Three Visual-Diagnostic Methods for the Detection of Enamel Cracks: An In Vitro Study

Area of Science:

• Dentistry
• Dental Diagnostics
• Biomaterials

Background:

• Tooth fractures, often originating as enamel cracks, are a primary cause of tooth loss.
• Current methods for detecting enamel cracks are not well-established or validated.
• Early detection of enamel cracks is crucial for preventing further tooth damage and loss.

Purpose of the Study:

• To validate and compare the efficacy of three clinical methods for detecting enamel cracks: dental operating microscope (DOM), near-infrared transillumination (NIR), and fiber-optic transillumination (FOTI).
• To assess the accuracy of these diagnostic tools in identifying enamel cracks under controlled in vitro conditions.

Main Methods:

• Utilized 89 extracted teeth as diagnostic models to simulate clinical scenarios.
• Employed hard-tissue slices as a control for determining actual crack depth.
• Analyzed the diagnostic accuracy of DOM, NIR, and FOTI using receiver operating characteristic (ROC) curves and microscopic examination (25× magnification).

Main Results:

• Fiber-optic transillumination (FOTI) and near-infrared transillumination (NIR) demonstrated higher accuracy (Area Under Curve [AUC] of 0.78 and 0.74, respectively) for detecting cracks on vestibular/oral surfaces compared to the dental operating microscope (DOM) (AUC 0.61).
• Overall AUC values across all surfaces were 0.70 for FOTI, 0.67 for NIR, and 0.57 for DOM.
• All tested methods significantly underestimated the actual crack depth (p < 0.001).

Conclusions:

• Fiber-optic transillumination (FOTI) and near-infrared transillumination (NIR) are suitable for the clinical detection of enamel cracks, especially on the vestibular and oral aspects of teeth.
• While effective for detection, these methods do not provide an accurate measurement of enamel crack depth.
• FOTI and NIR show promise as valuable adjuncts for the clinical identification of enamel cracks, aiding in early diagnosis and management.