Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany.
BMC Oral Health. 2021 Mar 5;21(1):97. doi: 10.1186/s12903-021-01465-8.
The purpose of this prospective clinical diagnostic study with validation was to compare the diagnostic accuracy of near-infrared transillumination (NIRT), laser fluorescence measurement (LF), alternating current impedance spectroscopy (ACIS) and their combinations as adjunct methods to visual examination (VE) for occlusal caries detection using a hybrid reference standard.
Ninety-six first and second non-cavitated permanent molars from 76 individuals (mean age 24.2) were investigated using (VE) (ICDAS) and bitewing radiography (BWR), as well as NIRT, LF and ACIS. The findings of BWR and NIRT were evaluated by two examiners while the other examinations were conducted by one calibrated dentist. The hybrid reference standard consisted of non-operative validation based on the results of VE and BWR and operative validation. Statistical analysis included cross-tabulations, calculation of sensitivity, specificity and area under the receiver operating characteristic curve at three diagnostic thresholds: caries in general, enamel caries and dentin caries.
NIRT, LF and ACIS exhibited high sensitivity for caries in general [1.00 (1.00-1.00), 0.77 (0.65-0.88), 0.75 (0.63-0.87)) and for dentin caries (0.97 (0.91-1.03), 0.76 (0.76-0.90), 0.64 (0.47-0.80)]. Sensitivity values for enamel caries were weak (0.21, 0.11, 0.37). Specificity values did not fall below 0.65 (NIRT) for all categories and methods, except for NIRT at the caries detection threshold (0.27). A combination of LF and ACIS with VE improved the diagnostic performance at the overall and the enamel caries threshold. The other methods showed fair to excellent discrimination at the overall caries threshold (NIRT 0.64, LF 0.89 and ACIS 0.86) and acceptable discrimination at the dentin caries threshold (NIRT 0.82, LF 0.81 and ACIS 0.79). AUROC for enamel caries exhibited the weakest discrimination. Accuracy was 65.6% for VE, 69.8% for BWR, 50.0% for NIRT, 53.1% for LF and 74.0% for ACIS. Reliability assessment for BWR and NIRT showed at least substantial agreements for all analyses.
The methods, NIRT, LF and ACIS, revealed different potential but no impeccable performance for occlusal caries detection. All are suitable instruments to detect hidden carious lesion in dentin. As auxiliaries to VE, LF and ACIS showed an increase in diagnostic performance.
本前瞻性临床诊断研究旨在通过混合参考标准，比较近红外透射（NIRT）、激光荧光测量（LF）、交流阻抗光谱（ACIS）及其组合作为附加方法，与视觉检查（VE）相比，对窝沟龋检测的诊断准确性。
共纳入 76 名患者的 96 颗第一和第二恒磨牙（平均年龄 24.2 岁），采用 VE（ICDAS）和牙合翼片（BWR），以及 NIRT、LF 和 ACIS 进行检查。BWR 和 NIRT 的检查结果由两名检查者进行评估，而其他检查由一名经过校准的牙医进行。混合参考标准由基于 VE 和 BWR 结果的非手术验证和手术验证组成。统计分析包括交叉表、计算三种诊断阈值（一般龋、釉质龋和牙本质龋）下的敏感性、特异性和受试者工作特征曲线下面积。
NIRT、LF 和 ACIS 在检测一般龋时具有较高的敏感性[1.00（1.00-1.00）、0.77（0.65-0.88）、0.75（0.63-0.87）]和牙本质龋[0.97（0.91-1.03）、0.76（0.76-0.90）、0.64（0.47-0.80）]。在检测釉质龋时，敏感性较弱（0.21、0.11、0.37）。除了 NIRT 在龋检测阈值下（0.27），特异性值均不低于 0.65（NIRT），所有类别和方法均如此。LF 和 ACIS 与 VE 的组合提高了整体和釉质龋阈值下的诊断性能。其他方法在整体龋阈值下具有良好到优秀的区分能力（NIRT 0.64、LF 0.89 和 ACIS 0.86），在牙本质龋阈值下具有可接受的区分能力（NIRT 0.82、LF 0.81 和 ACIS 0.79）。釉质龋的 AUROC 表现出最弱的区分能力。VE 的准确性为 65.6%，BWR 为 69.8%，NIRT 为 50.0%，LF 为 53.1%，ACIS 为 74.0%。BWR 和 NIRT 的可靠性评估显示，所有分析均至少具有实质性一致性。
NIRT、LF 和 ACIS 等方法对窝沟龋检测具有不同的潜力，但没有无可挑剔的性能。所有这些方法都适合检测牙本质中的隐匿性龋损。作为 VE 的辅助手段，LF 和 ACIS 显示出诊断性能的提高。
