Minuesa-García Elena, Iranzo-Cortés José Enrique, Almerich-Torres Teresa, Bellot-Arcís Carlos, Montiel-Company José María, Almerich-Silla José Manuel
Departamento de Estomatología, Facultad de Medicina y Odontología, Universidad de Valencia, C/Gascó Oliag Num. 1, 46010 Valencia, Spain.
J Clin Med. 2022 May 23;11(10):2937. doi: 10.3390/jcm11102937.
In this study, we compare the efficacy and diagnostic concordance of the ICDAS, the radiographic criterion and the instrument known as the DIAGNOdent fluorescence laser pen on occlusal caries lesions using a histological section as the gold standard. Of 100 teeth that did not present cavitated occlusal lesions or occlusal fillings, 80 were chosen through a randomization program and examined by two previously trained and calibrated researchers. Subsequently, the teeth were sectioned with a diamond disk and observed under an optical microscope. The results were studied for caries with a limit established in enamel and caries with extension to dentin. The intra-examiner (0.821-0.933) and inter-examiner (0.817-0.924) reproducibility obtained for both ICDAS and DIAGNOdent for the diagnosis of borderline enamel caries was high. Similarly, intra-examiner (0.686-1.000) and inter-examiner (0.809-0.944) reproducibility for diagnosis of caries with dentin extension was also high for both methods. The sensitivity obtained was 0.76 (ICDAS), 0.87 (DIAGNOdent) and 0.58 (Rx), whereas the specificity obtained was 0.66 (ICDAS), 0.4 (DIAGNOdent) and 0.77 (Rx) for lesions limited to enamel. For lesions with extension to dentin, the sensitivity obtained was 0.73 (ICDAS), 0.82 (DIAGNOdent) and 0.09 (Rx), and the specificity obtained was 0.79 (ICDAS), 0.52 (DIAGNOdent) and 0.97 (Rx). Sensitivity increases in both cases by combining diagnostic methods. In conclusion, ICDAS and DIAGNOdent are better diagnostic methods than Rx for the detection of occlusal caries, and the combination of these methods helps to obtain a better diagnosis.
在本研究中，我们以组织学切片作为金标准，比较了国际龋病检测和评估系统（ICDAS）、影像学标准以及DIAGNOdent荧光激光笔在检测咬合面龋损方面的疗效和诊断一致性。在100颗未出现龋洞型咬合面病变或咬合面充填物的牙齿中，通过随机程序选取80颗，并由两名先前经过培训和校准的研究人员进行检查。随后，用金刚石切割盘对牙齿进行切片，并在光学显微镜下观察。研究结果针对釉质内局限的龋病以及累及牙本质的龋病进行分析。对于可疑釉质龋的诊断，ICDAS和DIAGNOdent的检查者内重复性（0.821 - 0.933）和检查者间重复性（0.817 - 0.924）都很高。同样，对于累及牙本质的龋病诊断，两种方法的检查者内重复性（0.686 - 1.000）和检查者间重复性（0.809 - 0.944）也很高。对于局限于釉质的病变，所获得的敏感度分别为0.76（ICDAS）、0.87（DIAGNOdent）和0.58（影像学检查），而特异度分别为0.66（ICDAS）、0.4（DIAGNOdent）和0.77（影像学检查）。对于累及牙本质的病变，所获得的敏感度分别为0.73（ICDAS）、0.82（DIAGNOdent）和0.09（影像学检查），特异度分别为0.79（ICDAS）、0.52（DIAGNOdent）和0.97（影像学检查）。在两种情况下，通过联合诊断方法，敏感度均有所提高。总之，在检测咬合面龋方面，ICDAS和DIAGNOdent比影像学检查是更好的诊断方法，并且这些方法的联合有助于获得更好的诊断。
