RESUMO
AIM: To evaluate the influence of examiner's clinical experience on detection and treatment decision of caries lesions in primary molars. DESIGN: Three experienced dentists (Group A) and three undergraduate students (Group B) used the International Caries Detection and Assessment System (ICDAS) criteria and bitewing radiographs (BW) to perform examinations twice in 77 primary molars that presented a sound or carious occlusal surface. For the treatment decision (TD), the examiners attributed scores, analyzing the teeth in conjunction with the radiographs. The presence and the depth of lesion were validated histologically, and reproducibility was evaluated. The sensitivity, specificity, accuracy, and area under the ROC curve values were calculated for ICDAS and BW. The associations between ICDAS, BW, and TD were analyzed by means of contingency tables. RESULTS: Interexaminer agreement for ICDAS, BW, and TD were excellent for Group B and moderate for Group A. The two groups presented similar and satisfactory performance for caries lesion detection using ICDAS and BW. In the treatment decision, Group A was shown to have a less invasive approach than Group B. CONCLUSION: The examiner's experience was not determinant for the clinical and radiographic detection of occlusal lesions in primary teeth but influenced the treatment decision of initial lesions.
Assuntos
Competência Clínica , Tomada de Decisões , Cárie Dentária/diagnóstico , Cárie Dentária/prevenção & controle , Planejamento de Assistência ao Paciente/normas , Exame Físico/normas , Radiografia Interproximal/normas , Cárie Dentária/diagnóstico por imagem , Odontólogos , Humanos , Variações Dependentes do Observador , Curva ROC , Estudantes de OdontologiaRESUMO
PURPOSE: To evaluate the reproducibility of visual exams under natural light (VE1), visual exams under artificial light (VE2), radiographic bitewing exams (BW), fibre optic transillumination exams (FOTI) and DIAGNOdent exams (DD) in epidemiological settings. MATERIALS AND METHODS: Three examiners and one benchmark examiner examined thirteen 12-year-old schoolchildren under epidemiological conditions for the D3 (carious lesions in dentin) and D1+D3 (carious lesions in enamel or dentin) diagnostic criteria. RESULTS: The reproducibility (intra/interexaminer agreement) under both diagnostic criteria was 'almost perfect' for the exams VE1 (D3: κintra = 0.91/κinter = 0.85; D1+D3: κintra = 0.89/κinter = 0.84), VE2 (D3: κintra = 0.91/κinter = 0.85; D1+D3: κintra = 0.88/κinter = 0.83), BW (D3: κintra = 0.95/κinter = 0.92; D1+D3: κintra = 0.99/κinter = 0.90) and FOTI (D3: κintra = 0.97/κinter = 0.93; D1+D3: κintra = 0.87/κinter = 0.83) exams and 'fair' for the DD exam (D3: κintra = 0.36/κinter = 0.35; D1+D3: κintra = 0.30/κinter = 0.32). CONCLUSION: It was concluded that the VE1, VE2, BW, and FOTI exams presented good reproducibility under epidemiological conditions, and can be used accurately in epidemiological surveys.
Assuntos
Cárie Dentária/diagnóstico , Calibragem , Criança , Esmalte Dentário/patologia , Restauração Dentária Permanente , Dentina/patologia , Estudos Epidemiológicos , Humanos , Lasers , Iluminação , Variações Dependentes do Observador , Fibras Ópticas , Exame Físico/normas , Radiografia Interproximal/normas , Reprodutibilidade dos Testes , Transiluminação/normasRESUMO
The aim of this study was to evaluate the accuracy of linear measurements made on conventional and digitized periapical and panoramic radiographic images of dry human hemi-mandibles. Images from the posterior region of 22 dry human hemi-mandibles were obtained by conventional panoramic and periapical radiography technique. Using a digital caliper, 3 vertical measurements were marked directly on the dry hemi-mandibles (reference measurements) as well as on the tracing from the conventional radiographic images of the specimens made onto acetate paper sheet: Distance 1: between the upper limit of the alveolar ridge and the lower limit at the mandible base; Distance 2: between the upper limit of the alveolar ridge and the upper limit of the mandibular canal; Distance 3: between the lower limit of the mandibular canal and the lower limit of the mandible base. Next, the radiographs were digitized and the three measurements were made on the digital images using UTHSCSA Image Tool software. Data were analyzed statistically by one-way ANOVA (α=0.05). There was no statistically significant differences (p>0.05) between periapical and panoramic radiographs or between the measurements recorded using the digital caliper and UTHSCSA software compared with dry mandible specimens for Distances 1 (p=0.783), 2 (p=0.986) and 3 (p=0.129). In conclusion, the radiographic techniques evaluated in this study are reliable for vertical bone measurements on selected areas and the UTHSCA Image Tool software is an appropriate measurement method.
