Faculty of Health and Medical Sciences, Section of Cariology and Endodontics, University of Copenhagen, Copenhagen, Denmark.
Department of Pediatric Dentistry, University of Sao Paulo, Sao Paulo, Brazil.
Clin Oral Investig. 2022 Mar;26(3):2597-2605. doi: 10.1007/s00784-021-04229-4. Epub 2021 Oct 20.
To examine the relationship between the ICCMS™ (International Caries Classification and Managing System) features of root caries lesions and the underlying depth of the lesion towards the pulp. In order to control for bias, the study followed the tailored document for risk of bias assessment (RoB-tool) recently published. A pilot study showed that the outline of the pulp was much clearer on horizontal compared to vertical sections through the lesions (p = 0.03) and that the histological stereomicroscopical (SM) assessed lesion depth towards the pulp was not influenced by the cutting direction (p = 0.155).
A sample of extracted permanent molar teeth (n = 100) were classified independently by two of the authors according to ICCMS™ as no sign of root caries lesion 0 = sound; 1 = initial lesion (non-cavitated); 2 = moderate lesion (cavity depth ≤ 2 mm) and 3 = extensive lesion (cavity depth > 2 mm). After horizontal sectioning (HS) through the lesion, the depth of the underlying lesion was SM assessed independently by two of the authors as 0 = no lesion; 1 = lesion in outer 1/3; 2 = middle 1/3; and 3 = inner 1/3 of the dentine towards the pulp.
Intra- and inter-reproducibility (weighted kappa values ≥ 0.83); the accuracy (Spearman's rho-values) = 0.94 and 0.95; and specificity/sensitivities/AUC values (three different thresholds) were ≥ 0.91, ≥ 0.93, and ≥ 0.96, respectively.
Under the umbrella of the RoB-tool, the validity in terms of the reproducibility and accuracy of the ICCMS™ root caries scoring system was high.
By means of the ICCMS™ root caries scoring system, the underlying lesion depth can be estimated, which must be considered when managing the lesion.
研究国际龋病分类和管理系统（ICCMS）根龋病变特征与病变向牙髓方向的潜在深度之间的关系。为了控制偏倚，本研究遵循最近发表的针对风险评估工具（RoB 工具）的定制文件。一项初步研究表明，与病变的垂直切片相比，水平切片中牙髓的轮廓要清晰得多（p=0.03），并且组织学立体显微镜评估向牙髓的病变深度不受切割方向的影响（p=0.155）。
从提取的恒磨牙中抽取样本（n=100），由两位作者根据 ICCMS 独立分类为：无根龋病变迹象 0=完好；1=初始病变（无腔隙）；2=中度病变（腔深≤2mm）和 3=广泛病变（腔深>2mm）。病变水平切片（HS）后，由两位作者独立通过立体显微镜评估病变下潜在的深度，分为 0=无病变；1=病变在外层 1/3；2=中层 1/3；3=向牙髓方向牙本质内层 1/3。
内部和外部再现性（加权 kappa 值≥0.83）；准确性（Spearman 相关系数值）=0.94 和 0.95；特异性/敏感性/AUC 值（三个不同的阈值）分别为≥0.91、≥0.93 和≥0.96。
在 RoB 工具的保护伞下，ICCMS 根龋评分系统的再现性和准确性的有效性很高。
通过 ICCMS 根龋评分系统，可以估计潜在的病变深度，在处理病变时必须考虑到这一点。
