title: Comparison of visual inspection, radiographic examination, laser fluorescence and their combinations on treatment decisions for occlusal surfaces.
abstract: OBJECTIVE
  To compare visual inspection (VI), radiographic examination (RX) and the laser fluorescence device DIAGNOdent (L), as well as their combinations in vitro regarding treatment decisions for occlusal surfaces.
  
  
  METHODS
  72 extracted human permanent teeth (molars and premolars) were used. Treatment decisions were recorded by three calibrated examiners, and the options available were fissure sealant and conservative restoration. For validation of treatment decisions, the teeth were sectioned and examined in a stereomicroscope. Thereafter, dental slices were scanned and the images were edited to facilitate classification of existing carious lesions. Intra and inter-examiner reproducibility for the determination of treatment plans were calculated using Cohen's kappa test (95%-CI). Sensitivity, specificity, positive and negative predictive values, and the area under the ROC curve were also calculated.
  
  
  RESULTS
  VI and L provided on average the greatest intra- and inter-examiner reproducibility, respectively. Although the combination of diagnostic methods may decrease both intra- and inter examiners reproducibility, combination of VI, L and RX resulted in the greatest sensitivity, being statistically superior to RX and L. There was more inter-examiner agreement for the option of restorative treatment, while the use of sealants as a treatment option yielded the lowest values. Negative predictive values were numerically inferior to positive predictive values, indicating that the examiners preferred not to restore a carious tooth than to proceed operatively in an intact tooth. The combination of the three methods studied showed the best results in determining treatment plans for occlusal surfaces, when compared to the other types of exams. On the other hand, radiographic examination and laser fluorescence were less efficient when used alone.
authors.affiliation: Bauru Dental School, University of São Paulo, Brazil.
authors.forename: Fabiano Bassalobre
authors.initials: FB
authors.lastname: Valera
authors.forename: Juliano Pelim
authors.initials: JP
authors.lastname: Pessan
authors.forename: Rubens Carneiro
authors.initials: RC
authors.lastname: Valera
authors.forename: José
authors.initials: J
authors.lastname: Mondelli
authors.forename: Célio
authors.initials: C
authors.lastname: Percinoto
mesh_terms: D001641:Bicuspid / Q000000981:diagnostic imaging / Q000473:pathology; D003657:Decision Making; D003731:Dental Caries / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy*; D003743:Dental Enamel / Q000000981:diagnostic imaging / Q000473:pathology; D003793:Dental Restoration, Permanent / Q000379:methods; D003804:Dentin / Q000000981:diagnostic imaging / Q000473:pathology; D005453:Fluorescence; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007834:Lasers; D008963:Molar / Q000000981:diagnostic imaging / Q000473:pathology; D010808:Physical Examination; D010895:Pit and Fissure Sealants / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011861:Radiography, Dental; D012680:Sensitivity and Specificity; D019228:Tooth Crown / Q000000981:diagnostic imaging / Q000473:pathology
chemical_list: D010895:Pit and Fissure Sealants