In vitro visual and visible light transillumination methods for detection of natural non-cavitated approximal caries
The objective was to evaluate a visible-light-transillumination (using Digital Imaging Fiber-Optic Transillumination machine: DIFOTI) method using occlusal view (DIFOTI-occl), axial view (buccal and lingual: DIFOTI-axial), and combination of all views (DIFOTI-all) for detecting non-cavitated approximal caries and to compare its performance to visual examination (International Caries Detection and Assessment System: ICDAS).
Materials and methods
Thirty extracted human premolars were selected (sound to lesions into the outer one-third of the dentine) based on micro-computed tomography (μ-CT). Teeth were mounted in a custom-made device to simulate approximal contact. DIFOTI (Electro-Optical Sciences Inc., Irvington, NY, USA) images were obtained from the occlusal, buccal, and lingual views. DIFOTI image and ICDAS examinations were performed and repeated by three trained/calibrated examiners. Sensitivity, specificity, area under receiver operating characteristics curve (Az), inter- and intra-class correlation coefficients (ICCs), and correlation were determined.
Sensitivity/specificity was for DIFOTI-occl: 0.42/0.75, DIFOTI-axial: 0.86/0.93, DIFOTI-all: 0.91/0.69, and for ICDAS: 0.89/0.83. Az for DIFOTI-occl was significantly lower than that of DIFOTI-axial (p < 0.001), DIFOTI-all (p = 0.002), and ICDAS (p = 0.005). Spearman correlation coefficients with μ-CT for DIFOTI-occl (r = 0.39) showed weak association, while DIFOTI-axial (r = 0.80), DIFOTI-all (r = 0.91), and ICDAS (r = 0.90) showed moderate association. ICCs for intra-examiner repeatability/inter-examiner agreement were for DIFOTI-occl (0.64/0.58), DIFOTI-axial (0.92/0.89), DIFOTI-all (0.85/0.83), and ICDAS (0.79/0.72).
The results of the current in vitro study suggest that, for detection of non-cavitated approximal caries lesions, DIFOTI performs better using axial than occlusal view.
Approximal non-cavitated caries detection is challenging. DIFOTI can observe images from occlusal-, buccal-, and lingual views. DIFOTI and visual (ICDAS) examinations of buccal- and lingual- and all-views are more suitable than those of occlusal view for a detection of non-cavitated approximal caries.
KeywordsApproximal caries Caries detection Visible light transillumination International caries detection and assessment system (ICDAS) Non-cavitated caries lesion Imaging geometry Digital imaging transillumination DIFOTI
The authors thank Drs. Anderson Hara and Ana Gossweiler, Indiana University School of Dentistry (IUSD), to participate in this study as examiners. We thank Dr. James C Williams, Department of Anatomy and Cell Biology, Indiana University School of Medicine for the assistance with Skyscan microfocus computed tomography. This study was conducted in Indiana University School of Dentistry, USA. This work was supported by Indiana University School of Dentistry, Department of Cariology, Operative Dentistry and Dental Public Health, 2016; and by Dental Master’s Thesis Award Program from Delta Dental Foundation (Okemos, MI, 2016). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The roles of authors were: conceived and designed the experiment: N. Abogazalah, G.J. Eckert; and M. Ando; performed examinations: N. Abogazalah and M. Ando; perform statistical analyses: G.J. Eckert; and wrote the paper: N. Abogazalah, G.J. Eckert; and M. Ando.
The work was supported by the Dental Master’s Thesis Award Program from Delta Dental Foundation.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
For this type of study, formal consent is not required.
- 1.Kassebaum NJ, Smith AGC, Bernabe E, Fleming TD, Reynolds AE, Vos T, Murray CJL, Marcenes W, Collaborators GBDOH (2017) Global, regional, and National Prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990-2015: a systematic analysis for the global burden of diseases, injuries, and risk factors. J Dent Res 96(4):380–387. https://doi.org/10.1177/0022034517693566 CrossRefGoogle Scholar
- 4.Ismail AI, Sohn W, Tellez M, Amaya A, Sen A, Hasson H, Pitts NB (2007) The international caries detection and assessment system (ICDAS): an integrated system for measuring dental caries. Community Dent Oral Epidemiol 35(3):170–178. https://doi.org/10.1111/j.1600-0528.2007.00347.x CrossRefGoogle Scholar
- 13.Ando M Perforance of digital imaging Fiber-optic Transilluminaton (DIFOTI) for detection of non-cavitated primary caries. Preliminary report. In: Stookey G, Kambara M (eds) 83rd International Association for Dental Research symposium : early detection of dental caries, Baltimore, Maryland, march, 11 2005. Therametric technologies Inc., Indianapolis, pp 41–52Google Scholar
- 16.Takei HH (1980) The interdental space. Dent Clin N Am 24(2):169–176Google Scholar
- 22.Mitropoulos P, Rahiotis C, Stamatakis H, Kakaboura A (2010) Diagnostic performance of the visual caries classification system ICDAS II versus radiography and micro-computed tomography for proximal caries detection: an in vitro study. J Dent 38(11):859–867. https://doi.org/10.1016/j.jdent.2010.07.005 CrossRefGoogle Scholar
- 26.Novaes TF, Matos R, Braga MM, Imparato JC, Raggio DP, Mendes FM (2009) Performance of a pen-type laser fluorescence device and conventional methods in detecting approximal caries lesions in primary teeth--in vivo study. Caries Res 43(1):36–42. https://doi.org/10.1159/000189705 CrossRefGoogle Scholar
- 27.ten Bosch JJ (1996) Light scattering and related methods in caries diagnosis. In: Stookey GK (ed) The first annual Indiana Conference. Indiana University School of Dentistry, Indianapolis, pp 81–90Google Scholar