Journal of Conservative Dentistry
Home About us Editorial Board Instructions Submission Subscribe Advertise Contact e-Alerts Login 
Users Online: 1708
Print this page  Email this page Bookmark this page Small font sizeDefault font sizeIncrease font size
 

 
Table of Contents   
ORIGINAL ARTICLE  
Year : 2023  |  Volume : 26  |  Issue : 2  |  Page : 199-206
DIAGNOdent versus International Caries Detection and Assessment System in detection of incipient carious lesions: A diagnostic accuracy study


Department of Conservative Dentistry, Faculty of Dentistry, Cairo University, Cairo, Egypt

Click here for correspondence address and email

Date of Submission02-Nov-2022
Date of Decision03-Jan-2023
Date of Acceptance06-Jan-2023
Date of Web Publication16-Mar-2023
 

   Abstract 

Aim: The present investigation aimed at assessing the diagnostic accuracy of DIAGNOdent compared to the International Caries Detection and Assessment System-II (ICDAS-II) in the detection of facial, smooth surface noncavitated carious lesions.
Settings and Design: Sixty patients were enrolled in the current study according to the eligibility criteria. There were 161 teeth with noncavitated, white spot carious lesions and 32 sound teeth.
Materials and Methods: Before examination, teeth were cleaned and polished and all patients were assessed under standardized operating conditions: preset dental unit position, operating light, and prolonged air drying (approximately 5 s). All teeth were assessed by two calibrated examiners individually without any contact using ICDAS-II and DIAGNOdent.
Statistical Analysis: The diagnostic accuracy of DIAGNOdent device was determined, including sensitivity, specificity, overall accuracy, positive and negative predictive values, and receiver operating characteristic curve analysis. Chi-square test was conducted to compare the distribution of ICDAS-II and DIAGNOdent scores. Inter-observer agreement between assessors was evaluated using Cohen's kappa test.
Results: In the current study, DIAGNOdent had an overall accuracy of 84.45% with sensitivity and specificity of 87.58% and 96.87%, respectively, and +PV and −PV of 97.7% and 83.9%, respectively, when score 0 represented sound tooth surface, while scores 1 and 2 were considered clinically noncavitated carious lesions. Moreover, when only ICDAS score 1 was considered representing first visual change in enamel, DIAGNOdent had an accuracy of 74.15% with sensitivity and specificity of 83.53% and 90.62%, respectively, and +PV and −PV of 93% and 78.6%, respectively. In the present study, when only ICDAS score 2 was considered representing distinct visual change in enamel, DIAGNOdent had an accuracy of 100% with sensitivity and specificity of 100% and 100%, respectively, and +PV and −PV of 100% and 100%, respectively.
Conclusions: The overall performance of DIAGNOdent was equivalent to the visual inspection using ICDAS-II. DIAGNOdent might be considered a useful adjunctive device for detection and monitoring development of noncavitated carious lesions on facial smooth surfaces.

Keywords: Accuracy; caries; DIAGNOdent; incipient; International Caries Detection and Assessment System

How to cite this article:
Shaalan OO. DIAGNOdent versus International Caries Detection and Assessment System in detection of incipient carious lesions: A diagnostic accuracy study. J Conserv Dent 2023;26:199-206

How to cite this URL:
Shaalan OO. DIAGNOdent versus International Caries Detection and Assessment System in detection of incipient carious lesions: A diagnostic accuracy study. J Conserv Dent [serial online] 2023 [cited 2023 Jun 10];26:199-206. Available from: https://www.jcd.org.in/text.asp?2023/26/2/199/371798



   Introduction Top


There is a current paradigm shift in conservative dentistry by substituting the surgical model with the medical model of treatment of dental caries. Dental caries is considered a dynamic process of demineralization and remineralization depending on the balance between risk and protective factors.[1] From the International Caries Detection and Assessment System (ICDAS) to the CariesCare International (CCI), the key aspects for diagnostic criteria of dental caries include lesion detection, lesion assessment, and finally, caries diagnosis. The newly introduced International Caries Classification and Management System and its practice version CCI have shared goals for caries management through avoiding occurrence of new lesions, preventing existing lesions from progression, and preserving valuable tooth structure.[2] Early detection of initial carious lesions aids in clinical decision-making during management, with either no care advised, preventive care advised, or conservative operative care advised. Moreover, after COVID-19 pandemic, there was an increase in the awareness of dental caries prevention through primary and secondary levels of prevention. This does not only apply on the medical model of treatment, with its benefits to the patient but also minimizes aerosol-generating procedures.[3]

