ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Optical Coherence Tomography (OCT) May Offer a Great Non-Invasive Method for Early Caries Detection
Clinical Question In a patient with developing decay, would Optical coherence tomography offer an early detection tool compared to traditional methods?
Clinical Bottom Line In literature published over the past 5 years, Optical Coherence Tomography showed promising results in early caries detection both in vivo and in vitro when compared to radiography and histology samples respectively. Further studies are required for clinical confirmation of the results and implementation methods in the clinical environment.
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) 23450799Shimada/201386 proximal surfaces of 53 patientsCase Series Experimental Study
Key resultsShimada Y et. al., concluded that “SS-OCT appears to be a more reliable and accurate method than bite wing radiographs for the detection and estimation of the depth of proximal lesions in the clinical environment.”
#2) 20848554Holtzman/201040 extracted teethLab Study
Key resultsHoltzman JS et. al., concluded that "In this ex vivo study, dentists were able to detect tooth decay beneath four commonly used dental sealants based on OCT images. Clinical investigations are now underway to determine the usefulness of this approach in vivo” and stated that “Agreement with histology (Cohen’s kappa) was best for OCT pre-sealant (k=0.886), followed by clinical exam (k=0.700) and OCT post-sealant (k=0.634). Radiographs agreed very poorly with histology: k(pre-sealant=0.091; k(post-sealant)=0.251. As evaluated using positive (PPV) and negative predictive values (NPV), detection of demineralization or caries was more accurate using OCT than with visual or radiographic examination. OCT was somewhat better in detecting lesions prior to sealant placement (PPV=0.929, NPV=1.000) than once sealants were in place (PPV=0.913, NPV=0.708). This effect varied in size depending on the type of sealant used, with OCT-diagnostics most accurate when Delton was used. The accuracy of radiographic diagnosis vs. histology as determined by PPV and NPV was overall not very good, and interestingly, it appeared to be somewhat more accurate after sealant placement (PPV=0.909, NPV=0.448) than before (PPV=0.833, NPV=0.382). ”Cohen's Kappa, Sensitivity, PPV, and NPV were 0.886, 1.000, 0.929, and 1.000 respectively for OCT(Pre-sealant) and 0.634, 0.808, 0.913,and 0.706 for OCT (Post-sealant).
#3) 23146817Gomez/2013112 permanent extracted teethLab Study
Key resultsGomez et. al., concluded that “even though all methods present similar performance in detecting occlusal caries lesions, visual inspection seems to be sufficient to be used in clinical practice for detection and assessment of lesion depth. Other methods may be useful in monitoring caries lesion behaviour. ”Correlation coefficient for OCT vs. histology was 0.65 with P<0.01, and with sensitivity of 0.98,0.95 and 0.32 and specificity of 0.52, 0.39, and 0.98 for sound, enamel level, and dentin level measured layers respectively.
#4) 23450799Maia/20106 Primary teethLab Study
Key resultsMaia AM et. al., concluded that "The technique showed great potential to be used on pediatric dentistry clinical on early caries detection with no pain, as it is a noninvasive method." The correlation index (95%) for the 3 measured layers; OCT 840 nm, OCT 1300 nm and histology were 0.347–0.429, 0.362–0.451 and 0.355–0.437 respectively with a standard deviation of 0.174,0.188 and 0.175 with a P value of 0.823.
#5) 23084870Nakagawa/201393 Extracted teethLab study
Key resultsNakagawa H et. al., concluded that "OCT can give clinicians information about internal tooth structure and will help clinical decision making on surgical intervention. "For the 9 years examiners with regards to visual inspection (VI), sensitivity and specificity were 0.96 and 0.78 , and 0.49 and 0.97 (for the second cut off), versus 0.98 and 0.67 (for the first cut off) and 0.59 and 0.84 (for the second cut off) for the 3 years examiners. With regards to SS-OCT, results for the 9 years examiners were 0.97 and 0.98 (for the first cut off) and 0.96 and 0.95 (for the second cut off) versus 0.98 and 0.89 (for the first cut off) and 0.64 and 0.91 (for the second cut off).
Evidence Search Optical coherence tomography, Caries, Early detection
Comments on
The Evidence
No Systematic reviews nor Meta-analysis studies were found for the OCT topic in caries detection. There are limited number of studies that validate the OCT method in vivo which is the corner stone of caries detection for practitioners. Most of the studies a lab/bench top studies were conducted which might not be applicable in the clinical environment. Both the in-vivo and in-vitro studies agreed that OCT is an accurate method for early detection of caries and offers a promising future in clinical monitoring of developing carious lesions.More case series and in vivo studies are required for further investigation
Applicability OCT is an accurate method for early detection of caries and offers a promising future in the clinical monitoring of developing caries lesions. Unfortunately relying solely on this method should be further discussed with more research in addition to discussing cost effectiveness and implementation in the dental clinics.
Specialty/Discipline (Public Health) (Oral Medicine/Pathology/Radiology) (General Dentistry) (Pediatric Dentistry) (Prosthodontics) (Restorative Dentistry)
Keywords Optical coherence tomography Caries
ID# 2536
Date of submission: 08/05/2013spacer
E-mail afify@uthscsa.edu
Author Ahmed Afify
Co-author(s) James Cullen
Co-author(s) e-mail CullenJ@livemail.uthscsa.edu
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
Basic Science Rationale
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Comments on the CAT
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