Klinischer Einsatz einer fluoreszenzbasierten Intraoralkamera für die Verlaufskontrolle an gesunden und initialkariösen Zähnen
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Philipps-Universität Marburg
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Abstract
Objective:
The early detection of dental caries is fundamental to the modern dentistry. While a decline in
the prevalence of dental caries has been observed in Germany and many other European
countries, caries nevertheless still represents the most common disease of the oral cavity. The
early detection of incipient lesions and the choice of appropriate and timely therapeutic
measures are paramount to dental practice in the current era. The modern practitioner
increasingly has access to new technologies to support visual inspection. These novel diagnostic
technologies each come with their own product-specific performance characteristics,
potentially limiting the scope of their clinical application. The success of modern dentistry
therefore rests in part on the identification and application of more subtle diagnostic techniques
to detect incipient lesions that often elude the optical assessment alone. Such a clinical caries
detection system would be ideal for the optimization of targeted, cost-effective prophylactic
measures.
Aim:
Sound tooth surfaces and incipient lesions require regular follow-up in order to prevent possible
caries or for the early detection of incipient caries progression. In the present in vivo study, the
ability of the digital fluorescence camera VistaProof to monitor healthy tooth surfaces and
incipient lesions in children during follow-up will be evaluated.
Subjects and Methods:
The positive vote of the Ethics Commission had already been obtained before the study began.
Informed and written consent was obtained for all study participants and their guardians. The
study comprised 36 patients (mean age 9.1 years), resulting in a total of 421 teeth (≙ n=1892
surfaces) for assessment. Visual assessment using the ICDAS system provided a reference
value that was compared to assessment with the VistaProof fluorescence camera. Systematic
follow-up was conducted at 6 and 12 months for both visual and fluorescence inspection.
Statistical analyses were performed with SPSS (v15.0) and MedCalc (v11.3.4.0) statistical
software. The reproducibility of the ICDAS II was calculated using the Cohen kappa (κ).
Correlation between the ICDAS-II method and the VistaProof assessment was determined
using the Spearman's rank correlation (rs). The diagnostic accuracy of VistaProof was assessed
using the area under the curve (AUC) method and the ICDAS-II assessment as the reference
standard. Sensitivity and specificity were also determined in this way. The Wilcoxon test was
used to determine whether changes in the enamel could be detected by VistaProof when there
was no change in the ICDAS score. The level for statistical significance was set at an α = 0.05.
Results:
All correlations were statistically significant and positive in direction (rs: 0.54 to 0.66; p <0.01).
All findings showed a significant association (χ2 <0.001). The diagnostic accuracy of
VistaProof was high, with sensitivities and specificities varying depending on the positivity cutoff
used. The consideration of the crosstabs revealed that 90% of examined tooth surfaces
showed no visual signs of lesions (ICDAS code 0; n = 1700) at the beginning of the study, while
an early changes could be detected in 10% (ICDAS codes 1 and 2), Early changes could be
detected by visual inspection in 11.3% at 6 months (T2) and 14.7% at 12 months (t3).
Over the course of the 12 months, therefore, progression of ICDAS codes was observed in 120
tooth surfaces (94 teeth). Of these, 47 surfaces (39%) involved the primary molars and 73 (61%)
affected permanent teeth. There were significant differences between ICDAS results for all time
points (t1 / t2: Wilcoxon p = 0.011, t2 / t3: p <0.001). For fluorescence measurements, a
significant difference was found between the first and second examination (p <0.001), whereas
difference in measurements between t2/t3 failed to attain statistical significance (p = 0.700). It
is important to note that not only does diagnostic accuracy and test characteristics of VistaProof
vary considerably depending on the cut-off point used, as noted above, but also that the
sensitivity for detecting lesions in deciduous teeth appears somewhat lower than in permanent
teeth (SE 74.5%-100%, SP 0%-97.1%).
Conclusion:
The present study suggests that the use of the VistaProof digital fluorescence camera to monitor
the progress of enamel lesions could provide comparable results to detailed visual inspections,
although not all changes could be reliably detected by the sole use of the system. It is therefore
recommended to use this technical detection methods in addition to the usual detailed visual
inspection.
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Dates
Created: 2017Issued: 2017-01-23Updated: 2017-01-23
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
CariesIntraoralkameraIntraoral Camera
DFG-subjects
KariesFissurenkaries
DDC-Numbers
610
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Vill, Gabriel: Klinischer Einsatz einer fluoreszenzbasierten Intraoralkamera für die Verlaufskontrolle an gesunden und initialkariösen Zähnen. : Philipps-Universität Marburg 2017-01-23. DOI: https://doi.org/10.17192/z2017.0025.