Development of a Fluorescence-Based Caries Scoring System for an Intraoral Scanner: An in vitro Study

BackgroundDental caries is a common chronic disease in children. Digital tools such as intraoral scanners (IOSs) may offer an efficient, scalable alternative to conventional visual examination for dental caries detection. IOSs are handheld devices that generate 3-dimensional (3D) models of the teeth and surrounding structures. Recent advances incorporating fluorescence technology into scanner hardware offer the potential for supporting dental caries detection. However, the performance of digital caries detection methods using 3D models that include both color and fluorescence in children’s teeth remains unknown.ObjectiveThis study aimed to assess the diagnostic agreement between visual examination and on-screen assessment of 3D models generated by an IOS in color and supplemented with fluorescence for caries detection in primary teeth.MethodsChildren participating in a clinical trial (n=216, mean age 5.6, SD 0.4 y) underwent visual examination using the International Caries Detection and Assessment System (ICDAS) and intraoral scanning using the TRIOS 4 IOS. Four trained registered dental practitioners independently assessed each participant’s 3D models in color and then supplemented with fluorescence, using a previously validated ICDAS index modified for on-screen assessments of 3D models. All 3D models were assessed again after 4 weeks. The time taken for intraoral scanning and on-screen assessment was recorded. Multilevel logistic regression was used to estimate and compare the likelihood of detecting caries between methods, and Bland-Altman plots were used to visualize agreement. Analyses were performed at the initial (ICDAS ≥01), moderate (ICDAS ≥03), and extensive (ICDAS ≥05) dental caries thresholds. Intraclass correlation coefficient (ICC) estimated method agreement and examiner reliability.ResultsOf 219 children enrolled, 216 completed dental assessments. A total of 9470 visible primary tooth surfaces were included in the analysis. The average time taken for on-screen assessment of each 3D model (color with fluorescence) was 3.5 (SD 2.3) minutes. The likelihood of detecting caries using color assessment of 3D models was similar to visual examination at all disease thresholds: initial (odds ratio [OR] 1.1, 95% CI 1.0‐1.3), moderate (OR 0.9, 95% CI 0.7‐1.1), and extensive (OR 1.0, 95% CI 0.7‐1.3). When color assessments were supplemented with fluorescence, the likelihood of detecting caries was 30% higher at the initial threshold relative to visual examination (OR 1.3, 95% CI 1.1‐1.5) and similar at the moderate (OR 0.9, 95% CI 0.7‐1.1) and extensive thresholds (OR 0.9, 95% CI 0.7‐1.3). Bland-Altman plots showed a high level of agreement at both moderate and extensive thresholds. Agreement between methods was high (ICC 0.9, 95% CI 0.9‐1.0). Intra- and inter-examiner reliability using intraoral scans ranged from good to excellent (ICC 0.8‐1.0).ConclusionsOn-screen assessment of 3D models in color demonstrated the highest agreement with visual examination for caries detection across all disease thresholds.

Determination of the functional space for fluid movement in the rat dentinal tubules using fluorescent microsphere