Assuntos
Cefalometria/normas , Mandíbula/diagnóstico por imagem , Radiografia Interproximal/normas , Radiografia Dentária Digital/normas , Radiografia Panorâmica/normas , Processo Alveolar/diagnóstico por imagem , Pontos de Referência Anatômicos/diagnóstico por imagem , Cefalometria/estatística & dados numéricos , Humanos , Processamento de Imagem Assistida por Computador/normas , Processamento de Imagem Assistida por Computador/estatística & dados numéricos , Radiografia Interproximal/estatística & dados numéricos , Radiografia Dentária Digital/estatística & dados numéricos , Radiografia Panorâmica/estatística & dados numéricos , Reprodutibilidade dos Testes , Software/normas , Software/estatística & dados numéricosRESUMO
This in vitro study evaluated the performance of visual (International Caries Detection and Assessment System [ICDAS]) and radiographic (bitewing [BW]) examinations for occlusal caries detection and their associations with treatment decision (TD). Permanent teeth (n=104) with occlusal surfaces varying from sound to cavitated were selected. Sites were identified from 10× occlusal surface photographs. Standardized bitewing (BW) radiographs were taken. Four dentists with at least five years of experience scored all teeth twice (one-week interval) for ICDAS (06), BW (0=sound, 1=caries restricted to enamel, 2=caries in outer third dentin, 3=caries in inner third dentin), and TD (0=no treatment, 1=sealant, 2=microabrasion and sealant, 3=round bur sealant, 4a=resin, 4b=amalgam). Histological validation was performed by observation under a light microscope, with lesions classified on a five-point scale. Intraexaminer and interexaminer repeatability were assessed using two-way tables and intraclass correlation coefficients (ICCs). Comparisons between percentage correct, specificity, sensitivity, and area under the receiver-operating characteristic (ROC) curve were performed using bootstrap analyses. ICCs for intraexaminer and interexaminer repeatability indicated good repeatability for each examiner, ranging from 0.78 to 0.88, and among examiners, ranging from 0.74 to 0.81. Correlation between ICDAS and TD was 0.85 and between BW and TD was 0.78. Correlation between the methods and histological scores was moderate (0.63 for ICDAS and 0.61 for BW). The area under the ROC curve was significantly greater for ICDAS than for BW (p<0.0001). ICDAS had significantly lower specificity than BW did (p=0.0269, 79% vs 94%); however, sensitivity was much higher for ICDAS than for BW (p<0.0001, 83% vs 44%). Data from this investigation suggested that the visual examination (ICDAS) showed better performance than radiographic examination for occlusal caries detection. The ICDAS was strongly associated with TD. Although the correlation between the ICDAS and BW was lower, it is still valuable in the clinical decision-making process.
Assuntos
Tomada de Decisões , Cárie Dentária/diagnóstico , Planejamento de Assistência ao Paciente , Exame Físico/normas , Radiografia Interproximal/normas , Área Sob a Curva , Dente Pré-Molar/diagnóstico por imagem , Dente Pré-Molar/patologia , Resinas Compostas/química , Amálgama Dentário/química , Cárie Dentária/diagnóstico por imagem , Cárie Dentária/prevenção & controle , Preparo da Cavidade Dentária/instrumentação , Esmalte Dentário/diagnóstico por imagem , Esmalte Dentário/patologia , Materiais Dentários/química , Restauração Dentária Permanente/métodos , Dentina/diagnóstico por imagem , Dentina/patologia , Microabrasão do Esmalte , Humanos , Dente Molar/diagnóstico por imagem , Dente Molar/patologia , Variações Dependentes do Observador , Selantes de Fossas e Fissuras/uso terapêutico , Curva ROC , Sensibilidade e EspecificidadeRESUMO
This in vivo study aimed to evaluate the performance of 2 fluorescence-based methods in detecting occlusal caries lesions in primary teeth, compared with the performance of visual inspection and radiographic methods, and to propose a mathematic correction of the diagnostic parameters due to the imperfect reference standard method used in the study. Two examiners assessed the occlusal surfaces of 407 primary teeth (62 children) using visual inspection (ICDAS), radiographic, DIAGNOdent pen (pen type laser fluorescence; LFpen), and fluorescence camera (FC) methods. At the noncavitated threshold (NC) the reference standard method was the results of ICDAS, and at the dentine caries threshold (D3) teeth diagnosed with dentine caries by ICDAS or radiographic methods were subjected to operative treatment to confirm the presence of lesion. Reproducibility, sensitivity, specificity, accuracy, and the area under the ROC curve were calculated for the methods at both thresholds. At the NC threshold, LFpen had a slightly better performance compared to the FC and radiographic methods. However, at the D3 threshold, both fluorescence-based methods performed similarly. Visual inspection and radiographic methods presented higher specificities but lower sensitivities than fluorescence methods. After corrections, there was a significant decrease in some parameters. In conclusion, both fluorescence-based methods presented similar performance in detecting occlusal dentine caries lesions in primary teeth, but they usually gave more false-positive results than did the visual and radiographic methods. The correction proposed shows that the performance of the methods can be overestimated, and the correction should be validated and considered in further studies that use an imprecise reference standard method.
