Wilde Sabrina, Campos Priscila-Hernández, Marcondes Ana-Paula-Marçal, Moura-Netto Cacio, Novaes Tatiane-Fernandes, Lussi Adrian, Diniz Michele-Baffi
School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
Post-graduate Program in Dentistry, Cruzeiro do Sul University - São Paulo, SP, Brazil.
J Clin Exp Dent. 2020 May 1;12(5):e479-e487. doi: 10.4317/jced.56445. eCollection 2020 May.
Some studies have addressed the influence of optical magnification on the detection of caries lesions using a visual scoring system. However, there is a lack of research related to the use of the CAST and ADA-CCS visual scoring systems. In addition, the reliability and accuracy of ADA-CCS index in permanent teeth were not studied yet. So, the aim of this study was to evaluate, in vitro, the influence of different levels of optical magnification on the detection of occlusal caries lesions in permanent molars using three visual scoring systems.
One occlusal site per tooth was analyzed in 120 extracted permanent molars. Two trained examiners inspected the teeth using ICDAS (International Caries Detection and Assessment System), CAST (Caries Assessment Spectrum and Treatment), and ADA-CCS (American Dental Association-Caries Classification System) visual criteria, twice with each scoring system, with a one-week interval between examinations. The study was conducted in three phases: (A) without optical magnification, (B) using a binocular lens (3.5× magnification), and (C) using an operating microscope (16× magnification). Then, the teeth were sectioned longitudinally through the center of the selected site and the section with the more severe lesion was histological evaluated considering the D1 (lesions in enamel and dentin) and D3 (dentin lesions) thresholds.
Kappa values for intra- and inter-examiner reproducibility were good to excellent for all systems. At the D1 threshold, sensitivity, accuracy, and area under the ROC curve were high for ICDAS and CAST in all phases. However, this was not the case for the ADA-CCS in phase C (<0.05). At the D3 diagnostic threshold, there was no significant difference between the visual scoring systems during the study phases (>0.05).
The magnification does not improve the accuracy of the visual scoring systems in the detection of occlusal caries lesions in permanent molars. Dental caries, caries detection, permanent teeth, visual examination, magnification.
一些研究探讨了光学放大对使用视觉评分系统检测龋损的影响。然而，关于使用CAST和ADA - CCS视觉评分系统的研究较少。此外，尚未对恒牙中ADA - CCS指数的可靠性和准确性进行研究。因此，本研究的目的是在体外评估不同程度的光学放大对使用三种视觉评分系统检测恒牙磨牙咬合面龋损的影响。
对120颗拔除的恒牙磨牙，每颗牙的一个咬合面进行分析。两名经过培训的检查者使用国际龋病检测与评估系统（ICDAS）、龋病评估光谱与治疗系统（CAST）和美国牙科协会龋病分类系统（ADA - CCS）的视觉标准对牙齿进行检查，每个评分系统检查两次，两次检查间隔一周。研究分三个阶段进行：（A）无光学放大；（B）使用双目放大镜（3.5倍放大）；（C）使用手术显微镜（16倍放大）。然后，沿选定部位的中心纵向切开牙齿，对病变较严重的切片进行组织学评估，考虑D1（釉质和牙本质病变）和D3（牙本质病变）阈值。
所有系统的检查者内和检查者间再现性的Kappa值均为良好至优秀。在D1阈值时，ICDAS和CAST在所有阶段的敏感性、准确性和ROC曲线下面积均较高。然而，在C阶段ADA - CCS并非如此（<0.05）。在D3诊断阈值时，研究各阶段视觉评分系统之间无显著差异（>0.05）。
放大倍数并不能提高视觉评分系统检测恒牙磨牙咬合面龋损的准确性。龋齿、龋病检测、恒牙、视觉检查、放大倍数。
