Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, SP, Brazil.
School of Dentistry, University of Guarulhos, Guarulhos, SP, Brazil.
PLoS One. 2018 Sep 6;13(9):e0202116. doi: 10.1371/journal.pone.0202116. eCollection 2018.
The purpose of this study was to compare the performance of two different models of smartphone and a conventional camera with that of direct clinical examination in detecting caries lesions at different stages of progression in deciduous molars. The photographic equipment consisted of two smartphones (iPhone and Nexus 4) and a conventional macro camera setup. First, in the laboratory phase of the study, we compared the images of 20 exfoliated primary teeth having caries lesions at different stages. Then, in the clinical phase of the study, the images of 119 primary molars from fifteen children (3 to 6 years old) were used. All of the photographic images were taken using the previously described devices. In both groups, two examiners, blinded to the photographic equipment used, assessed the images independently on a computer screen, and classified them according to the International Caries Detection and Assessment System (ICDAS). The teeth were then examined directly by two other experienced examiners, and the consensus reached was considered the reference standard. Parameters of validity, such as percentage of correct answers, agreement with the reference standard, sensitivity, specificity and inter-examiner agreement (using the weighted kappa test) were calculated. The examiners performed similarly in both in vitro and in vivo studies. Inter-examiner reliability was approximately 0.7 for all the devices in the laboratory setting, and for the macro camera photography system in the clinical setting, but it was approximately 0.9 for the iPhone and Nexus images taken in vivo. With regard to the percentage of correct answers, the highest values were observed for sound and extensive caries lesions in both laboratory and clinical settings. The percentage of correct answers for initial and moderate lesions was particularly low in the clinical evaluation, irrespective of the camera devices used. Therefore, we concluded that photographic diagnosis using smartphone images is feasible and accurate for distinguishing sound tooth surfaces from extensive caries lesions; however, photographic images are not a good method for accurately detecting initial and moderate caries lesions.
本研究的目的是比较两种不同型号的智能手机和传统相机与直接临床检查在检测乳牙不同进展阶段龋损的性能。摄影设备包括两部智能手机（iPhone 和 Nexus 4）和传统的微距相机。首先，在研究的实验室阶段，我们比较了 20 颗具有不同进展阶段龋损的自然脱落的乳牙的图像。然后，在研究的临床阶段，使用 15 名 3 至 6 岁儿童的 119 颗乳磨牙的图像。所有的摄影图像都是使用之前描述的设备拍摄的。在两组中，两名检查者，对使用的摄影设备不知情，在计算机屏幕上独立评估图像，并根据国际龋病检测和评估系统（ICDAS）对其进行分类。然后，由另外两名经验丰富的检查者直接检查牙齿，并认为达成的共识为参考标准。有效性参数，如正确答案的百分比、与参考标准的一致性、敏感性、特异性和检查者之间的一致性（使用加权 kappa 检验）均被计算。在体外和体内研究中，检查者的表现相似。在实验室环境中，所有设备的检查者间可靠性约为 0.7，在临床环境中，微距相机摄影系统的检查者间可靠性约为 0.9，但在体内拍摄的 iPhone 和 Nexus 图像的检查者间可靠性约为 0.9。关于正确答案的百分比，在实验室和临床环境中，观察到健康和广泛龋损的最高值。在临床评估中，初始和中度病变的正确答案百分比特别低，而与所使用的相机设备无关。因此，我们得出结论，使用智能手机图像进行摄影诊断可以区分健康的牙面和广泛的龋损，是可行且准确的；然而，摄影图像不是准确检测初始和中度龋损的好方法。
