Assessment of the efficiency of dental excavation methods using laser speckle imaging.

This paper introduces a novel application of the laser speckle technique in dentistry, focusing on assessing the efficiency of dental excavation methods used to remove decayed tooth structure. The aim is to evaluate the efficiency of two chemo-mechanical agents and the high-speed drill using the laser speckle technique, which offers objective, non-invasive, and real-time evaluation capabilities. Extracted human primary molars with active occlusal carious lesions were sectioned into three parts, with each part allocated to one of three groups: Group 1 (Brix3000®), Group 2 (Papacarie DUO®), and Group 3 (High-speed drill mechanical caries removal). Caries removal was performed using the designated agent or method for each group. After caries excavation, speckle imaging using a 632.8 nm laser was conducted. Additionally, SEM was used to acquire micro-photographs of the surface morphology of the treated samples. The findings reveal insights into the comparative efficiency of the three dental excavation agents and methods using the laser speckle technique. The speckle parameters extracted from speckle patterns generated by treated teeth provide valuable information for evaluating the performance of the excavation methods. The scanning electron microscopy images also offer detailed visual evidence to support the analysis. This paper demonstrates the potential of the laser speckle technique for assessing the efficiency of dental excavation methods. The objective, non-invasive, and real-time evaluation provided offers advantages over subjective visual assessment and manual measurements.

Comparing modified USPHS and FDI criteria for the assessment of glass ionomer restorations in primary molars utilising clinical and photographic evaluation.

PURPOSE: To compare the applicability of modified US Public Health Service (USPHS) and FDI criteria for evaluating glass ionomer cement (GIC) restorations in primary posterior teeth through digital image analysis. METHODS: This comparative analytic study was conducted at the Children's Dental Clinic RSKGM FKG UI, involving 40 GIC restorations on lower first primary molars in children aged 4-9 years. After cleaning, the restorations were assessed clinically using modified USPHS and FDI criteria before taking digital images, then the collected images were re-evaluated using both sets of criteria, and the clinical assessment results were compared to the digital image assessment results. RESULTS: Statistical analysis revealed significant differences between the clinical evaluation of GIC restorations in primary teeth and their corresponding digital photographs when using the modified USPHS criteria, and although the use of FDI criteria yielded different results, these differences were not statistically significant. CONCLUSION: The assessment of GIC restorations through digital images aligns more closely with clinical assessments using the FDI criteria compared to the modified USPHS criteria.

ORCA-EFCD consensus report on clinical recommendation for caries diagnosis. Paper I: caries lesion detection and depth assessment.

OBJECTIVES: The aim of the present consensus paper was to provide recommendations for clinical practice considering the use of visual examination, dental radiography and adjunct methods for primary caries detection. MATERIALS AND METHODS: The executive councils of the European Organisation for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD) nominated ten experts each to join the expert panel. The steering committee formed three work groups that were asked to provide recommendations on (1) caries detection and diagnostic methods, (2) caries activity assessment and (3) forming individualised caries diagnoses. The experts responsible for "caries detection and diagnostic methods" searched and evaluated the relevant literature, drafted this manuscript and made provisional consensus recommendations. These recommendations were discussed and refined during the structured process in the whole work group. Finally, the agreement for each recommendation was determined using an anonymous Delphi survey. RESULTS: Recommendations (N = 8) were approved and agreed upon by the whole expert panel: visual examination (N = 3), dental radiography (N = 3) and additional diagnostic methods (N = 2). While the quality of evidence was found to be heterogeneous, all recommendations were agreed upon by the expert panel. CONCLUSION: Visual examination is recommended as the first-choice method for the detection and assessment of caries lesions on accessible surfaces. Intraoral radiography, preferably bitewing, is recommended as an additional method. Adjunct, non-ionising radiation methods might also be useful in certain clinical situations. CLINICAL RELEVANCE: The expert panel merged evidence from the scientific literature with practical considerations and provided recommendations for their use in daily dental practice.

Occlusal caries detection and monitoring using a 3D intraoral scanner system. An in vivo assessment.

