This in vitro study aimed to compare outcomes of dental caries detection using visual inspection classified according to the International Caries Detection and Assessment System (ICDAS) with objective assessments using a well-established laser fluorescence system (Diagnodent pen) and a novel diffuse reflectance spectroscopy (DRS) device. One hundred extracted permanent premolars and molars were utilized, including sound teeth, teeth with non-cavitated caries, or teeth with small cavitated lesions. A total of 300 regions of interest (ROIs) were assessed using each detection method. Visual inspection, being a subjective method, was performed by two independent examiners. The presence and extent of caries were histologically verified according to Downer's criteria, serving as a reference for other detection methods. Histological results revealed 180 sound ROIs and 120 carious ROIs, categorized into three different extents of caries. Overall, there was no significant difference between the detection methods in sensitivity (0.90-0.93) and false negative rate (0.05-0.07). However, DRS exhibited superior performance in specificity (0.98), accuracy (0.95), and false positive rate (0.04) compared to other detection methods. Although the tested DRS prototype device exhibited limited penetration depth, it shows promise as a method, particularly for the detection of incipient caries.

Czech Institute of Informatics Robotics and Cybernetics Czech Technical University Prague 166 36 Prague Czech Republic

Department of Computing and Control Engineering University of Chemistry and Technology Prague 166 28 Prague Czech Republic

Institute of Dental Medicine 1st Faculty of Medicine of the Charles University and General University Hospital Prague 121 08 Prague Czech Republic

Institute of Histology and Embryology 1st Faculty of Medicine Charles University Prague 128 01 Prague Czech Republic

Zobrazit více v PubMed

Marinho V.C., Chong L.-Y., Worthington H.V., Walsh T. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database Syst. Rev. 2016:CD002284. doi: 10.1002/14651858.cd002284.pub2. PubMed DOI PMC

Horst J.A., Tanzer J.M., Milgrom P.M. Fluorides and Other Preventive Strategies for Tooth Decay. Dent. Clin. N. Am. 2018;62:207–234. doi: 10.1016/j.cden.2017.11.003. PubMed DOI PMC

Kocak N., Cengiz-Yanardag E. Clinical performance of clinical-visual examination, digital bitewing radiography, laser fluorescence, and near-infrared light transillumination for detection of non-cavitated proximal enamel and dentin caries. Lasers Med. Sci. 2020;35:1621–1628. doi: 10.1007/s10103-020-03021-2. PubMed DOI

Gimenez T., Piovesan C., Braga M.M., Raggio D.P., Deery C., Ricketts D.N., Ekstrand K., Mendes F.M. Visual Inspection for Caries Detection: A systematic review and meta-analysis. J. Dent. Res. 2015;94:895–904. doi: 10.1177/0022034515586763. PubMed DOI

Gugnani N., Pandit I.K., Srivastava N., Gupta M., Sharma M. International Caries Detection and Assessment System (ICDAS): A New Concept. Int. J. Clin. Pediatr. Dent. 2011;4:93–100. doi: 10.5005/jp-journals-10005-1089. PubMed DOI PMC

Dikmen B. ICDAS II criteria (international caries detection and assessment system) J. Istanb. Univ. Fac. Dent. 2015;49:63–72. doi: 10.17096/jiufd.38691. PubMed DOI PMC

Ekstrand K.R., Gimenez T., Ferreira F.R., Mendes F.M., Braga M.M. The International Caries Detection and Assessment System—ICDAS: A Systematic Review. Caries Res. 2018;52:406–419. doi: 10.1159/000486429. PubMed DOI

Geibel M.-A., Carstens S., Braisch U., Rahman A., Herz M., Jablonski-Momeni A. Radiographic diagnosis of proximal caries—Influence of experience and gender of the dental staff. Clin. Oral Investig. 2017;21:2761–2770. doi: 10.1007/s00784-017-2078-2. PubMed DOI

Turchiello R.Z., Pedrotti D., Braga M.M., Rocha R.O., Rodrigues J.A., Lenzi T.L. Do undergraduate dental students perform well detecting and staging caries and assessing activity by visual examination? A systematic review and meta-analysis. Int. J. Paediatr. Dent. 2019;29:281–293. doi: 10.1111/ipd.12463. PubMed DOI

Todorova V., Filipov I., Petrova R. In Vitro Comparison of Several Methods for Initial Proximal Caries Detection. Folia Med. 2020;62:358–364. doi: 10.3897/folmed.62.e47534. PubMed DOI

Pretty I.A. Caries detection and diagnosis: Novel technologies. J. Dent. 2006;34:727–739. doi: 10.1016/j.jdent.2006.06.001. PubMed DOI