Based on a recently published systematic review,[4] visual assessment remains the methods of choice for detection of caries among all surfaces and dentitions either permanent or deciduous. The ICDAS-II was suggested in Baltimore, Maryland, March 2005, showing considerable diagnostic accuracy and reproducibility in detection of carious lesions, especially noncavitated lesions.[5] Therefore, this method was considered a reliable caries detection method in most clinical conditions and has been recommended to be used in daily clinical practice.[6] However, visual examination is subjective and is highly dependent on the dentist's skills and experience. Besides visual detection systems, laser fluorescence assessment was also considered a suitable method for caries detection.[4] One of these methods is DIAGNOdent 2095 (KaVo, Biberach, Germany), which is based on fluorescence absorption of bacterial by-products from carious surfaces using a diode laser of 655 nm wavelength, and this will reflect the actual activity of carious lesions and aid in objective assessment of the incipient lesions' progression.[7] Caries progression is represented numerically on the screen of the device with a scale ranging from 0 to 99.

A recent systematic review[8] found that both sensitivity and specificity of fluorescence-based caries assessment methods were 80%, while visual caries assessment methods had a sensitivity of 80% and specificity of 75%. Laboratory data demonstrated that both the visual and the fluorescence methods had similar diagnostic accuracy and were both reliable for detection of initial carious lesions.[8],[9] However, there is limited evidence available in the current literature due to scarce in vivo studies. Recent systematic reviews[6],[8] recommended that more in vivo studies are warranted to assess the diagnostic accuracy of both assessment methods. Moreover, Foros et al.[4] conducted another recent systematic review and concluded that there was a lack of in vivo trials assessing the diagnostic accuracy of DIAGNOdent in detecting carious lesions of facial smooth surfaces.

Given the current gap of knowledge, the present investigation aimed at assessing the diagnostic accuracy of DIAGNOdent compared to the ICDAS-II visual assessment as a reference standard in the detection of facial, smooth surface noncavitated carious lesions. The null hypothesis tested, was that there will be no difference between both methods in detecting initial carious lesions in facial smooth surfaces.


   Materials and Methods Top


The current investigation was registered in ClinicalTrials.gov (ID: NCT05127356) at November 19, 2021, approved by the Research Ethics Committee (Approval Number: 11-2-22) at February 22, 2022, conducted in accordance with the Helsinki Declaration of 1975, as revised in 2013 and reported according to STARD guidelines.[10] Sample size was calculated according to the results of a previous systematic review[4] in which the area under the curve (AUC) for diagnostic accuracy of fluorescent camera for buccal smooth surface carious lesions was 0.84 and AUC for diagnostic accuracy of visual examination was 0.99. By adopting an alpha (α) level of 0.05 (5%), power = 80%. The predicted sample size (n) was a total of 58 patients. Sample size calculation was performed using MedCalc software, version 19 for windows (MedCalc Software Ltd., Ostend, Belgium).

A total of 200 patients ranging from 18 to 30 years old were examined, and patients with at least one noncavitated white spot lesion on facial smooth surfaces were included using convenient consecutive sampling. Healthy teeth were also included to assess specificity, while cavitated and arrested discolored lesions and teeth with other developmental defects or teeth with dental restorations were excluded. Out of the 200 patients examined, 60 patients fulfilled the eligibility criteria and were recruited from the clinic of the department of conservative dentistry. Written informed consent was signed by the eligible participants before enrollment in the present trial. There were 161 teeth with noncavitated, incipient carious lesions and 32 sound teeth in the current study. Carious and sound teeth were examined to compare the diagnostic accuracy of both caries assessment methods. The examination was carried out in the main clinic of the department of conservative dentistry between February 22, 2022 and March 24, 2022. Before examination, teeth were cleaned and polished using Pro-Brush (Kerr, Orange, CA, USA) and all patients were assessed under standardized operating conditions: preset dental unit position, operating light, and prolonged air drying (approximately 5s). [Figure 1] represents the STARD flow diagram to report the flow of participants in the current study.
Figure 1: STARD flow diagram to report flow of participants and lesions in the study