OBJECTIVE: To assess the agreement in detecting and monitoring occlusal caries over thirty months using conventional visual and radiographic assessment and an intraoral scanner system which supports automated caries scoring. METHODS: Ninety-one young participants aged 12-19 years were included in the study. All occlusal surfaces were examined visually, radiographically (when indicated), and scanned with the TRIOS 4 intraoral scanner. TRIOS Patient Monitoring software (vers. 2.3, 3Shape TRIOS A/S, Denmark) was used for automated caries detection on the 3D digital models. RESULTS: Fifty-five of the study participants were re-examined after 30-months. Significant differences regarding caries detection were found between the conventional methods and the automated caries scoring system (p < 0.01), with moderate positive percent agreement (49-61%) and high negative percent agreement (87-98%). All methods reported significant caries progression over the follow-up period (p < 0.01). However, the automated system showed significantly more caries progression than the other methods (p < 0.01). CONCLUSIONS: The software for automated caries detection and classification showed moderate positive agreement and strong negative agreement with the conventional methods considering both the baseline and the follow-up assessments. The automated caries scoring system detected significantly fewer caries lesions and tended to underestimate the caries severity. All methods indicated significant caries progression over the follow-up period, while the automated system detected more caries progression. CLINICAL SIGNIFICANCE: The TRIOS system supporting automated occlusal caries detection and classification can assist in detecting and monitoring occlusal caries on permanent teeth as a complementary tool to the conventional methods. However, the operator should be aware that the automated system shows a tendency to underestimate the caries presence and lesion severity.

A Deep Learning-Based System for the Assessment of Dental Caries Using Colour Dental Photographs.

D1ental caries remains the most common chronic disease in childhood, affecting almost half of all children globally. Dental care and examination of children living in remote and rural areas is an ongoing challenge that has been compounded by COVID. The development of a validated system with the capacity to screen large numbers of children with some degree of automation has the potential to facilitate remote dental screening at low costs. In this study, we aim to develop and validate a deep learning system for the assessment of dental caries using color dental photos. Three state-of-the-art deep learning networks namely VGG16, ResNet-50 and Inception-v3 were adopted in the context. A total of 1020 child dental photos were used to train and validate the system. We achieved an accuracy of 79% with precision and recall respectively 95% and 75% in classifying 'caries' versus 'sound' with inception-v3.

Evaluation of a new 3D-printed tooth model allowing preoperative ICDAS assessment and caries removal.

INTRODUCTION: Teaching caries lesion management with operative care requires tooth models with highly realistic anatomical detail and caries lesions that can be assessed using ICDAS. This study aimed to develop and evaluate a new 3D-printed teeth model for ICDAS assessment and caries removal for pre-clinical hands-on education. METHODS: Printable tooth with different layers for enamel, dentin and carious lesions was designed and tested by 31 dental students. They were asked to visually and radiologically assess the ICDAS severity of the simulated carious lesions, establish the therapeutic strategy according to CariesCare 4D, and perform a qualitative assessment of the models based on five-point Likert scale items. RESULTS: Concerning carious lesions, the texture was realistic, and the shade was adequate for 94% and 97% of the participants. Ninety per cent of the participants found the model adequate to perform an ICDAS visual assessment. Seventy-four per cent of the students found the hardness adequate. Concerning the difference in shade and the noticeable hardness difference between enamel and dentin, participants have mixed agreement with a proportion of 61% and 55%, respectively. All the participants agreed these 3D-printed models provide a good caries simulation, are suitable for hands-on operative dentistry courses, and that learning outcomes better than the standard model. CONCLUSION: The present work shows that rapid prototyping paves the way for customized educational models capable of supporting operative but also preoperative skills. 3D printing opens up new opportunities by reducing the gap between pre-clinical training and clinical reality in caries management, which can positively impact the quality of patient care.

Caries Lesion Assessment Using 3D Virtual Models by Examiners with Different Degrees of Clinical Experience.

Background and Objectives: Dental caries is a preventable, reversible disease in its early stages. This study evaluated the intra-rater agreement of International Caries Assessment and Detection System (ICDAS) scores with Medit i500® and Omnicam® scanners versus traditional clinical examinations and the inter-rater agreement using the Omnicam® among senior dentists and dental students and between these two groups. Materials and Methods: A total of 24 patients aged between 21 and 34 years, randomly selected from dental students and interns, underwent four examinations (three intraoral scans and one clinical examination), and the corresponding ICDAS scores were recorded by a randomly selected rater out of the 31 available examiners. The examination team consisted of dental students, dentists with less than 3 years, and dentists with more than 5 years of clinical experience. The following inter- and intra-rater agreement tests for the ordinal data were chosen: Fleiss' kappa coefficient, Cohen's weighted kappa, and inter-class correlations. Results: For all examination techniques, there was statistically significant agreement for the experienced raters (p < 0.05). The highest positive interclass correlation was obtained for inter-rater agreement tests of 288 observations recorded by senior dentists: ICC = 0.969 (95% CI 0.949-0.981). Conclusions: Intra-rater reliability was excellent for Omnicam compared to clinical exams conducted by senior dentists but moderate for Medit i500. Although inter-rater agreement using Omnicam was poor between students and between senior dentists and students, it was excellent among senior dentists.

