Shimada Yasushi, Sato Takaaki, Inoue Go, Nakagawa Hisaichi, Tabata Tomoko, Zhou Yuan, Hiraishi Noriko, Gondo Tadamu, Takano Syunsuke, Ushijima Kei, Iwabuchi Hirotoshi, Tsuji Yukiko, Alireza Sadr, Sumi Yasunori, Tagami Junji
Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan.
Department of Periodontology, Shenzhen Stomatological Hospital, Southern Medical University, 1092 Jianshe Road, Luohu District, Shenzhen 518001, China.
Materials (Basel). 2022 Aug 28;15(17):5947. doi: 10.3390/ma15175947.
(1) Background: Dental caries, if diagnosed at the initial stage, can be arrested and remineralized by a non-operative therapeutic approach preserving tooth structure. Accurate and reproducible diagnostic procedure is required for the successful management of incipient caries. The aim of this study was to evaluate the diagnostic accuracy of 3D swept-source optical coherence tomography (3D SS-OCT) for enamel caries at smooth tooth surface if the lesion was with remineralization. (2) Methods: Forty-seven tooth surfaces of 24 extracted human teeth visibly with/without enamel caries (ICDAS code 0−3) were selected and used in this study. The tooth surfaces of investigation site were cleaned and visually examined by four dentists. After the visual inspection, SS-OCT scanning was performed onto the enamel surfaces to construct a 3D image. The 2D tomographic images of the investigation site were chosen from the 3D dataset and dynamically displayed in video and evaluated by the examiners. A five-rank scale was used to score the level of enamel caries according to the following; 1: Intact enamel. 2: Noncavitated lesion with remineralization. 3: Superficial noncavitated lesion without remineralization. 4: Deep nonvacitated lesion without remineralization. 5: Enamel lesion with cavitation. Sensitivity and specificity for 3D OCT image and visual inspection were calculated. Diagnostic accuracy of each diagnostic method was calculated using weighted kappa. Statistical significance was defined at p = 0.05. (3) Results: 3D SS-OCT could clearly depict enamel caries at smooth tooth surface as a bright zone, based on the increased backscattering signal. It was noted that 3D SS-OCT showed higher sensitivity for the diagnosis of remineralized lesions and deep enamel lesions without cavitation, as well as cavitated enamel lesions (p < 0.05). No significant difference of specificity was observed between the two diagnostic methods (p > 0.05). Furthermore, 3D SS-OCT showed higher diagnostic accuracy than visual inspection (p < 0.05). (4) Conclusions: Within the limitations of this in vitro study, 3D SS-OCT showed higher diagnostic capacity for smooth surface enamel caries than visual inspection and could also discriminate lesion remineralization of enamel caries.
（1）背景：龋齿若在初始阶段被诊断出来，可通过非手术治疗方法阻止其发展并实现再矿化，从而保留牙齿结构。对于早期龋齿的成功管理，需要准确且可重复的诊断程序。本研究的目的是评估三维扫频光学相干断层扫描（3D SS - OCT）在光滑牙面釉质龋损且伴有再矿化时的诊断准确性。（2）方法：本研究选取了24颗拔除的人牙的47个可见有无釉质龋（国际龋病检测和评估系统[ICDAS]代码0 - 3）的牙面。对研究部位的牙面进行清洁，并由四位牙医进行目视检查。目视检查后，对釉质表面进行SS - OCT扫描以构建三维图像。从三维数据集中选取研究部位的二维断层图像并以视频形式动态显示，由检查人员进行评估。根据以下标准使用五级评分量表对釉质龋的程度进行评分：1：完整釉质。2：有再矿化的非龋洞性病变。3：无再矿化的浅表非龋洞性病变。4：无再矿化的深层非龋洞性病变。5：有龋洞的釉质病变。计算3D OCT图像和目视检查的敏感性和特异性。使用加权kappa计算每种诊断方法的诊断准确性。统计学显著性定义为p = 0.05。（3）结果：基于背向散射信号增加，3D SS - OCT能够清晰地将光滑牙面的釉质龋描绘为一个明亮区域。值得注意的是，3D SS - OCT在诊断再矿化病变、无龋洞的深层釉质病变以及有龋洞的釉质病变方面显示出更高的敏感性（p < 0.05）。两种诊断方法之间未观察到特异性的显著差异（p > 0.05）。此外，3D SS - OCT显示出比目视检查更高的诊断准确性（p < 0.05）。（4）结论：在本体外研究的局限性范围内，3D SS - OCT在光滑表面釉质龋的诊断能力上高于目视检查，并且还能够区分釉质龋的病变再矿化情况。