Click here to view


Assessors' calibration

Two assessors were trained and calibrated to use both visual and laser assessment methods 2 weeks prior to the beginning of the study. Assessors were trained for using DIAGNOdent 2095 (KaVo, Biberach, Germany) laser fluorescence device according to the manufacturer's instructions and were trained to assess teeth using the ICDAS system.[5],[11] For calibration, ten patients were recruited and assessed independently by both assessors using both methods till reaching a satisfactory calibration, whenever there was a disagreement, they discussed to reach for a consensus. There was almost perfect inter-examiner agreement for DIAGNOdent and ICDAS-II (kappa = 0.86 and 0.97, respectively) during calibration period.

Visual assessment using the International Caries Detection and Assessment System-II

All teeth were assessed by each examiner individually without any contact using ICDAS-II.[11] Sound teeth were scored as 0 and noncavitated enamel initial lesions were scored as 1 and 2. ICDAS-II scores were as follows:

  • Code 0: Sound tooth surface
  • Code 1: First visual change in enamel
  • Code 2: Distinct visual change in enamel when viewed wet
  • Code 3: Localized enamel breakdown due to caries with no visible dentin
  • Code 4: Underlying dark shadow from dentin with or without localized enamel breakdown
  • Code 5: Distinct cavity with visible dentin
  • Code 6: Extensive distinct cavity with visible dentin.


Laser fluorescence assessment using DIAGNOdent

All teeth were assessed by each examiner individually at different times without any contact using DIAGNOdent 2095 (KaVo, Biberach, Germany) laser fluorescence device. The device was calibrated using the given ceramic standard, followed by acquiring baseline value through measuring fluorescence of a sound spot on the smooth surface of the tooth. The tip of the DIAGNOdent was then applied on the noncavitated white spot lesion and rotated around a vertical axis, three readings were obtained, and the highest reading was then registered. DIAGNOdent fluorescence readings were between 0 and 99; these readings were categorized according to a previous classification.[12] Sound teeth were scored as 1 and noncavitated enamel initial lesions were scored as 2 and 3. DIAGNOdent categorical scores were as follows:

  • Score 1: 0–4 (healthy tooth structure)
  • Score 2: 5–10 (outer half enamel caries)
  • Score 3: 11–20 (inner half enamel caries)
  • Score 4: 21+ (dentin caries).


Statistical analysis

Continuous data were presented as mean and standard deviation, while categorical data were presented as frequencies (n) and percentages (%). The diagnostic accuracy of DIAGNOdent device was determined, including sensitivity, specificity, overall accuracy, positive and negative predictive values, and receiver operating characteristic (ROC) curve analysis, in detection of noncavitated carious lesions in facial smooth surfaces compared with traditional ICDAS-II. Spearman's rank correlation was used to measure the level of correlation between ICDAS-II scores and DIAGNOdent readings. Chi-square test was conducted to compare the distribution of ICDAS-II and DIAGNOdent scores. Inter-observer agreement between assessors regarding ICDAS-II and DIAGNOdent modalities was evaluated using Cohen's kappa test. Statistical analysis was performed using MedCalc software, version 19 for Windows (MedCalc Software Ltd, Ostend, Belgium), and the significance level was set at P ≤ 0.05.


   Results Top


Demographic data

Sixty patients participated in the current trial; 40 females (66.66%) and 20 males (33.33%) with a mean age of 23.7 ± 4.4 (ranging from 18 to 30 years). A total of 193 teeth according to the eligibility criteria were examined, including 120 anterior teeth (62.18%), 56 premolars (29.02%), and 17 molars (8.8%).