Time-resolved SWIR imaging for the assessment of the activity of occlusal caries lesions.

The aim of this study was to develop a clinical SWIR reflectance handpiece to assess the activity of lesions on the occlusal surfaces. The time-resolved reflectivity of 10 active and 10 arrested occlusal caries lesions on extracted teeth was monitored at 1470 nm using a benchtop system and a modified clinical prototype during forced air drying. The presence of a highly mineralized surface layer measured with microcomputed tomography (microCT) was used to indicate lesion activity. Multiple kinetic parameters were extracted from the acquired SWIR time versus intensity dehydration curves and used to assess lesion activity. Three parameters: delay, %Ifin , and rate calculated from the SWIR dehydration curves were significantly different (p < 0.05) between active and arrested lesions. The modified clinical probe was able to completely dehydrate all the active lesion areas in the occlusal pits and fissures in less than 30 s.

Three-Dimensional Assessment of Radiographic Changes after Indirect Pulp Capping Using Silver Diamine Fluoride with or without Potassium Iodide in Young Permanent Teeth (12-Month RCT).

The aim of this study was to conduct a three-dimensional (3D) evaluation of radiographic changes after indirect pulp capping (IPC) with silver diamine fluoride (SDF) with or without potassium iodide (KI) and resin-modified glass ionomer cement (RMGIC) in deep carious young permanent molars using cone-beam computed tomography (CBCT). 108 first permanent molars with deep occlusal cavitated caries lesions, in forty-nine 6- to 9-year-old children, were randomly allocated to one of 3 groups (n = 36) and treated with SDF+KI, SDF, and RMGIC as IPC materials. CBCT scans were taken at 0 and 12 months to assess tertiary dentin formation (volume and grey level intensity), increase in root length, and pathological changes such as secondary caries, periapical radiolucency, internal resorption, and obliteration of the pulp. The 3D image analysis procedures were performed using ITK-SNAP and 3D Slicer CMF. Comparisons were made using analysis of variance with a fixed effect for treatment and random effects for patient and patient-by-treatment to account for within-patient correlations. A two-sided 5% significance level was used. There were no significant differences among the three groups regarding tertiary dentin volume (p = 0.712) and grey level intensity (p = 0.660), increase in root length (p = 0.365), prevention of secondary caries (p = 0.63), and periapical radiolucency (p = 0.80) in the analysed 69 CBCT scans. The study did not find differences among the groups regarding quality and quantity of tertiary dentin formed, increase in root length, absence of secondary caries, and other signs of failure as shown by CBCT. Clinical Significance: The results show no significant differences in radiographic outcomes (quality and quantity of tertiary dentin formed, increase in root length, absence of secondary caries, and other signs of failure) when using SDF+KI, SDF, and RMGIC in IPC. The results of this study can help guide treatment decision-making regarding use of SDF and SDF+KI as IPC materials in deep cavitated lesions.

Assessment of the activity of secondary caries lesions with short-wavelength infrared, thermal, and optical coherence tomographic imaging.

Significance: Leakage in the interfaces between restorative materials and tooth structure allows for fluid and bacterial acid infiltration, causing restoration failure due to secondary caries. Dentists spend more time replacing composite restorations than placing new ones. Previous in vitro and in vivo studies on enamel and root surfaces using shortwave-infrared (SWIR) and thermal imaging during dehydration with forced air have been promising for assessing lesion activity. Aim: We hypothesized that SWIR reflectance and thermal imaging methods can be used to monitor the activity of secondary caries lesions around composite restorations. The objective of this study was to employ these methods to measure the rate of fluid loss from lesions during dehydration with forced air to assess lesion activity. Approach: Sixty-three extracted human teeth with total of 109 suspected secondary lesions were examined using SWIR and thermal imaging during dehydration. The thickness of the highly mineralized transparent surface layer (TSL) at lesion interfaces indicative of lesion activity was measured by optical coherence tomography (OCT). Micro-computed tomography (MicroCT) was used to further confirm lesion severity and structure. OCT and MicroCT measurements of lesion structure, depth, and severity were correlated with fluid loss rates measured with SWIR reflectance and thermal imaging. Results: TSL thickness measured with OCT correlated with both SWIR reflectance and thermal measurements of rates of fluid loss ( p < 0.05 ). Increasing TSL thickness led to decreased permeability of lesions, potentially indicating full lesion arrest at TSL ≥ 70 µ m . SWIR performed better than thermal imaging for secondary lesion activity assessment, although both methods performed best on smooth surface lesions. Conclusions: Nondestructive SWIR reflectance and OCT imaging methods are promising for clinically monitoring the activity of secondary caries lesions.

