Der Einsatz des International Caries Detection and Assessment System (ICDAS-II) - Eine Pilotstudie

Problem: In the age of modern dentistry, a decline in caries prevalence, and above all widespread carious lesions, can be observed. Carious changes to the hard tooth structure appear increasingly as initial lesions. This fact makes it necessary to carry out a caries diagnosis procedure that detects and differentiates dental caries not just at the cavitation stage but earlier, in the initial stage. This is possible using the International Caries Detection and Assessment System (ICDAS II). Until now, only very few studies have investigated how ICDAS II can be learned and applied by student examiners without clinical experience. Aim: The aim of the study was to assess examiner reproducibility in student examiners without previous clinical experience. Furthermore, the learnability of the system by means of an additional training unit was assessed and the level of correlation of visual findings with radiological findings was determined. Material and method: 224 extracted teeth (156 molar and 68 anterior and canine) were available for the study. Following extraction, these were first cleaned and subsequently fixed in 26 special dental arches. The study group comprised 24 dentistry students in the 6th semester. The examinations were carried out in groups of twelve (Group A and Group B) following a training session. Each student was given four randomly selected tooth sets. Three weeks later, the second examinations were conducted with the same tooth sets in each case. Prior to this second examination, only Group A was given another training session. All tooth sets being examined were also examined by two accredited dentists (reference examiners). Moreover, X-ray images were made of all the teeth to determine the correlation between the visual findings and the radiological findings. Statistics: Statistical evaluation was carried out using the SPSS program (version 16.0). To determine reproducibility, Cohen’s kappa value (κ) was calculated. The correlation between the visual findings and the radiological findings was analysed using Spearman’s rank correlation coefficient (rs). Results: There was a relatively wide range in the kappa values calculated. The kappa values for the surface condition were between 0.27 and 0.96 (intra-examiner reproducibility) and between 0.02 und 0.90 (inter-examiner reproducibility). The kappa values for the caries code were between 0.24 and 0.83 (intra-examiner reproducibility) and between 0.10 and 0.72 (inter-examiner reproducibility). A comparison of the kappa values between Group A and Group B did not show any significant difference (p>0.05) for either the surface condition or the caries code. The Spearman rank correlation coefficient for the correlations between the findings of the visual examinations and the radiological examinations was between 0.64 and 0.79 for the various tooth surfaces. All correlations were statistically significant (p<0.01). Discussion and conclusions: It could be shown that the ICDAS-II system can be learned easily by dentistry students in the 6th semester. However, the wide range of kappa values indicates difficulties in implementation which can mainly be linked to a lack of clinical experience. An additional theory unit showed an improvement in reproducibility data and should be taken into account in follow-up studies.