Inter-observer agreement for the International Caries Detection and Assessment System-II and DIAGNOdent scoring systems

There was almost perfect inter-examiner agreement for DIAGNOdent and ICDAS-II (kappa = 0.84 and 0.94, respectively).

Spearman's rank correlation between the International Caries Detection and Assessment System-II scores and DIAGNOdent readings

Spearman's rank correlation coefficient was computed for the highest scores/measurements given by both operators for each method. The calculation resulted in a strongly significant positive correlation between ICDAS-II scores and DIAGNOdent readings (r = 0.892, P < 0.0001).

Distribution of the International Caries Detection and Assessment System-II scores and DIAGNOdent readings

A total of 193 teeth were examined in this study. According to ICDAS-II, 32 teeth were scored as sound (ICDAS 0), of which 22 of them were scored as sound using the DIAGNOdent device (DIAGNOdent score 1) and 10 were scored as having outer enamel caries (DIAGNOdent score 2). Meanwhile, 85 teeth were scored as the first visual change in enamel based on ICDAS-II (ICDAS 1), when these teeth were assessed by the DIAGNOdent method, 6 of them were scored as sound (DIAGNOdent score 1) and 76 were scored as outer enamel caries (DIAGNOdent score 2) and 3 were scored as inner enamel caries (DIAGNOdent score 3). Furthermore, 76 teeth were scored as a distinct visual change in enamel according to ICDAS-II (ICDAS 2), of which 7 were scored as outer enamel caries (DIAGNOdent score 2) and 69 were scored as inner enamel caries (DIAGNOdent score 3) according to DIAGNOdent scoringsystem [Table 1]. Chi-square test showed that there was a statistically significant difference in score distribution between ICDAS-II and DIAGNOdent methods (P < 0.0001).
Table 1: Association between the International Caries Detection and Assessment System-II and DIAGNOdent scoring systems

Click here to view


Diagnostic accuracy of DIAGNOdent

The level of agreement between DIAGNOdent and traditional ICDAS-II in detection of smooth surface noncavitated carious lesions was also investigated in this study. The reference standard was ICDAS-II, score 0 represented healthy tooth surface (negative), while ICDAS scores 1 and 2 represented diseased noncavitated carious lesions (positive). To compare the level of agreement within ICDAS 1 and 2 individually, ICDAS 1 was considered healthy, while ICDAS 2 was considered diseased [Table 2]. [Figure 2] shows ROC curves for DIAGNOdent in caries detection on smooth surface lesions based on ICDAS-II as a reference standard.
Table 2: Diagnostic accuracy of DIAGNOdent method in caries detection based on the International Caries Detection and Assessment System-II as reference standard

Click here to view
Figure 2: ROC curves for DIAGNOdent in caries detection on smooth surface lesions based on ICDAS-II as reference standard. (a) ROC curve for DIAGNOdent in caries detection on smooth surface lesions based on ICDAS-II as reference standard (negative: ICDAS 0, positive: ICDAS 1 and 2). (b) ROC curve for DIAGNOdent in caries detection on smooth surface lesions based on ICDAS-II as reference standard (negative: ICDAS 0, positive: ICDAS 1). (c) ROC curve for DIAGNOdent in caries detection on smooth surface lesions based on ICDAS-II as reference standard (negative: ICDAS 0, positive: ICDAS 2). (d) ROC curve for DIAGNOdent in caries detection on smooth surface lesions based on ICDAS-II as reference standard (negative: ICDAS 1, positive: ICDAS 2). ROC: Receiver operating characteristic, ICDAS: International Caries Detection and Assessment System

