Use of ICDAS II and fluorescence-based intraoral camera in early occlusal caries detection: a clinical study

Aim: Aim of this in vivo study was to compare the performances of ICDAS II and of an intraoral camera to detect pit and fissures’ early caries lesions. Materials and Methods: 1011 permanent teeth (320 premolars and 691 molars) in 13-26 years old patients were evaluated at the 1st Observation Unit of Department of Oral and Maxillofacial Sciences, “Sapienza” University of Rome. Two blinded operators inspected the unrestored occlusal surfaces of each tooth: the first one assigned an ICDAS II code, while the second one assessed the VistaCam score by using VistaCam ix Proof, Dürr Dental. Level of agreement between the two procedures was expressed by using Cohen’s/Fleiss’ kappa statistic. Results: 283 (28%) of the assessed teeth showed ICDAS II code 0, 334 (33%) code 1, 189 (18.7%) code 2, 176 (17.4%) code 3 and 29 (2.9%) code 4. VistaCam assessed in 513 teeth (50.7%) sound enamel surfaces [0-1.2], 292 (28.9%) initial enamel decays [1.2- 1.5] and 206 (20.4%) deep enamel decays [1.5-3]. ICDAS II code 0 (n=283) was classified by fluorescence camera as 244 sound surfaces, 32 enamel decays and 7 deep enamel decays. ICDAS II codes 1 and 2 were diagnosed in 22 and 41 cases respectively, as deep enamel decays. The weighted kappa test showed coefficients ranging from 0.553 to 0.641 with an estimate of 0.61. These results showed a moderate agreement between the two methods. Conclusion: In conclusion, our data suggest that there is a poor agreement between the two detection methods, especially in ICDAS II codes 1 and 2 occlusal caries. Future randomized study will better define the role of the operator in visual inspection and in fluorescence-based camera use. Until then, ICDAS II and fluorescence-based cameras should be considered as the standard of care.