Use of the ICDAS system and two fluorescence-based intraoral devices for examination of occlusal surfaces

Aim: The aims of this study were to assess the interexaminer reliability of ICDAS and Soprolife intra-oral camera ex vivo using 5 examiners and to compare in vivo the validity of two fluorescence-based intra-oral devices in examining occlusal surfaces with early carious lesions. Materials and methods: Thirty-seven occlusal surfaces of posterior primary and permanent teeth of 20 children were examined using Diagnodent pen (KaVo, Biberach/Riß, Germany) and Soprolife (Acteon Group, La Ciotat, France) fluorescence intra-oral camera. The white light photos, made by Soprolife camera, were evaluated using ICDAS scores and the Soprolife fluorescence photos were scored as sound, enamel caries and dentine caries by 5 experienced dentists. The dentists were trained for the use of ICDAS system with a short online training programme (ICDAS.org) and for the scoring of caries on the fluorescence images with example images. Statistics: cut-offs were made for ICDAS, Soprolife and Diagnodent to distinguish sound surfaces and enamel caries from dentinal caries. The inter-examiner reliability was calculated using intra-class correlation coefficient. Results: On white light images the examiners found 16 enamel caries and 21 dentine caries with the ICDAS system. On the Soprolife fluorescent images 24 enamel lesions, 9 dentine lesions and 4 sound surfaces were observed. The inter-examiner reliability (ICC) of the ICDAS system on white light photographs and of Soprolife on the fluorescent images for average measures was 0.70 and 0.72, respectively. The sensitivity and specificity of Soprolife (95%CI) was 0.43 and 1.0 respectively, using ICDAS as a reference standard. The sensitivity and specificity of Diagnodent (95%CI) was 0.62 and 0.81 respectively. Conclusion: A short training of dentists in the use the ICDAS system resulted in satisfactory inter-examiner reliability for the analysis of occlusal lesions on white light images. Soprolife and Diagnodent do not contribute to a better detection of early carious lesions.