Histological validation of the automated caries detection system (ACDS) in classifying occlusal caries with the ICDAS II system in vitro
Abstract
Aim
To
compare the diagnostic performance of the automated caries detection
system (ACDS) for the detection and diagnosis of occlusal caries with
the histological appearance of the lesions.
Methods
Eighteen
posterior permanent teeth were used, out of which 40 sections were made
and 53 areas were evaluated. Teeth with hypoplastic and/or
hypomineralised areas or sealants on the occlusal surfaces were excluded
from the study. The teeth that were used for this study were a subgroup
of the teeth used in the study that introduced ACDS system. This
subgroup consisted of teeth having in their occlusal surfaces early
carious lesions classified as international caries detection and scoring
system (ICDAS) 0, 1, 2 and 3 after clinical examination by the
examiners. Histological preparations were classified by experienced
examiners based on the Ekstrand, Ricketts and Kidd (ERK) system and for
the respective occlusal surfaces by the ACDS system based on ICDAS II
system. There were two threshold limits considered as carious in either
system ICDAS ≥ 2 or ≥ 3 and ERK index ≥ 2 or ≥ 3 and all possible
combinations were analysed. Statistical methods of weighted version of
kappa coefficient, Kendall’s tau-b correlation coefficient and p-values
using the Fisher’s exact method were used at the confidence level of
0.05.
Results
Intra-examiner
kappa coefficient agreement was 0.87 and 0.89 while the inter-examiner
for the two trials were 0.87 and 0.92. The ICDAS3-ERK3 combination
between the ACDS and histological sections presented the best agreement
with kappa coefficient 0.76, agreement 92.5%, sensitivity 100% and
specificity 91.1%. ICDAS3-ERK3 combination between the optical
examination of the examiners compared to the histological preparations
showed kappa coefficient 0.87, agreement 96.2%, sensitivity 100%,
Specificity 95.6%.
Conclusion
The
evidence supports the view that ACDS classification of occlusal
surfaces based on the ICDAS system are comparable with classification to
that of an examiner and with the histology of the lesion. The use of
ACDS has the distinct advantage though of removing the subjectivity of
the examiner since it performs the classification without any
intervention by him.
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