Comparison o Imaging Methods for Recording Developmental Defects of Enamel

Objectives: Developmental defects of enamel (DDE) are characterized as hypoplasia, opacities, and post-eruptive breakdown by the Enamel Defects Index (EDI).  To optimize the visualization of DDE, two digital imaging methods – fixed focal length, hand-held light microscope (ProScope™) and macro single lens reflex camera (Nikon D90) with ring flash – were evaluated to determine the better method to document DDE in children. Methods: The maxillary central incisors of children (ages 2-5 years) were imaged using the microscope (50x and 100x magnifications) and the camera.  Aim 1 was to determine which imaging method better captured the DDE by evaluating the images for focus and EDI score.  Aim 2 was to determine which method was more acceptable for use by evaluating the operator and child acceptance and time needed to take the images.  The order of the digital imagery method was randomized, and inter- and intra-examiner agreement was assessed for the two examiners. Results: Digital images for 35 children with a mean age 3.6 years SD 1.0, age range 2-5 years were compared.  The mean image focus score for the microscope was 3.4 SD 1.5 and camera was 4.2 SD 1.1 (0-5 scale with “5” as best focus).  The frequency of defects detected by the microscope was 62 (50x) and 45 (100x), and the camera was 58.  Operator acceptability scores averaged 4.6 and 4.1 (5 maximum) for the microscope and camera, respectively.  Child acceptance scores were 4.5 for both the microscope and the camera.  The average time to capture images for the microscope was 88 seconds and 53 seconds for the camera. Inter-examiner agreement was 89% and intra-examiner agreement was 90% and 91%. Conclusion: Findings support the use of the camera and hand held microscope (50x) are comparable when recording images of developmental defects of enamel of young children’s teeth.