Evaluation of the effectiveness of digital photos taken using different techniques in tele dentistry in the diagnosis of occlusal caries

Objective: The aim of this study is to investigate the efficacy of clinical visual and radiological examinations and digital photographs obtained with smart phones, intraoral camera and macro camera in the diagnosis of occlusal caries in vitro and in vivo according to ICDAS II criteria. Method: This study was carried out in 2 stages, in vitro and in vivo. First, in the in vitro phase of the study, 46 previously extracted permanent molars were stored in 1% sodium hypochlorite and the surface of the teeth was cleaned with dental cavitron. İn vivo phase of the study, the occlusal surfaces of 268 permanent molars of the patients who applied to the clinic were evaluated. Teeth were evaluated in vitro and in vivo by two dentists using both visual and bite-wing radiographs according to ICDAS II criteria, and the consensus was accepted as the gold standard. Later, the occlusal surfaces of these teeth were photographed by a different dentist using 4 different equipment (Samsung Galaxy A71 phone, Samsung Galaxy A70 phone, Super Cam CF 689 intraoral camera, Canon EOS 400D macro camera). The resulting photos were transferred to the computer. Two different dentists evaluated the photographs on the computer screen, unaware of the photographic equipment used and independently of each other according to the ICDAS II criteria. Statistical analysis of the data was made in IBM SPSS 25 program. Validity parameters such as percentage of correct diagnoses, agreement with the gold standard, sensitivity, specificity, and interobserver agreement were calculated. Statistical significance level was determined as p <0.05. Result: Interobserver agreement was found to be statistically significant for all equipment in vitro (0.63-0.69) and in vivo (0.70-0.87). Only the intra-oral camera had excellent interobserver agreement (0.87) in vivo. When the relationship between the caries diagnosis results of the equipment and the gold standard is evaluated statistically; While it was highest for Samsung Galaxy A70 (0.72) in vitro, it was found better for Samsung Galaxy A71 (0.63) in vivo. Diagnostic efficiency (0.56) of the intraoral camera was found to be low compared to other equipment, especially in the in vivo environment. The macro camera showed phone-like results both in vitro (0.67) and in vivo (0.60). Conslusion: It was concluded that the efficacy of the Samsung Galaxy A70 and A71 smartphones used in the diagnosis of occlusal caries was similar to the macro camera, but more successful than the intraoral camera. In addition, when evaluating all photographs taken for tele dentistry application, both in vitro and in vivo conditions; It was observed that initial and moderate occlusal caries were diagnosed with higher accuracy than severe caries according to the ICDAS II score. Key Words: Tele dentistry, Occlusal caries, ICDAS II, Photographing