BACKGROUND Dental caries is a common chronic disease in children, yet large-scale surveillance is limited by the resource demands of clinical examinations. Digital tools like intraoral scanners may offer a scalable alternative for caries detection, enabling more efficient data collection for research and population-level oral health monitoring. OBJECTIVE To assess the diagnostic agreement between visual examination and on-screen assessment of 3D models generated by an intraoral scanner (IOS) in colour and supplemented with fluorescence for caries detection in primary teeth. METHODS Children participating in a clinical trial (n=216, mean age 5.6 years) underwent visual examination using the International Caries Detection and Assessment System (ICDAS) and intraoral scanning using the TRIOS 4 IOS (3Shape TRIOS A/S Denmark). Four trained registered dental practitioners independently assessed each participant’s 3D models in colour, then supplemented with fluorescence, using a previously validated ICDAS index modified for on-screen assessments of 3D models. All 3D models were assessed again four weeks later. The time taken for intraoral scanning and on-screen assessment was recorded. Multilevel logistic regression was used to estimate and compare the likelihood of detecting caries between methods, and Bland–Altman plots were used to visualise agreement. Analyses were performed at the initial (ICDAS>01), moderate (ICDAS>03), and extensive (ICDAS>05) dental caries thresholds. Intraclass Correlation Coefficient (ICC) estimated method agreement and examiner reliability. RESULTS 8,209 visible primary tooth coronal surfaces were analysed. The likelihood of detecting caries using colour assessment of 3D models was similar to visual examination at all disease thresholds: initial (odds ratio 1.1, 95% confidence interval (CI) 1.0–1.3), moderate (0.9, 0.7-1.1) and extensive (1.0, 0.7–1.3). When colour assessments were supplemented with fluorescence, the likelihood of detecting caries was 30% higher at the initial threshold relative to visual examination (1.3, 1.1-1.5) and similar at the moderate (0.9, 0.7-1.1) and extensive thresholds (0.9, 0.7-1.3). Bland-Altman plots showed a high level of agreement at both moderate and extensive thresholds. Examiner reliability using intraoral scans ranged from good to excellent. CONCLUSIONS On-screen assessment of 3D models in colour shows greatest agreement with visual examination for caries detection at all disease thresholds. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12622001237774 INTERNATIONAL REGISTERED REPORT RR2-10.2196/51578

Objectives To define an expert Delphi consensus on when to intervene in the caries process and existing carious lesions.Methods Non-systematic literature synthesis, expert Delphi consensus process and expert panel conference.Results Lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations may be placed for form, function, aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated lesions which are cleansable. Cavitated lesions which are not cleansable usually require minimally invasive management. In specific circumstances, mixed interventions may be applicable. Occlusally, cavitated lesions confined to enamel/non-cavitated lesions extending radiographically into deep dentine may be exceptions. Proximally, cavitation is hard to assess tactile-visually. Most lesions extending radiographically into the middle/inner third of dentine are assumed to be cavitated. Those restricted to the enamel are not cavitated. For lesions extending radiographically into the outer third of dentine, cavitation is unlikely. These lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds.Conclusions Comprehensive diagnosis is the basis for systematic decision-making on when to intervene in the caries process and existing lesions.

ObjectivesThe aim of the present prospective multicenter clinical study was to compare the detection of proximal caries with near-infrared light reflection (NILR) versus bitewing radiography (BWR). Materials and methodsIntraoral scans were performed on 100 patients in five dental clinics using an intraoral scanner (iTero Element 5D, Align Technology, Tempe, AZ, USA) that includes a near-infrared light source (850 nm) and sensor. Reflected near-infrared light images of posterior teeth were used by the individual dentists to detect proximal caries and the results were compared to the BWRs. In a total of 3499 proximal surfaces of molars and premolars which were examined, 223 carious lesions were detected by BWR, while NILR detected 549 carious lesions. Caries detection using both methods was also done by an expert team of five dentists, highly experienced in NILR image interpretation, who used the same sets of clinically-obtained data. Sensitivity, specificity, and accuracy were calculated for caries detection by both the dentists and the expert team. Fifty-nine of the detected carious lesions were clinically treated and the observations during caries excavation were compared with those done with NILR and BWR. Statistical analysis to compare between NILR and BWR diagnosis was performed using non-parametric two-sided McNemar's Chi-Square test with the significance level set at p < 0.05. Kappa coefficients were calculated to assess the level of agreement between the two caries detection methods. ResultsAccuracy of NILR detection of early enamel lesions was 88% and that of carious lesions involving the dentino-enamel junction (DEJ) was 97%. Accuracy was found to be higher at 96% and 99%, respectively, when the same data were examined by the expert team. Direct observation during caries-excavation treatment suggested that NILR detected early enamel lesions that were not detectable with BWR alone. ConclusionsWithin the limitations of the present study, NILR was more sensitive than BWR in detecting early enamel lesions and comparable to BWR in detecting lesions that involved the DEJ. Clinical relevanceReflected near-infrared light images that are generated simultaneously with 3D intra-oral scanning may be used reliably for detection, screening, and monitoring of proximal caries, thus potentially minimizing the traditional use of ionizing radiation.

