Hanne Hintze

Reliability of Visual Examination, Fibre-Optic Transillumination, and Bite-Wing Radiography, and Reproducibility of Direct Visual Examination Following Tooth Separation for the Identification of Cavitated Carious Lesions in Contacting Approximal Surfaces

The aim of this study was to evaluate the diagnostic accuracy of visual, fibre-optic transillumination (FOTI), and bite-wing radiographic examination performed by 4 observers for the identification of cavitated carious lesions in contacting approximal surfaces, and to assess the inter-observer agreement with these methods and with direct visual examination conducted after tooth separation, the method used as validation for definitive determination of cavitation. A total of 338 unrestored approximal surfaces in 53 students were examined independently by 4 dentists using the diagnostic methods under study. The results from the diagnostic methods were compared with the results from the validation method for each observer. The sensitivities for identification of cavitated lesions using visual examination ranged from 0.12 to 0.50. For FOTI and radiography, the sensitivities ranged from 0.00 to 0.08 and from 0.56 to 0.69, respectively. The specificities exceeded 0.90 for all observers with all methods. Kappa values expressing inter-observer reproducibility were lowest for FOTI, followed by visual and radiographic examination. On the basis of these results, it was concluded that FOTI was the least reliable of the diagnostic methods tested. For the validation method, the inter-observer agreement was only ‘substantial’. This implies that the method cannot be used as a validation for other diagnostic methods applied for the identification of cavitated carious lesions in contacting approximal surfaces. However, visual inspection after tooth separation may serve as a supplementary diagnostic tool to conventional visual and radiographic examination for clinical management of aproximal carious lesions.

In vitro comparison of D- and E-speed film radiography, RVG, and visualix digital radiography for the detection of enamel approximal and dentinal occlusal caries lesions.

The aims of this study were (1) to compare the accuracy of conventional D- and E-speed film radiography and direct digital radiography using the RadioVisioGraphy and Visualix systems for the detection of enamel approximal caries lesions and (2) to compare the accuracy of D- and E-speed films and the Visualix system for the detection of dentinal occlusal caries lesions. In total, 122 approximal surfaces were examined in vitro by 3 observers and 65 occlusal surfaces by 2 observers. The true caries diagnosis was based on histological assessment of the surfaces after sectioning the teeth. Approximal surfaces were deemed diseased by the presence of a demineralization in enamel, while occlusal surfaces were deemed diseased by the presence of a demineralization into dentine. The diagnostic accuracy for each radiographic method was expressed as a receiver operating characteristic (ROC) curve area. For the approximal surfaces, the areas under the ROC curves ranged from 0.53 (Visualix) to 0.70 (E-speed film). For the occlusal surfaces, the areas ranged from 0.62 (Visualix) to 0.79 (D- and E-speed films). No statistically significant differences between mean ROC curve areas for the radiographic methods were found either for the approximal or for the occlusal surfaces. It was concluded that radiography was of almost no value in the detection of enamel approximal caries lesions, but of some value in the detection of dentinal lesions in occlusal surfaces.

Radiographic detection of occlusal caries in noncavitated teeth: A comparison of conventional film radiographs, digitized film radiographs, and RadioVisioGraphy

The aim of this study was to compare the accuracy of conventional film radiographs, digitized radiographs, and RadioVisioGraphy (RVG) for the detection of dentinal caries in occlusal surfaces of noncavitated extracted teeth. Eighty-one fully erupted extracted third molars were assessed by four observers using five radiographic methods: conventional film radiographs, digitized radiographs with contrast enhancement and with a filtering procedure, and RVG with contrast enhancement and with x function. Scoring criteria were dichotomous. Histologic sections (500 to 600 microns thick) served as the validation criterion. The two digital methods with contrast enhancement tended to perform more accurately than, although not significantly different from, the other three methods (p greater than 0.05). Average likelihood ratios (true positive/false positive) were 4.3 (conventional film radiographs), 4.4 (RVG with contrast enhancement), 3.6 (RVG with x function), 4.9 (digitized radiographs with contrast enhancement), and 3.7 (digitized radiographs with filtering procedure). Observers 1 and 2 (oral radiologists) performed better than observers 3 and 4 with all five methods (p less than 0.005).