Assessment of YOLOv3 for caries detection in bitewing radiographs based on the ICCMS™ radiographic scoring system.

OBJECTIVES: To assess the feasibility of the YOLOv3 model under the intersection over union (IoU) thresholds of 0.5 (IoU50) and 0.75 (IoU75) for caries detection in bitewing radiographs based on the International Caries Classification and Management System (ICCMS™). MATERIALS AND METHODS: We trained the YOLOv3 model by feeding 994 annotated radiographs with the IoU50 and IoU75 thresholds. The testing procedure (n = 175) was subsequently conducted to evaluate the model's prediction metrics on caries classification based on the ICCMS™ radiographic scoring system. RESULTS: Regarding the 4-class classification representing caries severity, YOLOv3 could accurately detect and classify enamel caries and initial dentin caries (class RA) (IoU50 vs IoU75: precision, 0.75 vs 0.71; recall, 0.67 vs 0.64). Concerning the 7-class classification signifying specific caries depth (class 0, healthy tooth; classes RA1-3, initial caries affecting outer half, inner half of enamel, and the outer 1/3 of dentin; class RB4, caries extending to the middle 1/3 of dentin; classes RC5-6, extensively cavitated caries affecting the inner 1/3 of dentin and involving the pulp chamber), YOLOv3 could accurately detect and classify caries with pulpal exposure (class RC6) (IoU50 vs IoU75: precision, 0.77 vs 0.73; recall, 0.61 vs 0.57) but it failed to predict the outer half of enamel caries (class RA1) (IoU50 vs IoU75: precision, 0.35 vs 0.32; recall, 0.23 vs 0.21). CONCLUSIONS: YOLOv3 yielded acceptable performances in both IoU50 and IoU75. Although the performance metrics decreased in the 7-class detection, the two thresholds revealed comparable results. However, the model could not consistently detect initial-stage caries affecting the outermost surface of the enamel. CLINICAL RELEVANCE: YOLOv3 could be implemented to detect and classify dental caries according to the ICCMS™ classification with acceptable performances to assist dentists in making treatment decisions.

Artificial Intelligence for Caries Detection: Value of Data and Information.

If increasing practitioners' diagnostic accuracy, medical artificial intelligence (AI) may lead to better treatment decisions at lower costs, while uncertainty remains around the resulting cost-effectiveness. In the present study, we assessed how enlarging the data set used for training an AI for caries detection on bitewings affects cost-effectiveness and also determined the value of information by reducing the uncertainty around other input parameters (namely, the costs of AI and the population's caries risk profile). We employed a convolutional neural network and trained it on 10%, 25%, 50%, or 100% of a labeled data set containing 29,011 teeth without and 19,760 teeth with caries lesions stemming from bitewing radiographs. We employed an established health economic modeling and analytical framework to quantify cost-effectiveness and value of information. We adopted a mixed public-private payer perspective in German health care; the health outcome was tooth retention years. A Markov model, allowing to follow posterior teeth over the lifetime of an initially 12-y-old individual, and Monte Carlo microsimulations were employed. With an increasing amount of data used to train the AI sensitivity and specificity increased nonlinearly, increasing the data set from 10% to 25% had the largest impact on accuracy and, consequently, cost-effectiveness. In the base-case scenario, AI was more effective (tooth retention for a mean [2.5%-97.5%] 62.8 [59.2-65.5] y) and less costly (378 [284-499] euros) than dentists without AI (60.4 [55.8-64.4] y; 419 [270-593] euros), with considerable uncertainty. The economic value of reducing the uncertainty around AI's accuracy or costs was limited, while information on the population's risk profile was more relevant. When developing dental AI, informed choices about the data set size may be recommended, and research toward individualized application of AI for caries detection seems warranted to optimize cost-effectiveness.

