Use of the ICDAS system and two fluorescence-based intraoral devices for examination of occlusal surfaces

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ABSTRACT

Aim

The aims of this study were to assess the inter-examiner reliability of ICDAS and Soprolife intra-oral camera ex vivo
using 5 examiners and to compare in vivo the validity of two fluorescence-based intra-oral devices in examining occlusal surfaces with
early carious lesions.

Methods

Thirty-seven occlusal surfaces of posterior primary and permanent teeth of 20
children were examined using Diagnodent pen (KaVo, Biberach/Ri, Germany) and Soprolife (Acteon Group, La Ciotat, France)
fluorescence intra-oral camera. The white light photos, made by Soprolife camera, were evaluated using ICDAS scores and the
Soprolife fluorescence photos were scored as sound, enamel caries and dentine caries by 5 experienced dentists. The dentists were
trained for the use of ICDAS system with a short online training programme (ICDAS.org) and for the scoring of caries on the
fluorescence images with example images. Statistics: cut-offs were made for ICDAS, Soprolife and Diagnodent to distinguish sound
surfaces and enamel caries from dentinal caries. The inter-examiner reliability was calculated using intra-class correlation coefficient.

Results

On white light images the examiners found 16 enamel caries and 21 dentine caries with the ICDAS system. On the
Soprolife fluorescent images 24 enamel lesions, 9 dentine lesions and 4 sound surfaces were observed. The inter-examiner reliability
(ICC) of the ICDAS system on white light photographs and of Soprolife on the fluorescent images for average measures was 0.70 and
0.72, respectively. The sensitivity and specificity of Soprolife (95CI) was 0.43 and 1.0 respectively, using ICDAS as a reference
standard. The sensitivity and specificity of Diagnodent (95CI) was 0.62 and 0.81 respectively.

Conclusion

A short training
of dentists in the use the ICDAS system resulted in satisfactory inter-examiner reliability for the analysis of occlusal lesions on white light
images. Soprolife and Diagnodent do not contribute to a better detection of early carious lesions.

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