Amelogenesis imperfecta a systematic literature review of associated dental and oro-facial abnormalities and their impact on patients

Objective. Amelogenesis imperfecta (AI) is a disease primarily affecting amelogenesis, but other aberrations have been reported. The purposes of this review were: (1) to identify other anomalies associated with AI, and (2) to describe the impact of the disease and its associated conditions on the oral health-related quality of life of patients, and the economic consequences. Material and methods. A literature search was conducted in the following databases: PubMed, EMBASE, Bibliotek.dk, The Cochrane Library, Web of Science, and OMIM, supplemented by a search for selected authors. Based on titles and abstracts, 137 papers were identified. Results. Most articles were case reports or case series with few cases. Aberrations were reported in the eruption process, in the morphology of the crown, in the pulp-dentine organ, and in the number of teeth. Gingival conditions and oral hygiene were usually reported to be poor, and calculus was a common finding. Open bite was the most commonly reported malocclusion. A negative impact on patients’ oral health-related quality of life was described, but information was scarce. No information was found on the economic impact. Conclusions. A number of aberrations associated with AI have been reported, but not sufficiently systematic to allow for a secondary analysis and synthesis of the findings. The impact on patients in terms of reduced quality of life and economic burden needs to be studied.

Relationship between Histological and Radiographic Caries Lesion Depth Measured in Images from Four Digital Radiography Systems

The aim of this study was to compare the accuracy of approximal caries lesion depth measurements in radiographs from four digital systems. Two CCD-based sensors, Dixi (Planmeca) and Sidexis (Sirona), and two phosphor plate systems, Digora (Soredex) and DenOptix (Gendex), were used to record radiographs of 177 extracted human teeth. Sixty-four radiographically visible lesions were selected and measured by 4 observers in the digital radiographs and in digital photographs of histological sections of the teeth. The gold standard (true measure) was defined as the mean of the 4 observers’ measurements on the histological sections. Two untrained observers underestimated general lesion depth in all the radiographic systems while each of 2 trained observers underestimated the depth in one of the systems. Analysis of variance revealed that Digora images resulted overall in the smallest underestimation, followed by Dixi, DenOptix and Sidexis. The differences between Digora and Sidexis and between Dixi and Sidexis were statistically significant (p < 0.05). Analysis of variance using the regression coefficient as the test variable demonstrated that the coefficients differed between DenOptix and the remaining systems (p < 0.05) while there were no significant differences between these (p > 0.05). It can be concluded that radiographs obtained with the Dixi and Digora systems were more accurate than Sidexis and DenOptix images for measurement of caries lesion depth. Still, a high probability exists that the individual lesion measurement is either overestimated or underestimated compared to the true lesion depth.

Implications of caries diagnostic strategies for clinical management decisions

OBJECTIVES In clinical practice, a visual-tactile caries examination is frequently supplemented by bitewing radiography. This study evaluated strategies for combining visual-tactile and radiographic caries detection methods and determined their implications for clinical management decisions in a low-caries population. METHODS Each of four examiners independently examined preselected contacting interproximal surfaces in 53 dental students aged 20-37 years using a visual-tactile examination and bitewing radiography. The visual-tactile examination distinguished between noncavitated and cavitated lesions while the radiographic examination determined lesion depth. Direct inspection of the surfaces following tooth separation for the presence of cavitated or noncavitated lesions was the validation method. The true-positive rate (i.e. the sensitivity) and the false-positive rate (i.e. 1-specificity) were calculated for each diagnostic strategy. RESULTS Visual-tactile examination provided a true-positive rate of 34.2% and a false-positive rate of 1.5% for the detection of a cavity. The combination of a visual-tactile and a radiographic examination using the lesion in dentin threshold for assuming cavitation had a true-positive rate of 76.3% and a false-positive rate of 8.2%. When diagnostic observations were translated into clinical management decisions using the rule that a noncavitated lesion should be treated nonoperatively and a cavitated lesion operatively, our results showed that the visual-tactile method alone was the superior strategy, resulting in most correct clinical management decisions and most correct decisions regarding the choice of treatment.

In vitro comparison of Kodak Ultra-speed, Ektaspeed, and Ektaspeed Plus, and Agfa M2 Comfort dental x-ray films for the detection of caries.

The aim of this study was to compare the diagnostic accuracy of two new dental x-ray films, Kodak Ektaspeed Plus (Plus) and Agfa M2 Comfort (M2), respectively, with the current Kodak Ultra-speed (Ultra) and Ektaspeed (Ekta) films for the detection of caries. A total of 103 occlusal and 224 proximal surfaces were examined independently by three observers. A histologic examination performed after the teeth were sectioned served as the validation method for lesion depth. Receiver operating characteristic curve areas were calculated to express the diagnostic accuracy. In the occlusal surfaces the receiver operating characteristic curve areas ranged from 0.764 (in Ultra films) to 0.800 (in Ekta films). In the proximal surfaces the receiver operating characteristic curve areas ranged from 0.550 (in Ultra films) to 0.696 (in Plus films). No statistically significant differences were found between the different film types.

