Detection and activity assessment of primary coronal caries lesions: a methodologic study

Area of Science:

• Dental diagnostics
• Caries detection and assessment
• Biomaterials in dentistry

Background:

• Accurate detection and assessment of dental caries are crucial for effective treatment planning.
• Existing caries detection systems require validation and improvement for clinical applicability.
• Novel diagnostic tools are needed to assess caries activity and predict lesion progression.

Purpose of the Study:

• To evaluate the reproducibility and accuracy of the International Caries Detection and Assessment System (ICDAS) I and II.
• To validate a new impression material (Clinpro, 3M ESPE) for detecting lactic acid in plaque.
• To develop and test a caries activity scoring system for coronal lesions.

Main Methods:

• Study (1): 141 extracted teeth examined using ICDAS I/II, validated against histology.
• Study (2): In situ validation of Clinpro impression material against pH meter measurements on 45 root dentin specimens.
• Study (3): Development of a caries activity scoring system based on ICDAS II, lesion location, and tactile sensation; tested on 225 lesions/surfaces in 35 children.

Main Results:

• Study (1): Excellent intra- and inter-examiner reproducibility (Kappa > 0.82) and strong associations (Spearman's rho > 0.90) for ICDAS.
• Study (2): Clinpro impression material showed acceptable accuracy compared to pH meter (combined sensitivity/specificity = 1.63).
• Study (3): Devised caries activity scoring system demonstrated acceptable accuracy (AUC = 0.84, combined sensitivity/specificity = 1.67).

Conclusions:

• ICDAS I and II are reproducible and accurate caries detection systems.
• Clinpro impression material shows potential for assessing plaque pH.
• A combined approach using visual appearance, lesion location, and tactile sensation accurately assesses coronal caries activity and depth.