Abogazalah N., Ando M. Alternative methods to visual and radiographic examinations for approximal caries detection. J. Oral Sci. 2017;59:315–322. doi: 10.2334/josnusd.16-0595. PubMed DOI

Marinova-Takorova M., Anastasova R., Panov V.E. Comparative evaluation of the effectiveness of five methods for early diagnosis of occlusal caries lesions—In vitro study. J. IMAB—Annu. Proceeding Sci. Pap. 2014;20:533–536. doi: 10.5272/jimab.2014203.533. DOI

Blazejewska A.I., Dacyna N., Niesiobędzki P., Trzaska M., Gozdowski D., Turska-Szybka A., Olczak-Kowalczyk D. Comparison of the detection of proximal caries in children and youth using DIAGNOcam and bitewing radiovisiography. Dent. Med. Probl. 2016;53:468–475. doi: 10.17219/dmp/64382. DOI

Alamoudi N., Khan J., El-Ashiry E., Felemban O., Bagher S., Al-Tuwirqi A. Accuracy of the DIAGNOcam and bitewing radiographs in the diagnosis of cavitated proximal carious lesions in primary molars. Niger. J. Clin. Pract. 2019;22:1576–1582. doi: 10.4103/njcp.njcp_237_19. PubMed DOI

Gostanian H.V., Shey Z., Kasinathan C., Caceda J., Janal M.N. An in vitro evaluation of the effect of sealant characteristics on laser fluorescence for caries detection. Pediatr. Dent. 2006;28:445–450. PubMed

Ekstrand K., Ricketts D.N.J., Kidd E.A.M. Reproducibility and Accuracy of Three Methods for Assessment of Demineralization Depth on the Occlusal Surface: An in vitro Examination. Caries Res. 1997;31:224–231. doi: 10.1159/000262404. PubMed DOI

Ricketts D., Kidd E., Weerheijm K., De Soet H. Hidden caries: What is it? Does it exist? Does it matter? Int. Dent. J. 1997;47:259–265. doi: 10.1002/j.1875-595X.1997.tb00786.x. PubMed DOI

Takamori K., Hokari N., Okumura Y., Watanabe S. Detection of Occlusal Caries under Sealants by Use of a Laser Fluorescence System. J. Clin. Laser Med. Surg. 2001;19:267–271. doi: 10.1089/10445470152612008. PubMed DOI

Heinrich-Weltzien R., Weerheijm K.L., Kühnisch J., Oehme T., Stösser L. Clinical evaluation of visual, radiographic, and laser fluorescence methods for detection of occlusal caries. ASDC J. Dent. Child. 2002;69:127–132. PubMed

Anttonen V., Seppä L., Hausen H. Clinical Study of the Use of the Laser Fluorescence Device DIAGNOdent for Detection of Occlusal Caries in Children. Caries Res. 2003;37:17–23. doi: 10.1159/000068227. PubMed DOI

Lussi A., Hellwig E. Performance of a new laser fluorescence device for the detection of occlusal caries in vitro. J. Dent. 2006;34:467–471. doi: 10.1016/j.jdent.2005.11.002. PubMed DOI

Rodrigues J., Hug I., Diniz M., Lussi A. Performance of Fluorescence Methods, Radiographic Examination and ICDAS II on Occlusal Surfaces in vitro. Caries Res. 2008;42:297–304. doi: 10.1159/000148162. PubMed DOI

Alkurt M.T., Peker I., Arisu H.D., Bala O., Altunkaynak B. In vivo comparison of laser fluorescence measurements with conventional methods for occlusal caries detection. Lasers Med. Sci. 2007;23:307–312. doi: 10.1007/s10103-007-0486-2. PubMed DOI

Tassoker M., Ozcan S., Karabekiroglu S. Occlusal Caries Detection and Diagnosis Using Visual ICDAS Criteria, Laser Fluorescence Measurements, and Near-Infrared Light Transillumination Images. Med. Princ. Pract. 2020;29:25–31. doi: 10.1159/000501257. PubMed DOI PMC

Pourhashemi S., Jafari A., Motahhari P., Panjnoosh M., Fard M.K., Sanati I., Sahadfar M., Pariab M. An in-vitro comparison of visual inspection, bite-wing radiography, and laser fluorescence methods for the diagnosis of occlusal caries. J. Indian Soc. Pedod. Prev. Dent. 2009;27:90–93. doi: 10.4103/0970-4388.55333. PubMed DOI