Objectives: To assess the level of acceptance and discomfort experienced by secondary school students when undergoing an atraumatic restorative treatment (ART) restoration. Subjects and Methods: Ninety secondary school students, aged 14 and 15 years, were included in the study. The ART restorations were prepared in 90 cavities and restored using an encapsulated high-viscosity glass ionomer. The depth of the cavities was judged from radiographs and clinically into outer, middle and inner third of dentine. Using a graded periodontal probe, cavity size was measured, into approximately half the width of the mesiodistal and buccolingual/palatal distance of the occlusal surface. The students were asked about the level of sensation experienced during cavity preparation immediately after completion of restoration. χ²-Test was used to test the effect of cavity depth and size on sensitivity from the teeth. Results: Of the 90 students, 6 (6.6%) and 26 (29.2%) experienced pain and discomfort, respectively, during cavity preparation, more often in large than in small cavities (p = 0.003) and in cavities extending into the inner third than in the middle and outer third of dentine (p < 0.0001). Only 1 student reported postoperative sensitivity. Conclusions: The ART approach to treat dental cavities was well accepted by this group of secondary school students. Only a few reported pain during cavity instrumentation, and this was more prevalent in large cavities and in cavities with the floor close to the pulp.

Proximal dental lesions, limited to dentine, are traditionally treated by invasive (drill and fill) means. Non-invasive alternatives (e.g. fluoride varnish, flossing) might avoid substance loss but their effectiveness depends on patients' adherence. Recently, micro-invasive approaches for treating proximal caries lesions have been tried. These interventions install a barrier either on top (sealing) or within (infiltrating) the lesion. Different methods and materials are currently available for micro-invasive treatments, such as sealing via resin sealants, (polyurethane) patches/tapes, glass ionomer cements (GIC) or resin infiltration. To evaluate the effects of micro-invasive treatments for managing proximal caries lesions in primary and permanent dentition in children and adults. We searched the following databases to 31 December 2014: the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via OVID, EMBASE via OVID, LILACs via BIREME Virtual Health Library, Web of Science Conference Proceedings, ZETOC Conference Proceedings, Proquest Dissertations and Theses, ClinicalTrials.gov, OpenGrey and the World Health Organization (WHO) International Clinical Trials Registry Platform. We searched the metaRegister of Controlled Trials to 1 October 2014. There were no language or date restrictions in the searches of the electronic databases. We included randomised controlled trials of at least six months' duration that compared micro-invasive treatments for managing non-cavitated proximal dental decay in primary teeth, permanent teeth or both, versus non-invasive measures, invasive means, no intervention or placebo. We also included studies that compared different types of micro-invasive treatments. Two review authors independently screened search results, extracted data and assessed the risk of bias. We used standard methodological procedures expected by Cochrane to evaluate risk of bias and synthesise data. We conducted meta-analyses with the random-effects model, using the Becker-Balagtas method to calculate the odds ratio (OR) for lesion progression. We assessed the quality of the evidence using GRADE methods. We included eight trials, which randomised 365 participants. The trials all used a split-mouth design, some with more than one pair of lesions treated within the same participant. Studies took place in university or dental public health clinics in Brazil, Colombia, Denmark, Germany, Thailand, Greenland and Chile. Six studies evaluated the effects of micro-invasive treatments in the permanent dentition and two studies on the primary dentition, with caries risk ranging from low to high. Investigators measured caries risk in different studies either by caries experience alone or by using the Cariogram programme, which combines eight contributing factors, including caries experience, diet, saliva and other factors related to caries. The follow-up period in the trials ranged from one to three years. All studies used lesion progression as the primary outcome, evaluating it by different methods of reading radiographs. Four studies received industry support to carry out the research, with one of them being carried out by inventors of the intervention.We judged seven studies to be at high overall risk of bias, primarily due to lack of blinding of participants and personnel. We evaluated intervention effects for all micro-invasive therapies and analysed subgroups according to the different treatment methods reported in the included studies.Our meta-analysis, which pooled the most sensitive set of data (in terms of measurement method) from studies presenting data in a format suitable for meta-analysis, showed that micro-invasive treatment significantly reduced the odds of lesion progression compared with non-invasive treatment (e.g fluoride varnish) or oral hygiene advice (e.g to floss) (OR 0.24, 95% CI 0.14 to 0.41; 602 lesions; seven studies; I(2) = 32%). There was no evidence of subgroup differences (P = 0.36).The four studies that measured adverse events reported no adverse events after micro-invasive treatment. Most studies did not report on any further outcomes.We assessed the quality of evidence for micro-invasive treatments as moderate. It remains unclear which micro-invasive treatment is more advantageous, or if certain clinical conditions or patient characteristics are better suited for micro-invasive treatments than others. The available evidence shows that micro-invasive treatment of proximal caries lesions arrests non-cavitated enamel and initial dentinal lesions (limited to outer third of dentine, based on radiograph) and is significantly more effective than non-invasive professional treatment (e.g. fluoride varnish) or advice (e.g. to floss). We can be moderately confident that further research is unlikely to substantially change the estimate of effect. Due to the small number of studies, it does remain unclear which micro-invasive technique offers the greatest benefit, or whether the effects of micro-invasive treatment confer greater or lesser benefit according to different clinical or patient considerations.