Assuntos
Cárie Dentária/diagnóstico , Lasers , Dente Decíduo/patologia , Área Sob a Curva , Criança , Pré-Escolar , Cárie Dentária/diagnóstico por imagem , Esmalte Dentário/patologia , Dentina/patologia , Reações Falso-Positivas , Feminino , Fluorescência , Humanos , Processamento de Imagem Assistida por Computador/métodos , Processamento de Imagem Assistida por Computador/normas , Lasers/normas , Masculino , Dente Molar/patologia , Fotografia Dentária/métodos , Fotografia Dentária/normas , Exame Físico/normas , Curva ROC , Radiografia Interproximal/normas , Padrões de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Coroa do Dente/patologiaRESUMO
The aim of this study was to evaluate the accuracy of linear measurements made on conventional and digitized periapical and panoramic radiographic images of dry human hemi-mandibles. Images from the posterior region of 22 dry human hemi-mandibles were obtained by conventional panoramic and periapical radiography technique. Using a digital caliper, 3 vertical measurements were marked directly on the dry hemi-mandibles (reference measurements) as well as on the tracing from the conventional radiographic images of the specimens made onto acetate paper sheet: Distance 1: between the upper limit of the alveolar ridge and the lower limit at the mandible base; Distance 2: between the upper limit of the alveolar ridge and the upper limit of the mandibular canal; Distance 3: between the lower limit of the mandibular canal and the lower limit of the mandible base. Next, the radiographs were digitized and the three measurements were made on the digital images using UTHSCSA Image Tool software. Data were analyzed statistically by one-way ANOVA (α=0.05). There was no statistically significant differences (p>0.05) between periapical and panoramic radiographs or between the measurements recorded using the digital caliper and UTHSCSA software compared with dry mandible specimens for Distances 1 (p=0.783), 2 (p=0.986) and 3 (p=0.129). In conclusion, the radiographic techniques evaluated in this study are reliable for vertical bone measurements on selected areas and the UTHSCA Image Tool software is an appropriate measurement method.
O objetivo deste estudo foi avaliar a acurácia de medidas lineares realizadas em radiografias panorâmicas e periapicais convencionais e digitalizadas de hemimandíbulas humanas secas. Imagens da região posterior de 22 hemimandíbulas humanas secas foram obtidas pelas técnicas panorâmica e periapical convencionais. Com o paquímetro eletrônico digital, foram realizadas três medições verticais diretamente sobre as hemimandíbulas (medidas referenciais), bem como sobre o decalque das imagens convencionais, em papel de acetato: Distância 1: Distância entre o limite superior do rebordo alveolar e o limite inferior da base da mandíbula; Distância 2: Distância entre o limite superior do rebordo alveolar e o limite superior do canal mandibular e Distância 3: Distância entre o limite inferior do canal mandibular e o limite inferior da base da mandíbula. Posteriormente, as radiografias foram digitalizadas e as três medidas foram realizadas nas imagens digitais utilizando o programa UTHSCSA Image Tool. Os dados foram analisados estatisticamente pelo teste ANOVA a um critério (α=0,05). Não houve diferenças estatisticamente significantes (p>0,05) entre as radiografias panorâmicas e periapicais, assim como para as medidas obtidas com o paquímetro e pelo programa UTHSCSA Image Tool, quando comparados aos espécimes mandibulares, avaliando as distâncias 1 (p=0,783), 2 (p=0,986) e 3 (p=0,129). Em conclusão, as técnicas radiográficas avaliadas neste estudo mostraram-se confiáveis para mensurações ósseas verticais na área selecionada e o programa de digitalização de imagens UTHSCSA Image Tool é um método adequado de aferição.
