Detection of Proximal lesions: ICDAS II versus Caries Detection Devices

Objectives: This study's aim was to compare the use of visual examination (ICDAS II criteria), ICDAS II with bitewing radiography (ICDAS II/BW), BW alone, fiberoptic transillumination (FOTI, Schott Fibre Optics), digital imaging fiberoptic transillumination (DIFOTIŽ, Electro-Optical Sciences), and DIAlux (DL, KaVo) for the detection of proximal caries. Methods: Seventy-two unrestored extracted posterior teeth representing the ICDAS II criteria (0-6) on proximal surfaces were selected. Care was taken to avoid selecting teeth with codes 4-6 on other surfaces. After cleaning the teeth were mounted on 6 set of manikins with 6 teeth mounted on each model (1 premolar and 2 molars per quadrant) with proximal surfaces in contact. Training was conducted on all methods prior to study initiation. All methods were applied on the selected proximal surfaces twice following manufacturer's instructions. Results: Intra-examiner repeatability was excellent for DiFOTI (k=0.97, wk =0.98), FOTI (k=0.96, wk=0.98), ICDAS II (k=1.00, wk=1.00), BW (k=0.96, wk=0.98) and ICDAS II /BW (k=0.98, wk=0.99), and was acceptable for DL (k=0.67, wk=0.83). There was high agreement between FOTI and DL (k=0.76, wk=0.87);ICDAS II/BW and ICDAS II (k=0.97, wk=0.99). Agreement was moderate between BW and DL (k=0.56, wk=0.74); BW and FOTI (k=0.48, wk=0.73); BW and ICDAS II (k=0.38, wk=0.64); ICDAS II and DL (k=0.39, wk=0.63); ICDAS II and FOTI (k=0.35, wk=0.62), ICDAS II/BW and DL (k=0.40, wk=0.62);ICDAS II/BW and FOTI (k=0.32, wk=0.60) and ICDAS II/BW and BW (k=0.42, wk=0.65). Conclusion: Intra-examiner agreement was high for all methods except for DL. The only methods that had high agreement in between them were FOTI and DL and the ICDAS II and ICDAS II/BW. All other combinations had moderate agreement likely due to the fact that some methods tended to give more severe scores to the lesions (DIFOTI scored higher than DL, FOTI, and BW while ICDASII/BW scored higher than all other methods).