To perform a systematic review and meta-analysis of the performance of different methods for detecting carious lesions in permanent and primary teeth, considering all types of tooth surface. Two reviewers searched PubMed, Embase, Scopus and other sources up to November 2020 to identify published and nonpublished studies in English. We focused on three caries detection methods: visual inspection (VI), radiographic (RX) and fluorescence-based (LF). We included studies investigating at least one of these methods which (a) assessed the accuracy of the method in detecting caries lesions; (b) considered occlusal, proximal or free smooth surfaces in primary or permanent teeth; (c) used a reference standard other than one of the three methods; and (d) reported data on sample size and accuracy. Multilevel analyses, meta-regressions and comparisons of bivariate summary receiver operating characteristics curves were undertaken. Two hundred and forty manuscripts from 14129 articles initially identified met the inclusion criteria. VI was better than RX on occlusal surfaces at all caries lesion thresholds and proximal surfaces of permanent teeth only at all lesion thresholds in laboratory setting. LF was slightly better than VI for advanced lesions on occlusal surfaces of permanent teeth in the clinical setting and for all lesions on proximal surfaces of permanent teeth in the laboratory setting. Still, LF was worse than VI for advanced occlusal lesions in permanent teeth in the laboratory setting. Although LF showed slightly better performance than VI with advanced lesions, the latter had significantly higher specificity than other methods in all settings. Visual caries detection alone is adequate for most patients in daily clinical practice regardless of tooth type or surface.

