Evaluation of early occlusal caries lesions with naked eye inspection, conventional radiography, direct digital radiography and laser fluorescence device

In this study, diagnostic efficiencies of visual inspection, conventional radiography, direct digital radiography and a new laser fluorescence device (Diagnodent, KaVo, Germany) were evaluated in comparison to the histological validation as gold standart. Extracted 250 human premolar and molar teeth with visually intact occlusal surfaces were used. The conventional and direct digital bite-wing radiographs of the teeth were taken under standardized conditions. Visual inspection, radiographic validation and Diagnodent measurements were assessed by two observers independently. Diagnodent measurements were repeated after two weeks under identical conditions.The teeth were stored in basic- fuchsin dye and than sectioned into two equal parts through their mesio-distal axes across the occlusal fossas for histological validation. The sections were examined by steromicroscope under x10 magnification. The relationship between visual inspection and radiographic and histological validations were evaluated with Kappa statistics and interobserver reliability was evaluated with oneway ANOVA. The relationship between Diagnodent and the other methods tested were evaluated with descriptive statistics and relationship between Diagnodent measurements and the histological validation was evaluated with ROC curves. Sensitivity and specificity values were calculated for all methods tested in the study. The relationship between all methods that are evaluated in this study found to be meanly weak. The interobserver reliability for conventional radiography was slightly better than visual examination and direct digital radiography. Interobserver reliability for Diagnodent measurements was 75 % and intraobserver reliability was-105- around 50 %. Specificity values were high and sensitivity values were low for visual inspection and radiographic methods while specificity values were low and sensitivity values were higher for Diagnodent measurements. According to the results of this study we can state that none of the techniques tested gave accurate results for the detection of early occlusal caries when used seperately. Diagnodent measurements caused high amounts of false positive diagnosis.