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Accuracy of visual and radiographic ICDAS-merged criteria for secondary caries on permanent posterior teeth
Yaysa Vásquez1, Margarita Usuga-Vacca1, Stefania Martignon1
1UNICA - Caries Research Unit, Research Department, Universidad El Bosque.
Background:
This in vitro study evaluated the diagnostic accuracy of visual and radiographic assessments for secondary caries (ICDAS-merged) on posterior permanent teeth.
Material And Methods:
Teeth were obtained from a university tooth bank and selected based on the presence of occlusal or proximal restorations. Two trained examiners assessed 296 restored surfaces using ICDAS-merged secondary caries criteria, grouping scores into sound (0), initial (1-2), moderate (3-4), and extensive (5-6). Scores were validated against a histological gold standard using three diagnostic thresholds: (1) sound vs. initial+moderate+extensive; (2) sound+initial vs. moderate+extensive; and (3) sound+initial+moderate vs. extensive. Analyses included Spearman correlation, weighted kappa, and calculation of sensitivity, specificity, and accuracy.
Results:
After sample evaluation included 129 premolar surfaces and 167 molar surfaces, restored either with amalgam (n = 194) or composite resin (n = 102). Both methods showed substantial inter- and intra-examiner reproducibility (kappa: 0.70-0.80). Correlation with histology was substantial for both visual (=0.73) and radiographic (=0.70) assessments. At the threshold of sound vs. initial+moderate+extensive, specificity was high (visual: 0.85; radiographic: 0.93), while sensitivity was higher for visual (0.80) than for radiographic criteria (0.68). Overall accuracy was high for both methods (visual: 0.83; radiographic: 0.81). Across restorative materials, visual assessment showed consistent accuracy for amalgam and composite restorations. In contrast, radiographic assessment showed lower sensitivity for amalgam (0.61) and composite (0.64) restorations at the same threshold. ICDAS-merged visual criteria demonstrated strong accuracy and reproducibility for detecting secondary caries in restored permanent teeth, regardless of restorative material.
Conclusions:
Radiographic criteria exhibited high specificity but lower sensitivity, particularly for early lesions, highlighting the value of visual inspection as a reliable method for detecting secondary caries in clinical settings.