This study compared the performance of fluorescence-based methods, radiographic examination, and International Caries Detection and Assessment System (ICDAS) II on occlusal surfaces. One hundred and nineteen permanent human molars were assessed twice by 2 experienced dentists using the laser fluorescence (LF and LFpen) and fluorescence camera (FC) devices, ICDAS II and bitewing radiographs (BW). After measuring, the teeth were histologically prepared and assessed for caries extension. The sensitivities for dentine caries detection were 0.86 (FC), 0.78 (LFpen), 0.73 (ICDAS II), 0.51 (LF) and 0.34 (BW). The specificities were 0.97 (BW), 0.89 (LF), 0.65 (ICDAS II), 0.63 (FC) and 0.56 (LFpen). BW presented the highest values of likelihood ratio (LR)+ (12.47) and LR– (0.68). Rank correlations with histology were 0.53 (LF), 0.52 (LFpen), 0.41 (FC), 0.59 (ICDAS II) and 0.57 (BW). The area under the ROC curve varied from 0.72 to 0.83. Inter- and intraexaminer intraclass correlation values were respectively 0.90 and 0.85 (LF), 0.93 and 0.87 (LFpen) and 0.85 and 0.76 (FC). The ICDAS II ĸ values were 0.51 (interexaminer) and 0.61 (intraexaminer). The BW ĸ values were 0.50 (interexaminer) and 0.62 (intraexaminer). The Bland and Altman limits of agreement were 46.0 and 38.2 (LF), 55.6 and 40.0 (LFpen) and 1.12 and 0.80 (FC), for intra- and interexaminer reproducibilities. The posttest probability for dentine caries detection was high for BW and LF. In conclusion, LFpen, FC and ICDAS II presented better sensitivity and LF and BW better specificity. ICDAS II combined with BW showed the best performance and is the best combination for detecting caries on occlusal surfaces.

BackgroundMost studies assessing the sensitivity and specificity of caries detection methods have been performed in vitro using the histological method as the gold standard showing inconsistent values. The aim of this study was to compare the sensitivity and specificity in detecting occlusal caries using the International Caries Detection and Assessment System (ICDAS II) with the radiographic method (RM), while using the Spectra™ Caries Detection System (SCDS) as the reference test.MethodsOne hundred sixty children, ages 7–12 years, participated in the study. Five zones in the occlusal surfaces of 859 primary and 632 first permanent molars were examined visually using ICDAS-II, the RM using bitewing radiographs and SCDS. The descriptive statistics of sensitivity and specificity were calculated and compared.ResultsFor all molars combined and for primary molars only, the sensitivity of ICDAS II was higher for detecting total caries (p < 0.001), caries in enamel (p < 0.001), and caries in dentin (p = 0.016), but it was not different for detecting caries in the dentin of permanent first molars (p = 0.214), and primary second molars (p = 0.761). The specificity of RM was higher for detecting total caries, caries in enamel for all molars combined and for permanent first molars (p < 0.001). For caries in dentin, the specificity of ICDAS II was higher for all molars combined and for primary molars only (p < 0.001). For total caries in primary molars only, and caries in dentin of permanent first molars only, the specificity was not different (p = 0.156 and p = 0.181 respectively).ConclusionsThe sensitivity and specificity of ICDAS II and RM changes depending on whether the carious lesion compromises the enamel or dentin, and if the caries detection is performed in the primary molars or permanent first molars.

The purpose of this study was to compare the validity of visual (VE), radiological (RE), cone beam computed tomography (CBCT), and laser fluorescence (LFE) examination methods for the detection of the occlusal noncavitated caries in permanent posterior teeth. Two examiners assessed 121 selected sites on the occlusal surfaces of 44 molar teeth by visual (International Caries Assessment and Detection System II [ICDAS]), radiographic (bite-wing projection) cone-beam computed tomography, and laser fluorescence (DIAGNOdent Pen) examination methods. After a 1-week interval, each measurement was repeated by two examiners. Then, the teeth were sectioned, and histological evaluation was performed, which serves as the gold standard. The lesion depths were classified and correlated with the methods evaluated for validation. The intra- and inter-examiner reliability (sensitivity, specificity) and reproducibility of all examination methods were calculated using a weighted Cohen's κ statistic. The correlation between the examination methods was determined using receiver operating characteristic (ROC) analysis indicating the area under the curve (AUC). CBCT exhibited excellent intra-examiner (0.76 for examiner 1, 0.78 for examiner 2) and fair to good inter-examiner (0.63 for the first, 0.64 for the second measurements) reproducibility. The intra-examiner reproducibility was excellent for the LFE method according to the weighted κ values of examiners 1 (0.90) and 2 (0.79). Among the combined methods, the highest AUC values (0.81-0.95) were obtained for the CBCT examination method performed by the two examiners at both the first and second measurements. Cone beam computed tomography showed better performance than other diagnostic methods.

