Comparison of Radiography, Laser Fluorescence and Visual Examination for Diagnosing Incipient Occlusal Caries of Permanent First Molars

Objectives: Early diagnosis of incipient and non-cavitated carious lesions is crucial for performing preventive treatments. The aim of this study was to compare the efficacy of three diagnostic methods of bitewing radiography, DIAGNOdent, and visual examination in diagnosing incipient occlusal caries of permanent first molars. Materials and Methods: In this diagnostic cross-sectional study, 109 permanent first molar teeth of 31 patients aged 7-13 years were examined visually, on bitewing radiographs, and using DIAGNOdent. Scoring of visual and radiographic examinations was based on Ekstrand’s classification. Visual examination after pit and fissure opening served as the gold standard. Receiver Operating Characteristic (ROC) curve was used to define the best cut- off point for DIAGNOdent compared with the gold standard. Inter-examiner reproducibility of visual and radiographic examinations was assessed using Kappa test and intraclass correlation coefficient (ICC) was calculated for DIAGNOdent values. Results: The sensitivity of detecting caries that had extended into the enamel was 81.4%, 86.3%, and 81.4% for visual examination, DIAGNOdent and radiography, respectively. Moreover, the specificity was 100%, 71.4%, and 100% for visual observation, DIAGNOdent and radiography, respectively in the enamel. The Kappa index for inter- examiner reliability was 0.7 and 0.8 for visual examination and radiography, respectively. The ICC was 0.98 for the values read by DIAGNOdent. Conclusion: Visual examination is the first choice for diagnosis of incipient caries. In suspicious cases, radiography and laser DIAGNOdent can be used as adjunct procedures