ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Near Infrared Light Transillumination (NILT) and Bitewing Radiographs Display Similar Accuracy in Diagnosing Interproximal Carious Lesions
Clinical Question In patients with class 2 carious lesions, is transillumination using NILT (Near Infrared Light Transillumination) more effective than bitewing radiographs for detection of early proximal carious lesions?
Clinical Bottom Line NILT and Bitewing radiographs show similar accuracy for diagnosing interproximal caries.
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) 26374746Kühnisch/201585 patients/127 interproximal carious lesions Gold standard-controlled diagnostic study
Key resultsThis study stated that there were no significant differences in the diagnostic accuracy of NILT-EDJ or bitewing radiographs when used to detect class II carious lesions involving the enamel-dentin junction (EDJ). The diagnostic accuracy for NILT-EDJ and digital radiography was 99.2% and 96.1%, respectively. Also, the 95% confidence interval (CI) for sensitivity for NILT-EDJ and digital radiography was calculated to be 95.7-99.9% and 91.1-98.3% respectively. Due to ethical concerns and to prevent over-treatment, any negative result ruled out caries, making specificity values not calculable.
#2) 20432277Staninec/201018 patients/33 carious lesionsGold standard-controlled diagnostic study
Key results97% of carious lesions detected on BW radiographs were also seen using near-infrared (NIR) imaging. All lesions were small, and only 10% were large enough to require restorations.
Evidence Search (("Dental Caries"[Mesh]) AND "Transillumination"[Mesh]) AND ( "Radiography, Dental"[Mesh] OR "Radiography, Dental, Digital"[Mesh] )
Comments on
The Evidence
These studies were clinical trials, which allowed for the most accurate setting in which the NILT technology would be used. One major drawback to the Kühnisch study design is that, for ethical reasons, specificity could not be calculated due to the risk for over-treatment. However, bitewing radiographs are a good comparison because they have specificity normally > 90%. According to Staninec, the NILT images also detected areas of demineralization that were not detected with radiography, suggesting that NILT may have better sensitivity than radiographs. These areas could not be confirmed, however, since these lesions would not warrant a restoration. Both articles stated they received financial support by KaVo and Hobins Kang but that there were no conflicts of interest. A study evaluating the use of NILT on extracted teeth would allow a better calculation of sensitivity and specificity, as teeth could be diagnosed and then evaluated without the risk for over-treatment. A study of extracted teeth would have the drawback, however, of not being as relevant clinically. Patients could not be randomized, and double-blindedness could not be achieved due to all patients receiving both NILT and dental radiographs.
Applicability The patient population in these studies is relatively representative of the patient population in private practice, except all recurrent caries were excluded from the study. The NILT-EDJ does require an initial investment to purchase the unit and cannot completely replace digital radiography due to its inability to clearly view the pulp. It could benefit patients, however, by allowing diagnosis of caries without the use of ionizing radiation. Potential harm to the patient is very low, although a specificity value was not calculated in this study.
Specialty/Discipline (General Dentistry) (Restorative Dentistry)
Keywords dental caries, diagnosis, transillumination, dental radiography, caries, cavities, interproximal decay, pit (fissure) cavity(ies), decay, tooth decay, smooth surface cavity(ies), diagnosis, bwx, bitewing(s), periapical(s), radiograph(s), PA, PA film(s), PA radiograph(s), transillumination, NILT, near infrared, near infrared transillumination, near infrared technology
ID# 2953
Date of submission: 10/20/2015spacer
E-mail fort@livemail.uthscsa.edu
Author Ryan Fort, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Luis C. Yepes, DDS
Faculty mentor/Co-author e-mail yepes@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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None available
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Comments on the CAT
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