View - Sandra Kalil Bussadori

visual method of diagnosis can detect dentine caries with
a sensitivity in excess of 0.6 and a specificity in excess of
0.8 in a sample of borderline lesions.
In the Downer histology the enamel-dentine junction
is taken as a diagnostic threshold to calculate diagnostic
accuracy at the D3 level (code 2–3), whereas in the ERK
histological system the enamel-dentine junction is not
used and the histological threshold 2–3 corresponds to
deeper dentine lesions (a threshold between outer third
of dentine and middle third of dentine). Despite this, similar
levels of sensitivity and specificity were obtained
when the same ICDAS-II cut-off 2–3 was used. Using
these ICDAS-II cut-offs and ERK histological threshold
allowed comparison with previous work where higher
sensitivity (0.92–0.97) and specificity (0.85–0.93) values
were obtained [Ekstrand et al., 1997]. In the present study,
when a higher ICDAS-II cut-off 3–4 was used, specificity
values increased to a mean of 0.90 at the expense of sensitivity,
which fell to a mean of 0.60. However, the level of
overall accuracy (sensitivity plus specificity) was of the
same order of magnitude as when ICDAS-II cut-off 2–3
was used.
A review of studies that included the validation of diagnostic
techniques against a histological gold standard
[Ie and Verdonschot, 1994] showed that visual inspection
performed comparatively poorly for occlusal caries diagnosis
compared to electrical resistance measurements
and fibre-optic transillumination. In addition to this, another
systematic review of the literature has shown that
for visual examination specificity is high but sensitivity
is low [Bader et al., 2001]. In these two reviews meta-analyses
have either not been carried out or the results should
be regarded with caution because of the heterogeneity of
the studies included. However, it would appear that in
general, visual examination has been regarded as poor for
caries detection. In contrast, this study has shown that by
meticulously examining clean dry teeth sensitivity of a
visual examination can be improved after a short training
period.
In summary, after a relatively short training period 3
examiners were able to achieve results using the ICDAS-
II system that were comparable to that of the examiner
carrying out the training. The ICDAS-II system demonstrated
reproducibility and diagnostic accuracy for the
detection of occlusal caries at varying stages of the disease
process comparable to those published in previous
studies using similar visual criteria. The moderate to
strong relationship with histological extent also demonstrates
its potential to monitor lesions with time. With the
development of more extensive and advanced training
packages and calibration exercises there may be scope to
improve the reproducibility and accuracy further. In addition,
such packages would allow further dissemination
of ICDAS-II, allowing data from clinical studies in primary
dental care, clinical trials and epidemiological surveys
to have greater clarity and comparability for metaanalyses.
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Jablonski-Momeni /Stachniss /Ricketts /
Heinzel-Gutenbrunner /Pieper