ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Micro-Computed Tomography is As Good As Histologic Sectioning as a Gold Standard for in vitro Determination of Proximal Caries Depth
Clinical Question For the in vitro determination of proximal caries depth, is micro-computed tomography comparable to histologic section as a gold standard?
Clinical Bottom Line Two in vitro studies comparing micro-CT, the ICDAS visual evaluation system and conventional or digital radiography found micro-CT to be as good as to histologic sectioning for the detection of non-lesions, lesions in the inner half of enamel and lesions entering dentin. The studies differed slightly in the agreement for lesions in outer enamel, but both showed at least moderate agreement of micro-CT with histologic sectioning for these lesions.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21930181Soviero/2011 Laboratory study
Key resultsThe kappa statistic agreement of micro-CT and histology was k= 0.81 (0.66-1) and the Spearman’s correlation was high for lesions in the outer enamel (rs=0.88) and outer dentin (rs=0.86). For the diagnostic task of identifying lesions that had crossed the DEJ, micro-CT displayed a sensitivity of 1 (0.79-1), specificity of 0.97 (0.84-0.99), PPV of 0.94 (0.0.71-0.99), NPV of 1 (0.89-1) and accuracy of 0.98. Forty-eight primary molar proximal surfaces were evaluated; 9 sound, 9 caries in outer enamel, 14 caries in inner enamel, 4 caries beyond CEJ but not spread in dentin, 4 caries that spread in the outer dentin and 8 caries in the inner dentin. Histology samples were 300 µm thick.
#2) 20654681Mitropoulos/2010Laboratory study
Key resultsKappa statistic agreement for micro-CT and histology for differing depths of caries was 0.74(0.59-0.88) overall; 0.82(0.56-0.93) for non-lesions, 0.51(0.1-0.7) for the outer half of enamel, 0.61(0.29-0.77) for the inner half of enamel and 0.71(0.4-0.88) for outer dentin lesions. Only two samples of lesions in the outer half of enamel were included in the total of 40 proximal surfaces; 16 sound, 2 outer enamel caries, 4 caries to the DEJ, 18 caries into dentin. The low number of outer enamel lesion samples may have lowered the ability to determine diagnostic performance for such lesions. Histology samples were 400 µm thick.
Evidence Search “dental caries [MESH} AND “proximal caries” AND “microtomography”
Comments on
The Evidence
The studies yielded similar statistical results with high levels of sensitivity, specificity, accuracy and inter-rater agreement. Overall agreement between micro-CT and histologic sectioning showed a kappa coefficient value of 0.81 in the first study and 0.74 in the second. The second study had only 2 (5%) lesions in outer enamel with a kappa correlation value of 0.51 while the first had 9 (18.7%) lesions in the outer half of the enamel layer with a kappa value of 0.84.
Applicability The clinical treatment of caries is based on the diagnostic determination of lesion depth to decide if treatment should be to attempt remineralization or mechanically remove tooth structure and place a restoration. Micro-computed tomography provides a non-destructive method for evaluating demineralization of tooth tissues, internal dental morphology and is relatively readily available. It has been employed in studies of cariology, radiology and dental research regarding the testing of remineralization and decay detection methodologies.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Pediatric Dentistry) (Restorative Dentistry)
Keywords proximal caries, depth determination, micro-CT
ID# 2796
Date of submission: 12/09/2014spacer
E-mail Makins@uthscsa.edu
Author Scott Makins, DMD
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author S. Thomas Deahl II, DMD, PhD
Faculty mentor/Co-author e-mail Deahl@uthscsa.edu
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