Rashid, Mohammed Fadhil
(2022)
In vitro comparison of early occlusal enamel caries detection and remineralisation using ICDAS II and diagnodent pen in permanent posterior teeth.
Masters thesis, Universiti Sains Malaysia.
Abstract
Dental caries is among the most commonly occurring oral diseases or
chronic infection. Various in-vitro studies have been carried out using LF
devices which reported excellent reproducibility as an adjunct caries diagnostic
option. Duraphat® (5% sodium fluoride) and Tooth Mousse Plus® (casein
phosphopeptide-amorphous calcium phosphate fluoride) are among commonly
used formulations for achieving remineralization of carious lesions (Cardoso et
al., 2014; Nhu et al., 2017). The occlusal carious lesion of 120 extracted teeth
were evaluated using ICDAS II and DDPen. Then the process of
remineralization was carried out by applying either the Colgate Duraphat® or
GC Tooth Mousse Plus®. The remineralized lesions were then re-evaluated
using ICDAS II and DDPen before performing sectioning and histological
examination. The sensitivity and specificity of ICDAS II and DDPen to detect
remineralization was calculated and a comparison with the gold standard
histological examination was also performed. ICDAS-II scoring performed for
the pre- and post-remineralization revealed highly significant difference for the
GC Tooth Mousse Plus® group as compared to the control group and a lesser
but significant difference for the Colgate Duraphat® group as compared to
control group. DDPen scoring for the pre- and post-remineralization revealed
that there was similar but significant difference with the use of Colgate
Duraphat® or GC Tooth Mousse Plus®. Different cut-off limits for the DDPen were analysed to determine which range was corresponded closest to the
Downer’s histological scores. A value of 0-13 for sound teeth, 14-20 for enamel
caries and >21 for dentine caries was identified as the most suitable. The
spearman’s rank correlation of ICDAS-II and DDPen with the Downer’s
histological score (gold standard) revealed a higher association of DDPen score
(.738) as compared to ICDAS-II scores (.430). The Area under the receiver
operator characteristics curve (AUROC) value of DDPen score and ICDAS-II
were compared corresponding to Downer’s histological classification. The
AUROC value at Downer’s level 1 was 0.972 for DDPen score range (0-13) and
0.811 for ICDAS-II code 0. The AUROC value at Downer’s level 2 was 0.894
for DDPen score range (14-20) and 0.667 for ICDAS-II code 1-2. The AUROC
value at c 3 was 0.838 for DDPen score range (>21) and 0.721 for ICDAS-II
code 3. The study concluded that both ICDAS II and DDPen were able to detect
remineralization. The cut-off values for DDPen most suitable for detecting
remineralization were determined as 0-13 being sound, 14-20 being enamel
caries, and >21 being dentine caries. The DDPen was found more sensitive than
ICDAS-II to detect remineralization when compared with the Downers
histological scores. This can be of particular interest in pregnant women and
children in which unnecessary exposure to ionizing radiations has to be avoided
to monitor the progression of early carious lesions.
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