Kanar Özlem, Tağtekin Dilek, Korkut Bora, Yanıkoğlu Funda, Kargül Betül
Department of Restorative Dentistry, Faculty of Dentistry, Marmara University Recep Tayyip Erdoğan Complex Health Campus, Başıbüyük Yolu 9/3 34854 Başıbüyük, Maltepe, İstanbul, Türkiye.
Department of Restorative Dentistry, Faculty of Dentistry, Istanbul Kent University, Istanbul, Türkiye.
BMC Oral Health. 2024 Dec 21;24(1):1529. doi: 10.1186/s12903-024-05323-1.
This study aimed to evaluate the accuracy of laser fluorescence (LF) readings in detection of caries removal by various techniques (CRTs).
A hundred and eighty extracted human molar teeth included in the study which were scored 3, 4, and 5 according to ICDAS. Each score group was randomly assigned to 4 subgroups according to CRT including ceramic bur (Group A), carbide bur (Group B), carbide bur with alumina abrasion (Group C), and carbide bur with bioactive glass (BAG) abrasion (Group D) (n = 15 for each group). A LF device (DIAGNOdent Pen, Kavo) was used to determine remaining caries. Histological sections of the teeth were examined under a dental operating microscope for validation. The data were analyzed using Fisher Freeman Halton, Fisher's Exact, Pearson Chi-Square, Bonferroni Adjusted Z tests, ROC analysis, Kappa statistic and Binary Logistic Regression(p < 0.05).
Histological examination revealed no significant differences among the CRTs and ICDAS scores (p > 0.05 for each). However, a significant difference was found between histological assessment and LF in ICDAS 5 score, specifically between Group B and Group D (p = 0.022), regarding caries presence. LF readings demonstrated over 0.9 area under curve (AUC) value regardless of CRT, except for ICDAS-4 score, and Group D in ICDAS-5 score. Overall, the AUC of LF was found to be 0.880 for the 38 cut-off point (p < 0.001), indicating a high level of accuracy. The univariate and multiple models showed the tested CRTs had no effect on the caries presence (p > 0.050).
The CRTs examined in this study demonstrated similar efficacy in terms of caries removal. However, the application of bioactive glass on caries-affected dentin may lead to overestimations in the LF readings. Additionally, LF on the cavity floor may not be clinically suitable for teeth with ICDAS 4 scores.
The clinical determination of caries removal endpoint is based on a multifactorial decision. However, when selective removal of soft dentin is performed, especially with bioactive glass abrasion in deep caries lesions, higher cut-off points might be determined in laser fluorescence readings to decide further operative intervention.
本研究旨在评估激光荧光（LF）读数在检测各种龋病去除技术（CRT）去除龋坏组织方面的准确性。
本研究纳入180颗拔除的人类磨牙，根据国际龋病检测与评估系统（ICDAS）进行评分，分为3分、4分和5分三组。每个评分组根据CRT随机分为4个亚组，包括陶瓷车针组（A组）、硬质合金车针组（B组）、氧化铝研磨硬质合金车针组（C组）和生物活性玻璃（BAG）研磨硬质合金车针组（D组）（每组n = 15）。使用LF设备（DIAGNOdent Pen，卡瓦公司）确定剩余龋坏。对牙齿的组织学切片在牙科手术显微镜下进行检查以进行验证。使用Fisher Freeman Halton检验、Fisher精确检验、Pearson卡方检验、Bonferroni校正Z检验、ROC分析、Kappa统计量和二元逻辑回归分析数据（p < 0.05）。
组织学检查显示CRT和ICDAS评分之间无显著差异（每项p > 0.05）。然而，在ICDAS 5分的情况下，组织学评估和LF之间存在显著差异，特别是B组和D组之间（p = 0.022），关于龋病的存在情况。除ICDAS - 4分以及ICDAS - 5分的D组外，无论CRT如何，LF读数的曲线下面积（AUC）值均超过0.9。总体而言，LF在38的截断点时AUC为0.880（p < 0.001），表明准确性较高。单因素和多因素模型显示所测试的CRT对龋病的存在没有影响（p > 0.050）。
本研究中检查的CRT在去除龋坏组织方面显示出相似的疗效。然而，在受龋病影响的牙本质上应用生物活性玻璃可能导致LF读数高估。此外，对于ICDAS评分为4分的牙齿，窝洞底部的LF在临床上可能不适用。
龋病去除终点的临床判定基于多因素决策。然而，当进行选择性去除软牙本质时，特别是在深龋病变中使用生物活性玻璃研磨时，在激光荧光读数中可能需要确定更高的截断点来决定进一步的手术干预。