Click here to view



   Discussion Top


In vitro data suggested that laser fluorescence and visual inspection have similar accuracy.[9],[13] There are limited evidence-based data in the literature regarding in vivo diagnostic accuracy of noncavitated carious lesions detection methods. In a previous systematic review[4] based on in vivo data, only 5 studies were eligible for meta-analysis and there was only one study assessing diagnostic accuracy of laser fluorescence (DIAGNOpen) for detection of noncavitated lesions in smooth facial surfaces with sensitivity and specificity of 0.32–0.78 and 0.64–0.85, respectively. There were no in vivo diagnostic accuracy studies for detection of noncavitated lesions in smooth facial surfaces using DIAGNOdent. The authors also reported that the sensitivity and specificity of DIAGNOdent in previous in vivo studies for occlusal surface in permanent dentition were 0.48–1 and 0.54–1, respectively;[4] there was a huge heterogeneity among studies with wide confidence intervals for the sensitivity and specificity. Moreover, comparison between in vitro and in vivo data regarding the accuracy of laser fluorescence for detection of incipient carious lesions showed that in vitro data exhibited better accuracy. Therefore, in vivo assessment of noncavitated carious lesions using laser fluorescence needed further studies.

Visual examination is the most commonly used method for detection of initial carious lesions due to its convenience, reliability,[14] and cost-effectiveness.[4] It is well established in the current literature that direct visual examination has good validity for detection of white spot lesions, where diagnosis is based on clinical appearance and texture of enamel rather than by-products of bacteria detected by laser fluorescence.[15],[16],[17],[18] Authenticating visual examination method for in vivo assessment in trials had many drawbacks compared to histological assessment, which is universally accepted as the reference gold standard to assess the accuracy of carious detection methods. Nevertheless, for histological assessment to be done, teeth under investigation should be extracted causing ethical issues.[8] Therefore, to assess in vivo diagnostic accuracy without histological examination, inter-examiner agreement should be used as a surrogate method to enhance accuracy.[19] The DIAGNOdent detects carious lesions through quantifying bacterial by-products (porphyrins) produced by cariogenic bacteria and detecting their biological fluorescence.[20] Furthermore, previous systematic reviews[13],[21] and other in vitro studies[16],[17],[18],[22],[23] showed that laser fluorescence detection methods such as DIAGNOdent and DIAGNOdent Pen had high in vitro sensitivity and specificity for detecting initial white spot lesions.

Although DIAGNOdent could be considered a reliable tool for caries diagnosis, some requirements are needed to minimize false-positive readings in clinical practice. For instance, DIAGNOdent overestimates readings for any minor alterations in properties of the dental substrate. Confounders such as stains, calculus, plaque, and degree of mineralization can affect the accuracy of readings.[24],[25],[26] Hence, standardized measurement protocol is required to enhance reading accuracy of DIAGNOdent. Teeth surfaces should be cleaned before measurements and dryness should be optimum to standardize moisture content of teeth, as it affects light scattering due to difference in refractive index between air and water.[24],[25],[26],[27] Light reflection of the dental unit lamp could affect DIAGNOdent results; therefore, it is very crucial to use the same lighting conditions such as intensity, angulation, and distance during measurements.[26]

In the current study, DIAGNOdent had an overall accuracy of 84.45% with sensitivity and specificity of 87.58% and 96.87%, respectively, and +PV and −PV of 97.7% and 83.9%, respectively, when score 0 represented sound tooth surface, while scores 1 and 2 were considered clinically noncavitated carious lesions, which indicated an excellent association between ICDAS-II and DIAGNOdent methods. Moreover, when only ICDAS score 1 was considered representing first visual change in enamel, DIAGNOdent had an accuracy of 74.15% with sensitivity and specificity of 83.53% and 90.62%, respectively, and +PV and −PV of 93% and 78.6%, respectively, which also indicated an excellent association between ICDAS-II and DIAGNOdent methods. In the present study, when only ICDAS score 2 was considered representing distinct visual change in enamel, DIAGNOdent had an accuracy of 100% with sensitivity and specificity of 100% and 100%, respectively, and +PV and −PV of 100% and 100%, respectively, which indicated a perfect association between ICDAS-II and DIAGNOdent methods. The findings presented herein were supported by two recent systematic reviews, where Thanh et al.[8] found that fluorescence-based diagnostic methods had a sensitivity and specificity of 80%, while Foros et al.[4] reported that the sensitivity ranged from 0.32 to 0.78 and the specificity ranged from 0.64 to 0.85.

