ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Logicon Caries DetectorTM (a computer-assisted caries diagnostic tool) may provide improved sensitivity for detection of caries that extends into dentin.
Clinical Question For previously unrestored teeth, how does Logicon Caries DetectorTM (LCD) compare to the current clinical diagnostic test (visual assessment of images) in the diagnosis of interproximal decay?
Clinical Bottom Line Logicon Caries DetectorTM, currently available only for use with Carestream (Kodak) imaging system, may improve the sensitivity of detecting interproximal dentin caries versus visual inspection of images alone. Drawbacks include initial software cost and additional dentist time to use the system/analyze images.
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) 21903524Tracy/2011Unknown (Radiographs of 76 non-cavitated, unrestored, interproximal surfaces).Retrospective Clinical Study
Key resultsW/LCD 4.0/RGV 6000:sensitivity-69 specificity-94 PPV-87 NPV-84 W/visual assessment only: sensitivity-30 specificity-97 PPV-86 NPV-70
#2) 21891917Behere/201150 extracted teeth/viewed 100 non-cavitated, unrestored, interproximal surfaces.In-vitro
Key resultsW/LCD 3.0/RGV 5000: sensitivity-100 specificity-96 PPV-50 NPV-100 W/visual assessment only: sensitivity-25 specificity-100 PPV-100 NPV-97
#3) 19557443Kazuyuki/201050 extracted premolars/viewed 100 non-cavitated, unrestored, interproximal surfaces.In-vitro
Key resultsMeasured as Az values (area under ROC curves) W/LCD 4.0/RGV 6000: 0.745 W/visual assessment only: 0.689 p value= 0.018
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Comments on
The Evidence
VALIDITY: Tracy Study: The gold standard was an experienced LCD user’s judgment confirmed by either a) cavity preparation of teeth determined to be decayed, or b) monitoring of “healthy” teeth over a three year period. This is reasonable and ethical gold standard for a clinical caries study. The gold standard was applied to all evaluated surfaces and was measured blind to LCD. The dentists using LCD were novices with both digital radiographs and LCD. LCD was used in the reference standard and the radiographs selected for the study did not include any surfaces that generated false positives or negative for the experienced LCD user. Competing interests: two of the authors are employees of Carestream. Behere Study: The gold standard used was magnified photographic images with a consensus among three dentists . The gold standard was used for all evaluated surfaces, which were measured blind to LCD. Limitations of this study include the prevalence of disease (only 4 of the 100 evaluated surfaces had dentinal decay), only non-cavitated lesions were studied, an older sensor and version of LCD were used, the x-rays were viewed in a quiet room with subdued lighting (which may not reflect a private practice setting), evaluations were performed by radiologist instead of general practitioners, and only one dentist performed the LCD analysis. No competing interests were noted. Kazuyuki Study: The gold standard (micro CT) was applied to all assessed surfaces. It is unclear from the study if it was blindly compared to LCD and visual assessment of images. Limitations of this study include the use of only premolars, only inexperienced (newly licensed) dentists performed the LCD analysis, and the images were viewed in a quiet room with subdued lighting (which may not reflect a private practice setting), no competing interests were noted. PERSPECTIVE: The diagnostic efficacy of LDC for interproximal decay in unrestored teeth does appear to show some improvement over visual assessment of images alone. It Computer-assisted diagnostic tools are intended to supplement, not replace, a dentist’s clinical judgment. LCD had greater sensitivity than visual assessment alone for dentinal caries. The specificity and NPVs remained relatively high in both modalities. However the evidence was inconclusive regarding the PPV; in one study the PPVs were only one point apart, in another there was a separation of 50%. The dentist’s and patient’s tolerance for the potential of false positives and unnecessary treatment would need to be considered when developing a treatment plan. In a high caries risk patient with a history of irregular visits, this may be tolerable, whereas in a patient that routinely visits the dentist and has a low incidence of caries, the risk may not be justified.
Applicability LCD analyzes radiographic images (which are already required to evaluate the interproximal surfaces of teeth), so there is no additional burden born by the patient. However LCD does require the dentist to invest additional time to analyze patients radiographs, as well as an initial investment of ~$3000 for the software. Furthermore LCD is only commercially available with Carestream (Kodak) digital x-rays.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Prosthodontics) (Restorative Dentistry)
Keywords Logicon, Computer-assisted, diagnosis, caries, detection
ID# 2531
Date of submission: 08/07/2013spacer
E-mail Parrone@uthscsa.edu
Author Martina Parrone
Co-author(s) Ryan Reyes
Co-author(s) e-mail ReyesRN@uthscsa.edu
Faculty mentor/Co-author S. Thomas Deahl, II, DMD,PhD
Faculty mentor/Co-author e-mail deahl@uthscsa.edu
Basic Science Rationale
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