Assuntos
Humanos , Cefalometria/normas , Mandíbula , Radiografia Interproximal/normas , Radiografia Dentária Digital/normas , Radiografia Panorâmica/normas , Processo Alveolar , Pontos de Referência Anatômicos , Cefalometria/estatística & dados numéricos , Processamento de Imagem Assistida por Computador/normas , Processamento de Imagem Assistida por Computador/estatística & dados numéricos , Reprodutibilidade dos Testes , Radiografia Interproximal/estatística & dados numéricos , Radiografia Dentária Digital/estatística & dados numéricos , Radiografia Panorâmica/estatística & dados numéricos , Software/normas , Software/estatística & dados numéricosRESUMO
This in vivo study aimed to evaluate the performance of methods of approximal caries detection in primary molars and to assess the influence of the discomfort caused by these methods on their performance. Two examiners evaluated 76 children (4-12 years old) using visual inspection (ICDAS), radiography and a laser fluorescence device (DIAGNOdent pen, LFpen). The reference standard was visual inspection after temporary separation with orthodontic rubbers. Surfaces were classified as sound, noncavitated (NC) or cavitated (Cav), and performance was assessed at both NC and Cav thresholds. Wong-Baker faces scale was employed to assess the discomfort. Multilevel analysis was performed to verify the influence of discomfort on performance, considering the number of false-positives and false-negatives as outcome. At NC threshold, visual inspection achieved better performance (sensitivities and accuracies around 0.67) than other methods (sensitivities around 0.25 and accuracies around 0.35). At Cav threshold, visual inspection presented lower sensitivity (0.23 and 0.19), and LFpen (0.52 and 0.42) and radiography (0.52) presented similar sensitivities. Concerning the influence of the discomfort, at NC threshold, when discomfort was present, the number of false-negative results was lower with LFpen and the number of false-positive results was higher with visual inspection. At Cav threshold, the number of false-positive results was higher with LFpen. In conclusion, radiography and LFpen achieved similar performance in detecting approximal caries lesions in primary teeth and the discomfort caused by visual inspection and LFpen can influence the performance of these methods, since a higher number of false-positive or false-negative results occurred in children who reported discomfort.
Assuntos
Cárie Dentária/diagnóstico , Dente Molar/patologia , Medição da Dor , Dente Decíduo/patologia , Área Sob a Curva , Criança , Pré-Escolar , Cárie Dentária/diagnóstico por imagem , Cárie Dentária/patologia , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Fluorescência , Humanos , Lasers , Masculino , Exame Físico/normas , Curva ROC , Radiografia Interproximal/normas , Padrões de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Desmineralização do Dente/diagnósticoRESUMO
The aim of this in vitro study was to assess the influence of varying examiner's clinical experience on the reproducibility and accuracy of radiographic examination for occlusal caries detection. Standardized bitewing radiographs were obtained from 166 permanent molars. Radiographic examination was performed by final-year dental students from two universities (A, n = 5; B, n = 5) and by dentists with 5 to 7 years of experience who work in two different countries (C, n = 5; D, n = 5). All examinations were repeated after 1-week interval. The teeth were histologically prepared and assessed for caries extension. For intraexaminer reproducibility, the unweighted kappa values were: A (0.11-0.40), B (0.12-0.33), C (0.47-0.58), and D (0.42-0.71). Interexaminer reproducibility statistics were computed based on means ± SD of unweighted kappa values: A (0.07 ± 0.05), B (0.12 ± 0.09), C (0.24 ± 0.08), and D (0.33 ± 0.10). Sensitivity, specificity, and accuracy were calculated at D(1) and D(3) thresholds and compared by performing McNemar test (p = 0.05). D(1) sensitivity ranged between 0.29 and 0.75 and specificity between 0.24 and 0.85. D(3) specificity was moderate to high (between 0.62 and 0.95) for all groups, with statistically significant difference between the dentists groups (C and D). Sensitivity was low to moderate (between 0.21 and 0.57) with statistically significant difference for groups B and D. Accuracy was similar for all groups (0.55). Spearman's correlations were: A (0.12), B (0.24), C (0.30), and D (0.38). In conclusion, the reproducibility of radiographic examination was influenced by the examiner's clinical experience, training, and dental education as well as the accuracy in detecting occlusal caries.
