Diagnostic agreement between visual examination and an automated scanner system with fluorescence for detecting and classifying occlusal carious lesions in primary teeth

 

Objective: To determine the diagnostic agreement between visual examination using the International Caries Detection and Assessment System (ICDAS) and on-screen assessment of 3D models with and without fluorescence for caries detection in primary teeth.

Methods: Children participating in a clinical trial (N=216, average age 5.6 years) underwent visual examination using ICDAS and intraoral scanning using the TRIOS 4 scanner (3Shape TRIOS A/S Denmark). Blinded to the clinical data, four trained and calibrated raters independently performed on-screen assessments for each child’s 3D models using a modified ICDAS. The 3D models were first examined with color, and caries presence and severity were recorded for each tooth surface. This was immediately followed by re-examination with the addition of fluorescence texture. All raters repeated the on-screen assessment process after 4 weeks. Time taken for intraoral scanning and on-screen assessment was recorded. Multilevel logistic regression was used to estimate the tooth surface level agreement between visual examination and on-screen assessment while accounting for the variability amongst the examiners and clustering of the dental caries data. Scatterplots were used to visualize the person level method agreement, and the Intraclass Correlation Coefficient (ICC) was used to calculate method agreement and examiner reliability. All analyses were undertaken at the initial (ICDAS>1), moderate (ICDAS>3), and extensive disease (ICDAS>5) thresholds.

Conclusion: The findings indicate on-screen assessment of 3D models generated using intraoral scanners is a feasible substitute for visual examination using ICDAS for dental caries data collection epidemiological research involving children.