Klinischer Einsatz einer fluoreszenzbasierten Intraoralkamera für die Verlaufskontrolle an gesunden und initialkariösen Zähnen

Problemstellung: Die frühzeitige Detektion der Karies stellt eine wichtige Anforderung an die moderne Zahnheilkunde dar. Zwar ist in Deutschland und vielen europäischen Ländern ein deutlicher Rückgang der Kariesprävalenz zu beobachten, dennoch ist die Karies nach wie vor die häufigste Erkrankung...

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Bibliographic Details
Main Author: Vill, Gabriel
Contributors: Jablonski-Momeni, Anahita (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2017
Online Access:PDF Full Text
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Objective: The early detection of dental caries is fundamental to the modern dentistry. While a decline in the prevalence of dental caries has been observed in Germany and many other European countries, caries nevertheless still represents the most common disease of the oral cavity. The early detection of incipient lesions and the choice of appropriate and timely therapeutic measures are paramount to dental practice in the current era. The modern practitioner increasingly has access to new technologies to support visual inspection. These novel diagnostic technologies each come with their own product-specific performance characteristics, potentially limiting the scope of their clinical application. The success of modern dentistry therefore rests in part on the identification and application of more subtle diagnostic techniques to detect incipient lesions that often elude the optical assessment alone. Such a clinical caries detection system would be ideal for the optimization of targeted, cost-effective prophylactic measures. Aim: Sound tooth surfaces and incipient lesions require regular follow-up in order to prevent possible caries or for the early detection of incipient caries progression. In the present in vivo study, the ability of the digital fluorescence camera VistaProof to monitor healthy tooth surfaces and incipient lesions in children during follow-up will be evaluated. Subjects and Methods: The positive vote of the Ethics Commission had already been obtained before the study began. Informed and written consent was obtained for all study participants and their guardians. The study comprised 36 patients (mean age 9.1 years), resulting in a total of 421 teeth (≙ n=1892 surfaces) for assessment. Visual assessment using the ICDAS system provided a reference value that was compared to assessment with the VistaProof fluorescence camera. Systematic follow-up was conducted at 6 and 12 months for both visual and fluorescence inspection. Statistical analyses were performed with SPSS (v15.0) and MedCalc (v11.3.4.0) statistical software. The reproducibility of the ICDAS II was calculated using the Cohen kappa (κ). Correlation between the ICDAS-II method and the VistaProof assessment was determined using the Spearman's rank correlation (rs). The diagnostic accuracy of VistaProof was assessed using the area under the curve (AUC) method and the ICDAS-II assessment as the reference standard. Sensitivity and specificity were also determined in this way. The Wilcoxon test was used to determine whether changes in the enamel could be detected by VistaProof when there was no change in the ICDAS score. The level for statistical significance was set at an α = 0.05. Results: All correlations were statistically significant and positive in direction (rs: 0.54 to 0.66; p <0.01). All findings showed a significant association (χ2 <0.001). The diagnostic accuracy of VistaProof was high, with sensitivities and specificities varying depending on the positivity cutoff used. The consideration of the crosstabs revealed that 90% of examined tooth surfaces showed no visual signs of lesions (ICDAS code 0; n = 1700) at the beginning of the study, while an early changes could be detected in 10% (ICDAS codes 1 and 2), Early changes could be detected by visual inspection in 11.3% at 6 months (T2) and 14.7% at 12 months (t3). Over the course of the 12 months, therefore, progression of ICDAS codes was observed in 120 tooth surfaces (94 teeth). Of these, 47 surfaces (39%) involved the primary molars and 73 (61%) affected permanent teeth. There were significant differences between ICDAS results for all time points (t1 / t2: Wilcoxon p = 0.011, t2 / t3: p <0.001). For fluorescence measurements, a significant difference was found between the first and second examination (p <0.001), whereas difference in measurements between t2/t3 failed to attain statistical significance (p = 0.700). It is important to note that not only does diagnostic accuracy and test characteristics of VistaProof vary considerably depending on the cut-off point used, as noted above, but also that the sensitivity for detecting lesions in deciduous teeth appears somewhat lower than in permanent teeth (SE 74.5%-100%, SP 0%-97.1%). Conclusion: The present study suggests that the use of the VistaProof digital fluorescence camera to monitor the progress of enamel lesions could provide comparable results to detailed visual inspections, although not all changes could be reliably detected by the sole use of the system. It is therefore recommended to use this technical detection methods in addition to the usual detailed visual inspection.