Nokhbatolfoghahaie H., AliKhasi M., Chiniforush N., Khoei F., Safavi N., Zadeh B.Y. Evaluation of Accuracy of DIAGNOdent in Diagnosis of Primary and Secondary Caries in Comparison to Conventional Methods. J. Lasers Med. Sci. 2013;4:159–167. doi: 10.22037/JLMS.V4I4.5042. PubMed DOI PMC

Kockanat A., Unal M. In vivo and in vitro comparison of ICDAS II, DIAGNOdent pen, CarieScan PRO and SoproLife camera for occlusal caries detection in primary molar teeth. Eur. J. Paediatr. Dent. 2017;18:99–104. doi: 10.23804/EJPD.2017.18.02.03. PubMed DOI

Castilho L.S., Cotta F.V., Bueno A.C., Moreira A.N., Ferreira E.F., Magalhães C.S. Validation of DIAGNOdent laser fluorescence and the International Caries Detection and Assessment System (ICDAS) in diagnosis of occlusal caries in permanent teeth: An in vivo study. Eur. J. Oral Sci. 2016;124:188–194. doi: 10.1111/eos.12257. PubMed DOI

Hill W., Petrou V. Caries Detection by Diode Laser Raman Spectroscopy. Appl. Spectrosc. 2000;54:795–799. doi: 10.1366/0003702001950409. DOI

Samek O., Telle H.H., Beddows D.C. Laser-induced breakdown spectroscopy: A tool for real-time, in vitro and in vivo identification of carious teeth. BMC Oral Health. 2001;1:1. doi: 10.1186/1472-6831-1-1. PubMed DOI PMC

Lussi A., Hibst R., Paulus R. DIAGNOdent: An Optical Method for Caries Detection. J. Dent. Res. 2004;83:80–83. doi: 10.1177/154405910408301s16. PubMed DOI

Izawa T., Wakaki M. Application of Laser Raman Spectroscopy to Dental Diagnosis; Proceedings of the SPIE BiOS; San Jose, CA, USA. 22–27 January 2005.

Liu L., Tang J., Li S.Z. A new method for caries diagnosis by characteristic spectrum; Proceedings of the 2009 2nd Inter-national Conference on Biomedical Engineering and Informatics; Tianjin, China. 17–19 October 2009; pp. 1–4.

Ruohonen M., Palo K., Alander J. Spectroscopic Detection of Caries Lesions. J. Med. Eng. 2013;2013:161090. doi: 10.1155/2013/161090. PubMed DOI PMC

Procházka A., Charvát J., Vyšata O., Mandic D. Incremental deep learning for reflectivity data recognition in stomatology. Neural Comput. Appl. 2022;34:7081–7089. doi: 10.1007/s00521-021-06842-6. DOI

Charvát J., Procházka A., Fričl M., Vyšata O., Himmlová L. Diffuse reflectance spectroscopy in dental caries detection and classification. Signal Image Video Process. 2020;14:1063–1070. doi: 10.1007/s11760-020-01640-4. DOI

Schwarz R.A., Gao W., Daye D., Williams M.D., Richards-Kortum R., Gillenwater A. Autofluorescence and diffuse reflectance spectroscopy of oral epithelial tissue using a depth-sensitive fiber-optic probe. Appl. Opt. 2008;47:825–834. doi: 10.1364/AO.47.000825. PubMed DOI PMC

Lussi A., Francescut P. Performance of Conventional and New Methods for the Detection of Occlusal Caries in Deciduous Teeth. Caries Res. 2003;37:2–7. doi: 10.1159/000068226. PubMed DOI

Luczaj-Cepowicz E., Marczuk-Kolada G., Obidzinska M., Sidun J. Diagnostic validity of the use of ICDAS II and DIAGNOdent pen verified by micro-computed tomography for the detection of occlusal caries lesions—An in vitro evaluation. Lasers Med. Sci. 2019;34:1655–1663. doi: 10.1007/s10103-019-02762-z. PubMed DOI

Hibst R., Paulus R., Lussi A. Detection of Occlusal Caries by Laser Fluorescence: Basic and Clinical Investigations. Med. Laser Appl. 2001;16:205–213. doi: 10.1078/1615-1615-00024. DOI

Fričl M. Analysis of Spectroscopic Images of Hard Dental Tissues. University of Chemistry and Technology; Prague, Czech Republic: 2020.

Martynek D. Diffuse Reflectance Spectroscopy in Dental Tissue Analysis. University of Chemistry and Technology; Prague, Czech Republic: 2022.