Assuntos
Competência Clínica , Cárie Dentária/diagnóstico por imagem , Radiografia Interproximal/normas , Área Sob a Curva , Cárie Dentária/patologia , Esmalte Dentário/diagnóstico por imagem , Esmalte Dentário/patologia , Dentina/diagnóstico por imagem , Dentina/patologia , Odontólogos , Educação em Odontologia , Humanos , Variações Dependentes do Observador , Fotografia Dentária , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estudantes de OdontologiaRESUMO
OBJECTIVES: To determine the intra- and interexaminer reliability of two methods (calliper and computerized images) for measuring the alveolar bone level on bitewing radiographs of pre-school children and to determine the extent to which one method can measure more sites. METHODS: Standardized paediatric bitewings were analysed with either an image analysis program (ImageTool) or a digital calliper (Digimatic Caliper). With each method, radiographs were measured three times by three trained examiners. The differences in the number of sites measured with the two methods were assessed with McNemar's tests and kappa statistics. Reliability was assessed with paired t-tests, intraclass correlation coefficients (ICCs), Bland-Altman and survival-agreement plots. RESULTS: The kappa statistics and McNemar's test indicated that examiners measured 14% fewer sites using ImageTool. Paired t-tests also demonstrated a statistically significant bias (range 0.11-0.23 mm) indicating larger measurements for this method, although these observed differences were considered clinically unimportant for the detection of 2 mm of bone loss (which was considered the threshold for periodontal disease). Intra- and interexaminer reliability (ICC range: 0.87-0.97) was considered good for both methods. CONCLUSIONS: Reliable methods to assess alveolar bone loss in primary teeth are important for the diagnosis of incipient periodontal diseases. Both studied methods proved to be reliable. With the Digimatic Caliper, however, more sites were measured.
Assuntos
Processo Alveolar/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Radiografia Interproximal/normas , Processo Alveolar/anatomia & histologia , Pré-Escolar , Métodos Epidemiológicos , Humanos , Radiografia Interproximal/instrumentaçãoRESUMO
AIM: This was to evaluate the accuracy of the different methods for diagnosing occlusal caries in vivo, and to compare their performance in primary and permanent teeth. STUDY DESIGN: Permanent teeth (199) and primary molars (65) with macroscopically intact occlusal surface, with caries lesions without cavitation (white spot) or with a darkened sulcus were selected. The teeth were examined by the following methods: visual inspection, bite-wing radiographs and DIAGNOdent. The validation method employed for asserting the existence of carious lesion was cavity preparation. RESULTS: When the total sample was taken into consideration, laser (DIAGNOdent) provided the highest accuracy (74.8%). Even when the total sample was stratified, the laser accuracy was still high for both primary (88.4%) and permanent molars (70.4%). Visual inspection also provided a high accuracy for primary teeth (83.9%). The chi-square test showed a statistically significant difference between permanent and primary teeth considering occlusal caries diagnosis (p=0.0001). The Kappa coefficient showed good inter-examiner reproducibility for all methods. McNemar test revealed that the degree of intra-examiner agreement for visual inspection was lower than for the other methods. CONCLUSIONS: As visual inspection also showed a high degree of accuracy, the laser method should be used as a complementary method in doubtful cases. Diagnostic methods of occlusal caries, in general, are more efficient in deciduous than in permanent teeth.
Assuntos
Cárie Dentária/diagnóstico , Lasers , Exame Físico/normas , Radiografia Interproximal/normas , Adolescente , Criança , Preparo da Cavidade Dentária , Humanos , Lasers/normas , Dente Molar/patologia , Variações Dependentes do Observador , Exame Físico/estatística & dados numéricos , Radiografia Interproximal/estatística & dados numéricos , Reprodutibilidade dos Testes , Dente Decíduo/patologiaRESUMO
O objetivo deste estudo foi avaliar dois sistemas de imagens no diagnóstico de lesão de furca. Foram realizados defeitos ósseos artificiais em suínos utilizando brocas esféricas para a obtenção de radiografias intra-orais. Periodontistas e radiologistas analisaram esta simulações por meio de filmes convencionais e imagens digitalizadas. Foi observado que os periodontistas apresentaram dificuldades em diagnosticar lesões de furca menores nos molares superiores e inferiores, enquanto que os radiologistas somente nos superiores. Quanto aos sistemas de avaliação, apresentaram resultados semelhantes, concluindo-se que a imagem digitalizada não aumenta a acurácia mas também não diminuiu a qualidade, importante para arquivamento e transferência de dados.