Lesion activity assessment of early caries using dye-enhanced quantitative light-induced fluorescence.

We aimed to determine whether dye-enhanced quantitative light-induced fluorescence (DEQLF), wherein porous structure of caries lesions is stained with a fluorescent dye, could quantitatively distinguish between active and inactive caries. A total of 126 bovine specimens were prepared to artificially simulate caries activity. Active caries were demineralized with 1% carbopol solution for 3 (A3), 5 (A5), and 10 days (A10). For inactive caries, half specimens in each group were remineralized with 2% NaF and reallocated into three groups (I3, I5, and I10, respectively). Wet specimens were dried with compressed air for 10 s and then dyed with 100-µM sodium fluorescein for 10 s. Fluorescence images of speicmens were captured with a QLF-digital 2 + Biluminator. Fluorescence intensity (ΔG) was measured in fluorescence images of dyed specimens. ΔG between active and inactive groups was compared using independent t-test, and ΔG among active groups (or inactive groups) were compared using ANOVA (α = 0.05). ΔG in the active groups was 33.7-59.0 higher than that in the inactive groups (P < 0.001). Except between I3 and I5, there was significant differences in ΔG according to the demineralization period (P < 0.001). DEQLF might be used to evaluate early caries activity, and longitudinally monitor changes in lesion activity.

Fluorescence spectrometry based chromaticity mapping, characterization, and quantitative assessment of dental caries.

PURPOSE: Dental caries detection, especially the accurate detection of early caries, facilitates prompt interventions. It is reasonably common to use fluorescence imaging for classification and evaluation of caries, but lacks a quantitative, precise and easy-to-use characterization for practical applications. In this study a quantitative approach for caries stage detection by correlating caries spectral and chromatic features was examined. METHODS: A 405 nm LED light source was used as the excitation source. A hyperspectral imaging camera is employed to collect 336 spectral data of different caries stages. Four critical intervals for different stages of caries were extracted by fluorescence spectral features. The mapping relationship between caries spectral and chromatic features was established by Fast Formula Fitting (FFF) and Neural Network Fitting (NNF) methods. RESULTS: The 470-780 nm spectral power distribution was proved to be the best matching color waveband guiding the selection of filters in future instrument development. The correlation coefficients for the two fitting methods were 0.990 and 0.999, respectively. Both methods achieved caries stage prediction at the pixel level with high accuracy using color information. The visualization region in the chromaticity diagram was created. CONCLUSIONS: This quantitative method enables accurate prediction of caries on the entire tooth surface and facilitates the development of portable and low-cost caries detection instruments.

Validity of near-infrared light transillumination for the assessment of proximal caries in permanent teeth.

PURPOSE: The aim of this study was to evaluate the performance of DIAGNOcam (DC) in diagnosing proximal caries and to compare its effectiveness with the International Caries Detection and Assessment System (ICDAS) and bitewing radiography (BWR). METHODS: 118 premolars extracted for orthodontic reasons were included and examined using three detection methods and validated by histological sections as the gold standard. The sensitivity, specificity and areas under the ROC curve (Az value) at the outer half enamel (D1), inner half enamel (D2) and dentine (D3) thresholds were compared between different methods. RESULTS: At all categories, the specificity of DC was almost as high as ICDAS and BWR. DC showed a significantly higher sensitivity (0.68) than both visual (0.33) and radiographic examination (0.47) at the D1 threshold. DC presented the highest Az value (area under the ROC curve) at the D1 and D2 threshold (0.81, 0.86), while BWR showed the greatest Az values at D3 (0.94). Furthermore, DC had the highest association strength with the gold standard (Spearman's ρ = 0.80). CONCLUSIONS: It can be concluded that DC could detect proximal caries effectively and showed comparable or even better performance than ICDAS and BWR.

Do panoramic radiographs offer improved diagnostic accuracy over clinical examination and other radiographic techniques in children?

