 92.7% (95% CI, 88%-96%) of the teeth by dentists with CCS training, 88.8% (95% CI, 84%-92%) of the teeth by those with ICDAS II training, and 62.3% (95% CI, 55%-69%) of teeth by the VT group. Web-based training was acceptable to all dentists in the CCS group (6 of 6) but fewer of the dentists in the ICDAS II group (5 of 7). The modified CCS translated clinically to more accurate caries detection, particularly compared to detection by untrained dentists (VT group). Moreover, the CCS was more accepted than was the ICDAS II, but dentists in both groups were open to the application of these systems. Agreement on caries staging requires additional training prior to a larger validation study.
国际龋病检测与评估系统（ICDAS II）和龋病分类系统（CCS）是为应用于临床实践而提出的龋病阶段描述系统。这项试点研究调查了临床医生对这些系统的培训情况以及在检测早期龋病和针对单颗牙齿治疗建议方面的使用情况。从纽约大学牙科学院诊所招募了由一组经过校准的检查人员确定患有一系列非龋洞性病变（CCS分级为第2级和第4级，ICDAS II分级为2 - 4级）的患者参与者（N = 8）。18名牙医——8名来自参与应用研究与学习的从业者（PEARL）网络，10名从全科牙科学会招募——被随机分配到3组中的1组：5名牙医仅使用视诊 - 触诊（VT）检查，7名接受了ICDAS II培训，6名接受了CCS培训。ICDAS II组和CCS组确定每颗牙齿的病变阶段，所有组决定推荐的治疗方案。在有和没有X光片的情况下对牙齿进行评估。接受CCS培训的牙医检测出92.7%（95%置信区间，88% - 96%）的牙齿患有龋病，接受ICDAS II培训的牙医检测出88.8%（95%置信区间，84% - 92%）的牙齿患有龋病，VT组检测出62.3%（95%置信区间，55% - 69%）的牙齿患有龋病。基于网络的培训在CCS组的所有牙医（6/6）中都可接受，但在ICDAS II组中接受的牙医较少（5/7）。与未受过培训的牙医（VT组）相比，改良后的CCS在临床上能更准确地检测龋病。此外，CCS比ICDAS II更易被接受，但两组牙医都对这些系统的应用持开放态度。在进行更大规模的验证研究之前，龋病分期的一致性需要额外的培训。