The current findings noticed that DIAGNOdent had less accuracy regarding early visual changes in enamel when compared to ICDAS-II, while for the more extended distinct visual change in enamel, DIAGNOdent demonstrated perfect accuracy. These observations were in line with previous studies[15],[28] validating fluorescence devices for evaluation of white spot lesions, showing less accuracy with early lesions and better accuracy with more extended lesions. This may be attributed to the low level of bacterial by-products in early incipient enamel lesions.[29]

In the present investigation, there was a strongly significant positive correlation (r = 0.892) between ICDAS-II scores and DIAGNOdent readings, which denotes that as the scores of ICDAS-II increased, the DIAGNOdent readings increased, and vice versa. This was also in agreement with another trial reporting a good correlation (r = 0.71) between ICDAS-II and DIAGNOpen readings.[30]

Furthermore, the present findings found almost perfect inter-examiner agreement for DIAGNOdent and ICDAS-II (kappa = 0.83844 and 0.94311, respectively), which was supported by similar results from other trials.[12],[24],[30] This emphasizes the importance of training and calibration before undergoing diagnostic accuracy studies. The examiners' calibration is very crucial to ensure high reproducibility during assessment of noncavitated carious lesions.[24],[31]

The ideal diagnostic tool for detection and monitoring progress of noncavitated white spot lesions should have high sensitivity and specificity. For a diagnostic test to be beneficial, the summation of sensitivity and specificity should be at least 1.5.[32] Additionally, the diagnostic tool for incipient caries should be user-friendly, easily applied in clinical situations by less experienced operators, noninvasive, cost-effective, and should also provide repeatability and reproducibility among different examiners.[15]

Combining DIAGNOdent and direct visual examination for diagnosis of facial smooth surfaces might be considered beneficial, through merging the merits of assessing enamel's mineral quantity together with texture and appearance. This could help clinicians to enhance their diagnostic efficiency and decision-making during management of early enamel lesions, thus halting lesions' progression using noninvasive preventive protocols.[33],[34],[35],[36] Besides, it has been reported that treatment decisions based on combining ICDAS and DIAGNOdent had better accuracy than decisions based on ICDAS only.[37]


   Conclusions Top


In the current investigation, DIAGNOdent has shown high sensitivity and specificity and excellent association with ICDAS-II, despite being less accurate in detecting the first visual change in enamel compared to visual examination. The overall performance of DIAGNOdent was equivalent to the visual inspection using ICDAS-II, so the null hypothesis could not be rejected. DIAGNOdent might be considered a useful adjunctive device for detection and monitoring development of noncavitated carious lesions on facial smooth surfaces.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Devadiga D, Shetty P, Hegde MN. Characterization of dynamic process of carious and erosive demineralization – An overview. J Conserv Dent 2022;25:454-62.  Back to cited text no. 1
  [Full text]  
2.
Pitts NB, Banerjee A, Mazevet ME, Goffin G, Martignon S. From 'ICDAS' to 'CariesCare International': The 20-year journey building international consensus to take caries evidence into clinical practice. Br Dent J 2021;231:769-74.  Back to cited text no. 2
    
3.
Pitts NB, Mayne C. Making cavities history: A global policy consensus for achieving a dental cavity-free future. JDR Clin Trans Res 2021;6:264-7.  Back to cited text no. 3
    
4.
Foros P, Oikonomou E, Koletsi D, Rahiotis C. Detection methods for early caries diagnosis: A systematic review and meta-analysis. Caries Res 2021;55:247-59.  Back to cited text no. 4
    
5.
ICDAS-Committee. International Caries Detection and Assessment System (ICDAS II). Criteria Manual. Baltimore, Maryland; 2005.  Back to cited text no. 5
    
6.
Ekstrand KR, Gimenez T, Ferreira FR, Mendes FM, Braga MM. The international caries detection and assessment system – ICDAS: A systematic review. Caries Res 2018;52:406-19.  Back to cited text no. 6
    
7.
Hibst R, Paulus R, Lussi A. Detection of occlusal caries by laser fluorescence: Basic and clinical investigations. Med Laser Appl 2001;16:205-13.  Back to cited text no. 7
    
