title: Proximal caries lesion detection using the Canary Caries Detection System: an in vitro study.
abstract: OBJECTIVE
  This study investigated the accuracy of the Canary System (CS) to detect proximal caries lesions in vitro, and compared it with conventional methods: International Caries Detection and Assessment System (ICDAS) II and bitewing radiography (BW).
  
  
  METHODS
  Visible proximal surfaces of extracted human teeth were assessed by ICDAS-II before setting them in five manikin mouth models. Then contacting proximal surfaces in mouth models were assessed by BW and CS. Histological validation with polarized-light microscopy served as a gold standard. Pairwise comparisons were performed on area under the curve (AUC), sensitivity, and specificity of the three methods, and corrected using Bonferroni's method. Sensitivities and specificities were compared using a test of proportions and AUC values were compared using DeLong's method.
  
  
  RESULTS
  The CS presented significantly higher sensitivity (0.933) than ICDAS-II (0.733, P = 0.01) and BW (0.267, P < 0.001), and ICDAS-II higher sensitivity than BW (P < 0.001). There were no significant differences between their specificity values: 0.825 (CS), 0.65 (ICDAS-II), and 0.875 (BW). The AUC of CS (0.862) was significantly higher than of ICDAS-II (0.681, P < 0.001) and BW (0.577, P < 0.001).
  
  
  CONCLUSIONS
  The CS demonstrated greater accuracy in detecting proximal lesions than ICDAS-II and BW, although without significantly higher specificity.
authors.affiliation: Department of Cariology and Endodontics, University of Ljubljana, Ljubljana, Slovenia. janja.jan@mf.uni-lj.si.
authors.forename: Janja
authors.initials: J
authors.lastname: Jan
authors.affiliation: School of Dental Sciences, University Sains Malaysia, Kelantan, Malaysia.
authors.forename: Wan Zaripah
authors.initials: WZ
authors.lastname: Wan Bakar
authors.affiliation: Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Sapna M
authors.initials: SM
authors.lastname: Mathews
authors.affiliation: Faculty of Dentistry, University of Nigeria, Enugu, Nigeria.
authors.forename: Linda O
authors.initials: LO
authors.lastname: Okoye
authors.affiliation: Department of Epidemiology & Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Ehler
authors.affiliation: Department of Epidemiology & Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Louden
authors.affiliation: Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Bennett T
authors.initials: BT
authors.lastname: Amaechi
mesh_terms: D001641:Bicuspid / Q000000981:diagnostic imaging / Q000473:pathology; D003481:Cuspid / Q000000981:diagnostic imaging / Q000473:pathology; D003731:Dental Caries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D003732:Dental Caries Activity Tests / Q000379:methods* / Q000706:statistics & numerical data; D003743:Dental Enamel / Q000000981:diagnostic imaging / Q000473:pathology; D003764:Dental Materials / Q000737:chemistry; D003937:Diagnosis, Differential; D006801:Humans; D007180:Incisor / Q000000981:diagnostic imaging / Q000473:pathology; D008963:Molar / Q000000981:diagnostic imaging / Q000473:pathology; D015588:Observer Variation; D016300:Radiography, Bitewing / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D003764:Dental Materials
keywords: Canary System; ICDAS-II; bitewing radiography; dental caries; proximal