Aim The aim of this study was to establish the diagnostic efficacy of panoramic radiographs in six clinical situations for paediatric patients: caries, acute dental infections, dental trauma, dental anomalies, developmental disorders and pathological conditions.Data sources The authors searched the following databases: Medline, Embase, the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects and the Cochrane Health Technology Assessment database. Forward citation searches of included studies were carried out. There were no language restrictions. The dates were restricted to include studies published between 1990-2018.Study selection Inclusion criteria: children under the age of 18 for whom the diagnostic accuracy of panoramic radiography was compared to either clinical or an alternative radiographic examination for the six included indications. Exclusion criteria: panoramic radiographs taken for orthodontic indications outwith those stated in the aim. Studies of all designs were included. Screening of titles, abstracts and full texts were completed independently and in duplicate by two authors. Disagreement was resolved by discussion including a third author. A total of 3,420 abstracts were screened, from which 175 full texts were reviewed. Sixteen studies across the six indications were included in the review.Data extraction and synthesis Data extraction was performed independently and in duplicate by two authors, with a third resolving disagreement. A standardised form was used which was initially piloted on ten papers. A narrative synthesis was carried out due to heterogeneity of the included studies precluding data synthesis.Results Assessment of bias was completed using the QUADAS 2 tool. Of 16 included studies, the majority were of high or unclear risk of bias for domains including: patient selection, conduct or interpretation of the index test, reference standard, and patient timing and flow. Regarding detection of caries, one study was included which demonstrated clinical examination detected more carious surfaces than panoramic radiographs (6.0%, 95% CI 4.1-7.8%), but that bitewing radiography combined with panoramic radiography led to a higher diagnosis of approximal lesions than clinical examination alone by 4.3% (p <0.0001). Concerning acute dental infection, one study was included that did not present diagnostic accuracy data. Three studies related to dental trauma were included, all of which examined condylar fractures. Only one study reported diagnostic accuracy data: 70% diagnostic accuracy with panoramic radiography compared to 92% utilising CT scans. Four studies included examined diagnosis of a spectrum of dental anomalies. The only study to provide data on diagnostic accuracy reported a sensitivity of 50% for correct identification of supernumerary teeth on panoramic radiographs, with a specificity of 97.2%. Five included studies pertained to developmental disorders. One study gave data on diagnostic accuracy of panoramic radiographs. This showed sensitivity of 68.2% for identification of abnormalities in familial adenomatous polyposis. Two studies included were related to pathological conditions - one reported that panoramic radiographs gave 75% sensitivity to identify abnormal condylar morphology in patients with TMJ synovitis, with a specificity of 66.7%.Conclusions The study concluded that more research is required concerning the diagnostic accuracy of panoramic radiographs for oral conditions in order to produce clinical guidance based on high-quality evidence.

Light-based diagnostic methods for the in vivo assessment of initial caries lesions: Laser fluorescence, QLF and OCT.

OBJECTIVES: To evaluate different light-based caries diagnostic methods for assessment of non-cavitated initial carious lesions on smooth surfaces. METHODS: 39 participants were included. For each participant, three regions of interest (ROI) with ICDAS codes 0, 1 or 2 were defined. All ROIs (n = 117) were investigated/imaged with laser fluorescence (LF, DIAGNOdent 2095; KaVo dental GmbH), quantitative light-induced fluorescence (QLF; Biluminator 2+, Inspektor Research Systems B.V.) and spectral-domain optical coherence tomography (SD-OCT; Telesto II, Thorlabs GmbH). The values of LF, ΔF of QLF, and the lesion extent assessed by OCT were categorized. Frequency distribution of LF-/QLF- and OCT-scores was determined for each ICDAS code included. Inter- and intra-examiner reproducibility of QLF and OCT measurements were assessed by unweighted kappa coefficient (ĸ) and Wilcoxon test (α = 0.05). RESULTS: Compared with LF and QLF, OCT showed various manifestations of carious lesions for visually sound ROIs and a larger variation of caries extent in depth within the same ICDAS code groups. Intra-examiner reproducibility ranged between 0.49 and 1.00 for the QLF analysis and between 0.95 and 0.99 for the OCT analysis. Inter-examiner reproducibility ranged between 0.17 and 0.32 for the QLF analysis and between 0.65 and 0.79 for the OCT analysis. CONCLUSION: LF and QLF were insensitive to less pronounced smooth-surface lesions while OCT allowed differentiation based on the penetration depth of the carious lesions. This makes OCT a suitable method to complement conventional visual inspection in order to detect and assess (very) early lesions.

Clinical validation of a novel bioluminescence imaging technology for aiding the assessment of carious lesion activity status.