Downer M.C. Concurrent Validity of an Epidemiological Diagnostic System for Caries with the Histological Appearance of Extracted Teeth as Validating Criterion. Caries Res. 1975;9:231–246. doi: 10.1159/000260160. PubMed DOI

Attrill D.C., Ashley P. Occlusal caries detection in primary teeth: A comparison of DIAGNOdent with conventional methods. Br. Dent. J. 2001;190:440–443. doi: 10.1038/sj.bdj.4800998a. PubMed DOI

Subka S., Rodd H., Nugent Z., Deery C. In vivo validity of proximal caries detection in primary teeth, with histological validation. Int. J. Paediatr. Dent. 2019;29:429–438. doi: 10.1111/ipd.12478. PubMed DOI

Huth K., Neuhaus K., Gygax M., Bücher K., Crispin A., Paschos E., Hickel R., Lussi A. Clinical performance of a new laser fluorescence device for detection of occlusal caries lesions in permanent molars. J. Dent. 2008;36:1033–1040. doi: 10.1016/j.jdent.2008.08.013. PubMed DOI

Bengtson A.L., Gomes A.C., Mendes F.M., Cichello L.R., Bengtson N.G., Pinheiro S.L. Influence of examiner’s clinical experience in detecting occlusal caries lesions in primary teeth. Pediatr. Dent. 2005;27:238–243. PubMed

Reis A., Mendes F.M., Angnes V., Angnes G., Grande R.H.M., Loguercio A.D. Performance of methods of occlusal caries detection in permanent teeth under clinical and laboratory conditions. J. Dent. 2006;34:89–96. doi: 10.1016/j.jdent.2005.04.002. PubMed DOI

Jablonski-Momeni A., Stachniss V., Ricketts D., Heinzel-Gutenbrunner M., Pieper K. Reproducibility and Accuracy of the ICDAS-II for Detection of Occlusal Caries in vitro. Caries Res. 2008;42:79–87. doi: 10.1159/000113160. PubMed DOI

Mitropoulos P., Rahiotis C., Stamatakis H., Kakaboura A. Diagnostic performance of the visual caries classification system ICDAS II versus radiography and micro-computed tomography for proximal caries detection: An in vitro study. J. Dent. 2010;38:859–867. doi: 10.1016/j.jdent.2010.07.005. PubMed DOI

Soviero V., Leal S., Silva R., Azevedo R. Validity of MicroCT for in vitro detection of proximal carious lesions in primary molars. J. Dent. 2012;40:35–40. doi: 10.1016/j.jdent.2011.09.002. PubMed DOI

Bader J.D., Shugars D.A., Bonito A.J. Systematic Reviews of Selected Dental Caries Diagnostic and Management Methods. J. Dent. Educ. 2001;65:960–968. doi: 10.1002/j.0022-0337.2001.65.10.tb03470.x. PubMed DOI

Foros P., Oikonomou E., Koletsi D., Rahiotis C. Detection Methods for Early Caries Diagnosis: A Systematic Review and Meta-Analysis. Caries Res. 2021;55:247–259. doi: 10.1159/000516084. PubMed DOI

Bader J.D., Shugars D.A. A systematic review of the performance of a laser fluorescence device for detecting caries. J. Am. Dent. Assoc. 2004;135:1413–1426. doi: 10.14219/jada.archive.2004.0051. PubMed DOI

Walsh L.J. Dental Caries. InTech Open; Rijek, Croatia: 2018. Caries Diagnosis Aided by Fluorescence. DOI

Markowitz K., Stenvall R., Graye M. The Effect of Distance and Tooth Structure on Laser Fluorescence Caries Detection. Oper. Dent. 2012;37:150–160. doi: 10.2341/10-179-L. PubMed DOI

Shoaib Z., Kamran M.A., Mannan M.M.N., Jeong M.Y. Approach to optimize 3-dimensional brain functional activation image with high resolution: A study on functional near-infrared spectroscopy. Biomed. Opt. Express. 2019;10:4684–4710. doi: 10.1364/BOE.10.004684. PubMed DOI PMC

Ohnishi M., Kusakawa N., Masaki S., Honda K., Shimada Y., Fujimoto I., Hirao K. Investigation on deep layer meas-urements in the cerebral cortex within the adult head by near infrared spectroscopy using an absorbance difference technique. J. Near Infrared Spectrosc. 2003;11:27–38. doi: 10.1255/jnirs.351. DOI

Si W., Xiong J., Huang Y., Jiang X., Hu D. Quality Assessment of Fruits and Vegetables Based on Spatially Resolved Spectroscopy: A Review. Foods. 2022;11:1198. doi: 10.3390/foods11091198. PubMed DOI PMC