Objective: A technology based on Fluorescence Imaging with Reflectance Enhancement (FIRE) for early detection of caries was validated, by comparing the earliest caries that FIRE, Quantitative light-induced Fluorescence (QLF), Diagnodent and visual examination (VE) can detect, and the sensitivity/specificity of the methods. Methods: Phase-I: Caries-like lesions were created on a defined area on 70 teeth by 14-day demineralization in acidified gel. During demineralization, teeth were examined daily for caries by VE, FIRE, QLF and Diagnodent. After each examination, 5 teeth were removed every 6h for 24h, thereafter daily. Tooth slice was cut from each lesion and histologically examined under polarizing-light microscope (PLM) for lesion presence/absence and lesion depth quantification. Phase-II: 56 teeth assembled on manikin mouth models were examined twice by two dentists for incipient caries using the four methods. Then each scored area was examined with PLM. Using Dentist-1 examination-1 data, the Areas under Receiver Operating Characteristics curves (A-ROC-c) defined by each diagnostic method were compared using Chi-squared tests. Using same data, the validity of each diagnostic method relative to PLM was calculated by Kappa statistics. Results: Earliest lesion depth detected by FIRE, QLF, and VE was 9.09�0.03�m. Diagnodent detected from 14.00�m. A-ROC-c were
Methods | Kappa | Sensitivity | Specificity | PPV | NPV |
QLF | 0.464 | .66 | .81 | .82 | .66 |
FIRE | 0.785 | .98 | .80 | .86 | .96 |
FIRE with WL | 0.843 | .99 | .84 | .89 | .98 |
VE | 0.633 | .85 | .78 | .83 | .81 |
Diagnodent | 0.267 | 0.35 | .94 | .88 | .54 |
FIRE with white light (WL) = 0.916�0.024, FIRE = 0.886�0.027, VE = 0.816�0.033, QLF = 0.738�0.036, Diagnodent = 0.644�0.031. FIRE (alone or with WL) had significantly (p<0.001) greater A-ROC-c than QLF and Diagnodent. Similar results were observed with subsequent examinations by both Dentists. Conclusion: FIRE can detect incipient caries lesion of <10�m depth. FIRE has a higher accuracy and validity in detecting caries than QLF and Diagnodent.
Keywords: Caries, Demineralization, Detection, Diagnosis and Digital image analysis
See more of: Cariology Research - Detection, Risk Assessment and Others