8.
Thanh MT, Van Toan N, Toan DT, Thang NP, Dong NQ, Dung NT, et al. Diagnostic value of fluorescence methods, visual inspection and photographic visual examination in initial caries lesion: A systematic review and meta-analysis. Dent J (Basel) 2021;9:30.  Back to cited text no. 8
    
9.
Bahrololoomi Z, Musavi SA, Kabudan M. In vitro evaluation of the efficacy of laser fluorescence (DIAGNOdent) to detect demineralization and remineralization of smooth enamel lesions. J Conserv Dent 2013;16:362-6.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Cohen JF, Korevaar DA, Altman DG, Bruns DE, Gatsonis CA, Hooft L, et al. STARD 2015 guidelines for reporting diagnostic accuracy studies: Explanation and elaboration. BMJ Open 2016;6:e012799.  Back to cited text no. 10
    
11.
Gugnani N, Pandit IK, 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.  Back to cited text no. 11
    
12.
Yazicioglu O, Yaman BC, Güler A, Koray F. Quantitative evaluation of the enamel caries which were treated with casein phosphopeptide-amorphous calcium fluoride phosphate. Niger J Clin Pract 2017;20:686-92.  Back to cited text no. 12
[PUBMED]  [Full text]  
13.
Hafez Ibrahim S. Diagnostic accuracy of digital radiography and novel diagnostic tools versus visual ICDAS criteria: A systematic review. MJD 2021;5:27.  Back to cited text no. 13
    
14.
Gimenez T, Piovesan C, Braga MM, Raggio DP, Deery C, Ricketts DN, et al. Visual inspection for caries detection: A systematic review and meta-analysis. J Dent Res 2015;94:895-904.  Back to cited text no. 14
    
15.
Kavvadia K, Seremidi K, Reppa C, Makou M, Lagouvardos P. Validation of fluorescence devices for evaluation of white spot lesions in orthodontic patients. Eur Arch Paediatr Dent 2018;19:83-9.  Back to cited text no. 15
    
16.
Aljehani A, Tranaeus S, Forsberg CM, Angmar-Månsson B, Shi XQ. In vitro quantification of white spot enamel lesions adjacent to fixed orthodontic appliances using quantitative light-induced fluorescence and DIAGNOdent. Acta Odontol Scand 2004;62:313-8.  Back to cited text no. 16
    
17.
Aljehani A, Yousif MA, Angmar-Månsson B, Shi XQ. Longitudinal quantification of incipient carious lesions in postorthodontic patients using a fluorescence method. Eur J Oral Sci 2006;114:430-4.  Back to cited text no. 17
    
18.
Staudt CB, Lussi A, Jacquet J, Kiliaridis S. White spot lesions around brackets: In vitro detection by laser fluorescence. Eur J Oral Sci 2004;112:237-43.  Back to cited text no. 18
    
19.
Fyffe HE, Deery C, Nugent ZJ, Nuttall NM, Pitts NB. Effect of diagnostic threshold on the validity and reliability of epidemiological caries diagnosis using the Dundee Selectable Threshold Method for caries diagnosis (DSTM). Community Dent Oral Epidemiol 2000;28:42-51.  Back to cited text no. 19
    
20.
Mansour S, Ajdaharian J, Nabelsi T, Chan G, Wilder-Smith P. Comparison of caries diagnostic modalities: A clinical study in 40 subjects. Lasers Surg Med 2016;48:924-8.  Back to cited text no. 20
    
21.
Twetman S, Axelsson S, Dahlén G, Espelid I, Mejàre I, Norlund A, et al. Adjunct methods for caries detection: A systematic review of literature. Acta Odontol Scand 2013;71:388-97.  Back to cited text no. 21
    
22.
Rodrigues JA, Sarti CS, Assunção CM, Arthur RA, Lussi A, Diniz MB. Evaluation of laser fluorescence in monitoring non-cavitated caries lesion progression on smooth surfaces in vitro. Lasers Med Sci 2017;32:1793-800.  Back to cited text no. 22
    
23.
Alencar CJ, Braga MM, de Oliveira E, Nicolau J, Mendes FM. Dye-enhanced laser fluorescence detection of caries lesions around brackets. Lasers Med Sci 2009;24:865-70.  Back to cited text no. 23
    
