LFpen/ ICDAS II in detecting occlusal caries in primary molars

Objectives:

The aim of the present study was to compare the performance of different methods (laser fluorescence, visual examination and radiography) in detecting occlusal caries in deciduous molars.

Methods:

Twenty-three primary molars were frozen directly after extraction. After defrosting and professional cleaning, the teeth were investigated with laser fluorescence (DIAGNOdent 2095 and DIAGNOdent pen, KaVo, Biberach, Germany), visual inspection ("traditional" [D₀-D₄] and ICDAS II) and radiography for occurrence of occlusal caries. Measurements and scoring were independently performed two times by two experienced examiners. The teeth afterwards underwent histological processing with thin sections; these were stained with Fuchsine dye and light green acetate. After taking photomicrographs under a stereo light microscope with two-fold magnification, caries extension (D₀-D₄) was assessed by two examiners. Outcome parameters were intra-and interexaminer reliability (ICC and Kappa), sensitivity, specificity, and AUC under the ROC curve. Statistics were obtained with SPSS 13.0 for Mac.

Results:

		LF	LFpen	visual	ICDAS II	radiography
Sensitivity	D1	0.833	0.833	0.85	0.933	0.517
	D3	0.857	1	0.643	0.893	0.75
Specificity	D1	0.875	1	0.562	0.563	0.781
	D3	0.844	0.719	0.953	0.859	0.75
AUC	D1	0.885	0.925	0.706	0.748	0.649
	D3	0.887	0.901	0.798	0.876	0.75
Intra-examiner reliability (ICC)		0.941; 0.824	0.903; 0.930	0.801; 0.419	0.881; 0.352	0.592; 0.830
Inter-examiner reliability (Kappa)		0.907	0.929	0.168	0.359	0.359

LFpen showed the highest sensitivity at the D₃ level in detecting occlusal caries in primary molars. AT the D₁ level, highest sensitivity was obtained with ICDAS II. Intra- and interexaminer reliability was substantially higher for LF than for either visual or radiographic examination.

Conclusion:

LFpen is recommendable as an adjunct tool for occlusal caries detection in primary molars. Careful visual caries diagnosis with ICDAS II system is promising regarding early caries detection, although its specificity is comparably low, and the system seems to need thorough training.

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