OBJECTIVES: Clinical validation of a bioluminescence imaging system (Cis) as measured by the level of agreement between clinician visual and tactile assessment of carious lesion presence and activity and the presence/absence of elevated luminescence on a tooth surface determined from intraoral image mapping. MATERIALS AND METHODS: This was a regulatory clinical study designed in consultation with the FDA. The design was a prospective, five-investigator, nonrandomized, post-approval, clinical study utilizing the Cis to provide images of elevated calcium ion concentration (indicative of active demineralization) on tooth surfaces via use of a photoprotein. Imaged teeth were identified as "sound" or having "active lesions." Images were scored independently for luminescence. RESULTS: A total of 110 participants aged 7-74 years were imaged. Of the 90 teeth assessed as "sound," 88 were deemed to show no luminescence by the reviewing investigator, a negative percentage agreement of 97.8% (significantly >50% agreement [p < .0001]; one-sided 97.5% confidence interval [CI]: 0.9220). Of the 86 teeth initially assessed as having an "active lesion," 78 were deemed to show luminescence by the reviewing investigator, a positive percentage agreement of 90.7% (significantly >50% agreement [p < .0001]; 97.5% CI: 0.8249). There were no patient-related adverse events. CONCLUSIONS: Results show, with a high level of agreement, that Cis can differentiate tooth surfaces clinically identified as involving active enamel lesions (ICDAS code 2/3), from sound sites (biochemically equivalent to inactive lesions) and that the system is safe for clinical use.

Can health kiosks be used to identify oral health care needs? A pilot study.

OBJECTIVE: The aim of this study was to investigate the reliability of digital imaging for detecting restorative treatment need among individuals in their 20s by comparing the outcome of digital imaging with clinical caries findings at the patient level. MATERIAL AND METHODS: Five intraoral clinical daylight and digital fluorescence images were taken extraorally of 21 patients. A clinical examination was then performed by a trained and calibrated dentist. Additionally, the patients answered a multiple-choice questionnaire about their health habits. The images were analysed and caries findings were recorded. For statistical analysis, sensitivity and specificity were calculated. Results were shown as ROC curves and AUC values. All analyses were done using SPSS (version 24.0, Chicago, IL). RESULTS: Caries lesions were most often detected in molars and least often in canines. When using the clinical status as gold standard, digital imaging gave an AUC value of 0.617, whereas the outcome by questionnaire gave an AUC value of 0.719. When using the combined outcome of digital imaging and the questionnaire, the AUC value was 0.694 with clinical validation. CONCLUSIONS: It can be concluded that health kiosks may help to reduce the number of patients waiting for dental treatment; more specifically, the questionnaire with individual feedback may provide a new instrument for providing instructions for homecare online. However, the camera system must be developed further, and dentists and dental hygienists require training to analyse the images.

Radiographic assessment of proximal surface carious lesion progression in Chilean young adults.

OBJECTIVE: To investigate the rate and associations of interproximal carious lesion progression. METHODS: Retrospective data were analysed from 125 young adults (age range: 18-29 years) with repeated bitewing radiographs collected over a 6-year period. Participants were submitted to different protocols of radiographic examination frequency. Transitions from outer enamel to outer dentine (OE-to-OD) and from outer dentine to dentine (OD-to-D) were selected because of their clinical relevance. Factors associated with each transition were assessed in Cox regression models. RESULTS: One hundred seven (85.6%) and 52 (41.6%) participants experienced OE-to-OD and OD-to-D transitions, respectively. In addition, 16.8% of 537 eligible surfaces progressed from OE-to-OD whereas 59.4% of 128 eligible surfaces progressed from OD-to-D. Incidence rates were 6.6 and 44.1 per 100 tooth surface-years, respectively. Mean survival time for OE-to-OD transition was 6.4 years (95% confidence interval: 6.0-6.9) and the median survival time for OD-to-D transition was 1.6 years (95%CI: 1.3-1.7). In adjusted Cox regression models, location in the lower jaw (hazard ratio: 0.34; 95% CI: 0.21-0.57) was inversely associated with OE-to-OD progression. In addition, proximal DMFS at baseline (HR: 0.93; 95%CI: 0.87-0.99) and location in the lower jaw (HR: 0.51; 95%CI: 0.26-0.99) were inversely associated with OD-to-D progression. CONCLUSIONS: This group of Chilean young adults has a high progression rate of proximal caries lesions. Location of the caries lesion and proximal DMFS were the only factors associated with caries progression.