24.
Pinelli C, Campos Serra M, de Castro Monteiro Loffredo L. Validity and reproducibility of a laser fluorescence system for detecting the activity of white-spot lesions on free smooth surfaces in vivo. Caries Res 2002;36:19-24.  Back to cited text no. 24
    
25.
Lussi A, Imwinkelried S, Pitts N, Longbottom C, Reich E. Performance and reproducibility of a laser fluorescence system for detection of occlusal caries in vitro. Caries Res 1999;33:261-6.  Back to cited text no. 25
    
26.
Shi XQ, Welander U, Angmar-Månsson B. Occlusal caries detection with KaVo DIAGNOdent and radiography: An in vitro comparison. Caries Res 2000;34:151-8.  Back to cited text no. 26
    
27.
Shi XQ, Tranaeus S, Angmar-Månsson B. Comparison of QLF and DIAGNOdent for quantification of smooth surface caries. Caries Res 2001;35:21-6.  Back to cited text no. 27
    
28.
Moriyama CM, Rodrigues JA, Lussi A, Diniz MB. Effectiveness of fluorescence-based methods to detect in situ demineralization and remineralization on smooth surfaces. Caries Res 2014;48:507-14.  Back to cited text no. 28
    
29.
Gomez J, Tellez M, Pretty IA, Ellwood RP, Ismail AI. Non-cavitated carious lesions detection methods: A systematic review. Community Dent Oral Epidemiol 2013;41:54-66.  Back to cited text no. 29
    
30.
Almosa NA, Lundgren T, Aldrees AM, Birkhed D, Kjellberg H. Diagnosing the severity of buccal caries lesions in governmental and private orthodontic patients at debonding, using the ICDAS-II and the DIAGNOdent Pen. Angle Orthod 2014;84:430-6.  Back to cited text no. 30
    
31.
Nyvad B, Machiulskiene V, Baelum V. Reliability of a new caries diagnostic system differentiating between active and inactive caries lesions. Caries Res 1999;33:252-60.  Back to cited text no. 31
    
32.
Power M, Fell G, Wright M. Principles for high-quality, high-value testing. Evid Based Med 2013;18:5-10.  Back to cited text no. 32
    
33.
Lopatiene K, Borisovaite M, Lapenaite E. Prevention and treatment of white spot lesions during and after treatment with fixed orthodontic appliances: A systematic literature review. J Oral Maxillofac Res 2016;7:e1.  Back to cited text no. 33
    
34.
Tulumbacı F, Oba AA. Efficacy of different remineralization agents on treating incipient enamel lesions of primary and permanent teeth. J Conserv Dent 2019;22:281-6.  Back to cited text no. 34
    
35.
Vashisht R, Indira R, Ramachandran S, Kumar A, Srinivasan MR. Role of casein phosphopeptide amorphous calcium phosphate in remineralization of white spot lesions and inhibition of Streptococcus mutans? J Conserv Dent 2013;16:342-6.  Back to cited text no. 35
[PUBMED]  [Full text]  
36.
Yadav RK, Bharti D, Tikku AP, Verma P, Shakya VK, Pandey P. Comparative evaluation of remineralizing effect of fluoride and nonfluoride agents on artificially induced caries using different advanced imaging techniques. J Conserv Dent 2022;25:26-31.  Back to cited text no. 36
  [Full text]  
37.
Akarsu S, Aktug Karademir S. In vitro comparison of ICDAS and DIAGNOdent pen in the diagnosis and treatment decisions of non-cavitated occlusal caries. ODOVTOS Int J Dent Sci 2019;21:67-81.  Back to cited text no. 37
    

Top
Correspondence Address:
Dr. Omar Osama Shaalan
35 Mohamad Farid Street, El Hay El Motamayz, Sixth of October City, Giza
Egypt
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcd.jcd_575_22

Rights and Permissions


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
 
  Search
 
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
   Conclusions
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed706    
    Printed34    
    Emailed0    
    PDF Downloaded32    
    Comments [Add]    

Recommend this journal