Clinical evaluation of visual, radiographic, and laser fluorescence methods for detection of occlusal caries.

The aim of this clinical study was to test cut-offs for occlusal caries detection by the laser fluorescence device DIAGNOdent (DD) in comparison to visual-ranked inspection (VI) and bitewing radiographs (BW) under condition of a general dental practice. 281 occlusal surfaces of permanent molars from 97 patients were examined with VI, DD and BW. Caries extent was verified by bioptical intervention (gold standard) of 248 molars. Upon biopsy no molar was assessed as caries free, 24 teeth had caries confined to enamel and 224 teeth revealed dentine caries. For dentine caries detection DD achieved the highest values for sensitivity (0.93), specificity (0.63) and agreement (0.89) followed by BW with figures of 0.70, 0.96 and 0.69, respectively. VI exhibited the lowest sensitivity (0.25) and agreement (0.25), but the highest specificity (1.00). It is advised to assess occlusal surfaces by a meticulous VI followed by the use of DD and/or BW as additional diagnostic tool of second choice. A DD value of > 20 could be confirmed as a sensitive cut-off for detection of occlusal dentine caries in first and second permanent molars. For the detection of early signs of enamel caries the DD seems to be less suitable.