COMPARISON OF THE EFFECTIVENESS OF VISUAL-TACTILE METHOD, DIAGNODENT DEVICE AND X–RAY IMAGES FOR DETECTION OF OCCLUSAL DENTAL CARIES

Cilj: Cilj ovog istraživanja bio je usporediti i utvrditi postoji li razlika između tri dijagnostičke metode (vizualno-taktilna metoda, radiografsko ispitivanje, lasersko fluorescentni sustav) za detekciju okluzalnog zubnog karijesa. Materijali i metode: U istraživanju je korišteno četrdeset i osam ekstrahiranih zubi, dvanaest premolara i trideset i šest molara bez restaurativnog ispuna (n = 48). Zubi su čuvani u 20% vodenoj otopini vodikovog peroksida. Prije istraživanja zubi su se očistili i posušili te time pripremili prikladni uvjeti za ispitivanje dijagnostičkim metodama. Zubi su se pohranili i numerirali u spužvi te su se slikali tehnikom zagrizne snimke. Potom su dva ispitivača dijagnosticirali okluzalni zubni karijes pomoću vizualno-taktilne metode temeljene na ICDAS klasifikaciji, radiografskog ispitivanja i lasersko fluorescentnog sustava (DIAGNOdent uređaj). Na samom kraju okluzalne karijesne lezije na zubima su se instrumentirale pomoću dijamantnih svrdala za mikropreparaciju. Dubina karijesnih lezija se utvrdila uz pomoć stomatološke sonde te se time odredio zlatni standard prema kojemu smo uspoređivali ispitivane dijagnostičke metode. Rezultati: DIAGNOdent uređaj je pokazao najveću točnost i osjetljivost pri detekciji okluzalnog zubnog karijesa, slijedi ga radiografsko ispitivanje te vizualno-taktilna metoda koja je imala najmanju osjetljivost, ali najvišu specifičnost. Vizualno – taktilna metoda i radiografsko ispitivanje su pokazali osrednju podudarnost mjerenja dvaju ispitivača dok je najlošiju podudarnost imao DIAGNOdent uređaj. Radiografsko ispitivanje zagrizne snimke nije dovoljno pouzdana metoda detekcije okluzalnog zubnog karijesa. Zaključak: Sve tri dijagnostičke metode su pokazale odstupanja od metode zlatnog standarda. Za uspješnu detekciju okluzalnog zubnog karijesa potrebno je koristiti kombinacije dijagnostičkih metoda kako bi što točnije i preciznije mogli postaviti ispravnu dijagnozu.Objectives: The purpose of this study was to compare and evaluate the effectiveness and differences between three diagnostical methods (visual – tactile method, X – ray images and DIAGNOdent device) for detection of occlusal dental caries. Materials and methods: Forty-eight extracted teeth, twelve premolars and thirty-six molars without restorative filling were used in this study (n = 48). The teeth were stored in a 20% hydrogen peroxide solution. Prior to the research the teeth were cleaned and dried to prepare suitable conditions for testing by diagnostic methods. The teeth were stored and numbered in a sponge, and then X – ray images were taken with the Bite-wing technique. Two examiners then diagnosed occlusal dental caries using visual - tactile examination based on ICDAS classification, radiographic examination based on X – ray images and laser fluorescence examination (DIAGNOdent device). Finally, occlusal surfaces of the teeth were microprepared with a diamond bur. The depth of the carious lesions was determined by a dental probe and thus the gold standard was set according to which we compared the tested diagnostic methods. Results: The DIAGNOdent device showed the highest accuracy and sensitivity for detecting occlusal dental caries, followed by radiographic examination and visual – tactile examination that had the lowest sensitivity but the highest specificity. Visual – tactile examination and radiographic examination showed fair to good inter – examiner agreement, while DIAGNOdent device showed poor inter – examiner agreement. Radiographic examination of the Bite – wing images is not a suffiecently reliable method to detect occlusal dental caries. Conclusion: All three diagnostic methods showed deviations from the gold standard method. For successful detection of occlusal dental caries, it is necessary to use combinations of diagnostic methods to make the correct diagnosis as accurately and precisely as possible