In vivo diagnosis of fissure caries using a new electrical resistance monitor.

The aim of this investigation was to study the accuracy of a newly developed electrical resistance monitor in diagnosing occlusal fissure caries in vivo in teeth without cavitation. The electrical resistance was measured in vivo on human third molars without existing restorations and without any macroscopic carious cavitation. Data from 41 sites on 26 occlusal surfaces were obtained. After measurement, the teeth were extracted, histologically prepared, and serially sectioned perpendicular to the occlusal surface and examined for the presence of caries. Nineteen sites had no caries, 7 had enamel caries, and 15 sites showed dentinal caries, 4 of which deep dentinal caries. For the diagnosis of occlusal caries with the electrical resistance monitor, the specificity was 0.77, the sensitivity 0.93, and the accuracy 0.83. Likelihood ratios for four diagnostic levels (no caries, enamel caries, dentinal caries, and deep dentinal caries) were 0.09, 0, 3.47, and 4.16, respectively. Diagnosis of occlusal caries using conventional bite-wing radiographs showed a specificity of 0.77, a sensitivity of 0.62, and an accuracy of 0.71. The electrical resistance monitor was well suited to detect in vivo occlusal caries under clinically intact fissures. The rather high value (0.23) of false-positive ratings, however, might lead to a substantial number of sound teeth being restored unnecessarily. Substantial improvement of occlusal, caries diagnosis may be achieved by combining this method with others.