Screening with Conventional and Digital Bite-Wing Radiography Compared to Clinical Examination Alone for Caries Detection in Low-Risk Children

The study compared conventional and digital bite-wing screening, performed in combination with a clinical examination for caries detection, in 168 14-year-old children with little caries experience. Radiography revealed 2-3 times more carious lesions than did clinical examination. Conventional and digital radiography detected dentinal caries in only 1.6 and 1.1%, respectively, of the clinically sound surfaces. Conventional, as well as digital radiography revealed caries in 7% of occlusal surfaces suspected of caries after a clinical examination. Of the suspected approximal surfaces, conventional radiography found caries in 25%, and digital radiography in 19%. From these results, it may be appropriate to perform radiographic screening in combination with clinical examination when the purpose is to assess caries prevalence, and as a basis for individual treatment decisions, if treatment is offered to surfaces with enamel lesions. However, if treatment is offered only to surfaces with clinically detected lesions and to surfaces with radiographically perceived dentinal lesions, it may not be appropriate to perform radiographic bite-wing screening, as less than 2% of the treatment-demanding surfaces will be overlooked by clinical examination alone. Instead, selective radiography should be conducted of surfaces suspected clinically as being carious.

Diagnostic Outcome of Methods Frequently Used for Caries Validation

The aim of this study was to compare the caries diagnostic outcome of four methods frequently used as validation for dental caries. The diagnostic outcome of clinical examination (CL), radiography (RA), and histology after serial tooth sectioning (HI-serial) on 373 approximal and 158 occlusal surfaces was compared, and furthermore histology after hemi- (HI-hemi) and serial sectioning on another 113 approximal and 53 occlusal surfaces was compared. Two thresholds for each method (CL: (1) sound vs. all caries scores, and (2) non-cavitated vs. cavitated lesions; RA and HI: (1) sound vs. all caries scores, and (2) no dentine vs. dentine lesions) were evaluated. In general, large differences in diagnostic outcomes were observed with the various methods. At threshold 1, CL resulted in significantly more lesions than both RA and HI-serial on approximal surfaces, and than RA on occlusal surfaces. At threshold 2, no significant differences between CL, RA and HI-serial were found on approximal surfaces, but on occlusal surfaces significantly more lesions were diagnosed with RA and HI-serial than with CL. Significantly more occlusal lesions were found by HI-serial than by RA at both thresholds 1 and 2. On approximal surfaces, a similar result was found only at threshold 1. On approximal surfaces, significantly more lesions were diagnosed with HI-serial than with HI-hemi at both thresholds 1 and 2. On occlusal surfaces the same was found only at threshold 1. The intra-observer reproducibility was higher using HI-serial than using RA and CL.

Surface-specific electrical occlusal caries diagnosis: reproducibility, correlation with histological lesion depth, and tooth type dependence

Electrical conductance measurements are being used experimentally for occlusal caries detection. Recently, it was suggested to cover the fissure system with a conducting medium, resulting in a surface–specific measurement. It was the aim of this study to determine in vitro the reproducibility of this modified technique for occlusal caries in posterior teeth, to determine for a large study sample the correlation between the electrical measurements and histological lesion depth, and to evaluate the difference between results for premolars and molars. For the reproducibility determination, surface–specific electrical resistance measurements were made using a sample of 68 posterior teeth. Eight operators performed measurements on all teeth, and repeated measurements on 24 teeth. The validity study included the previous sample and the collected samples from two more studies, resulting in a total sample of 325 posterior teeth. One operator had performed electrical resistance measurements on all teeth in the sample. Reproducibility was good: mean Pearsons correlation coefficient 0.89 (±0.05) for interexaminer correlation, and 0.86 (±0.12) for intra–examiner correlation, using log (resistance) as the result parameter. The correlation coefficient between log(resistance) and histological lesion depth for the large sample was –0.78 for all teeth, –0.64 for premolars, and –0.73 for molars. The regression line for molars was located below the regression line for premolars: at a hypothetical histology score of 2.5 (a dentine caries threshold) the estimated resistance threshold would be 507 kΩ for premolars, and 233 kΩ for molars. Converted to Electronic Caries Monitor (ECM) readings, the difference is about 1.4 on the ECM scale. It was concluded that the in vitro reproducibility of the described surface–specific method for electrical resistance measurement is very good, even for inexperienced operators. The correlation between measurements and histological lesion depth is moderate to good. The method is sensitive to electrode area differences, which will result in different clinical cut–offs for caries diagnosis in premolar and molar teeth.