Reproducibility of Fluorescence-Based Cameras for Detection of Caries in Primary Teeth

Background: The early detection of dental caries is a main task in modern dentistry. Fluorescence-based methods have been proposed to aid caries lesion detection. Therefore the use of two systems VistaCam iX and VistaCam iX HD is a novel method in diagnosis purposes.

The aim of the in-vitro study was to evaluate the intra-examiner reproducibility of the fluorescence based camera systems VistaCam iX (VC) and VistaCam iX HD (VC HD) and their correlation with the ICDAS. The values measured with the VC were compared to the succeeding model VC HD. Therefore the following hypotheses were formulated: ICDAS correlates significantly with VC and also with VC HD. There should be no significance between the measurements of VC and VC HD.

Methods: Firstly a visual examination (ICDAS as reference value) was performed on 55 primary teeth. Then the fluorescence measurements (VC and VC HD) were completed and repeated after five days. Statistical analyses were performed with MedCalc (Version 16.8.4). The distribution of the findings was represented using cross-tabulation and analyzed using the chi-squared test (χ²). The intra-examiner-reproducibility was calculated using the intraclass correlation coefficient (ICC) and the Cohen´s kappa (κ). The Bland and Altman method was applied for VC and VC HD. The Wilcoxon-test was used to compare the values between VC and VC HD. The level for statistical significance was set at α = 0.05.

Results: The correlation between the ICDAS and the both fluorescence based methods was statistically significant (p < 0.05). The intra-examiner reproducibility was in the moderate range for VC (ICC = 0.65) and in the high range for VC HD (ICC = 0.97). Cohen´s Kappa was moderate for VC (κ = 0.42) and substantial for VC HD (κ = 0.64). In the Bland-Altman plots the range between the upper and lower limits of agreement was 0.89 for VC and 0.68 for VC HD. The Wilcoxon test showed significant differences (p < 0.0001).

Conclusion: The fluorescence based cameras can be used as adjunct tools for detecting and monitoring caries. As not all changes of caries can be reliably detected the cameras cannot be used solitary.