DEVELOPMENT OF A RISK-ASSESSMENT TOOL FOR PREDICTION OF PULMONARY HYPERTENSION AND MORTALITY IN PATIENTS WITH INTERSTITIAL LUNG DISEASE

MP38-03 XPERT BLADDER CANCER MONITOR AND NARROW BAND IMAGING IN ROUTINE FOLLOW UP OF PATIENTS WITH NON-MUSCLE INVASIVE BLADDER CANCER

This in vitro study evaluated the performance of visual (International Caries Detection and Assessment System [ICDAS]) and radiographic (bitewing [BW]) examinations for occlusal caries detection and their associations with treatment decision (TD). Permanent teeth (n=104) with occlusal surfaces varying from sound to cavitated were selected. Sites were identified from 10× occlusal surface photographs. Standardized bitewing (BW) radiographs were taken. Four dentists with at least five years of experience scored all teeth twice (one-week interval) for ICDAS (0–6), BW (0=sound, 1=caries restricted to enamel, 2=caries in outer third dentin, 3=caries in inner third dentin), and TD (0=no treatment, 1=sealant, 2=microabrasion and sealant, 3=round bur sealant, 4a=resin, 4b=amalgam). Histological validation was performed by observation under a light microscope, with lesions classified on a five-point scale. Intraexaminer and interexaminer repeatability were assessed using two-way tables and intraclass correlation coefficients (ICCs). Comparisons between percentage correct, specificity, sensitivity, and area under the receiver-operating characteristic (ROC) curve were performed using bootstrap analyses. ICCs for intraexaminer and interexaminer repeatability indicated good repeatability for each examiner, ranging from 0.78 to 0.88, and among examiners, ranging from 0.74 to 0.81. Correlation between ICDAS and TD was 0.85 and between BW and TD was 0.78. Correlation between the methods and histological scores was moderate (0.63 for ICDAS and 0.61 for BW). The area under the ROC curve was significantly greater for ICDAS than for BW (p<0.0001). ICDAS had significantly lower specificity than BW did (p=0.0269, 79% vs 94%); however, sensitivity was much higher for ICDAS than for BW (p<0.0001, 83% vs 44%). Data from this investigation suggested that the visual examination (ICDAS) showed better performance than radiographic examination for occlusal caries detection. The ICDAS was strongly associated with TD. Although the correlation between the ICDAS and BW was lower, it is still valuable in the clinical decision-making process.

Background:Minimally invasive dentistry (MID) encompasses early caries diagnosis through caries risk assessment (CRA), early detection of incipient carious lesion including primary and secondary prevention based on scientific evidence that remineralization of demineralized enamel and dentin is possible if detected early. Although the dental curriculum focuses on the advantages of MID in tooth preservation, this science is not usually translated into practice.Aim:This study aimed to evaluate the knowledge, attitude, and skills of dental practitioners of Puducherry regarding the concepts of MID.Subjects and Methods:Data were collected through an online survey questionnaire based on awareness and practice of MID. Statistical evaluation was done on SPSS by Chi-square test.Results:A total of 126 dentists responded of which only 55% were trained in MID during their undergraduate and internship period, mainly through lectures (49.6%). Nearly 81% agreed that CRA should be conducted for all patients. Almost 42.7% had heard about International Caries Detection and Assessment System, but only 25.9% used a blunt explorer for caries detection. About 13.7% use magnification (loupes/microscope), but majority (84.7%) use radiographs. More than 70% were unaware of newer methods of caries detection. Statistically significant differences were found (P < 0.05) regarding qualification and experience about the effectiveness of Atraumatic Restorative Treatment and sandwich technique for treatment of caries in permanent teeth and high caries-risk children.Conclusion:Although there is knowledge about advantages of MID among dentists of Puducherry, it does not benefit patients, as many practitioners still follow the traditional principles of total caries removal.