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Objective: So far there are few possibilities to classify the activity of carious lesion, only the visual-tactile criteria can currently make this diagnosis. The aim of this study was to assess the correlation of the newly developed CALCIVIS Imaging System with the common visual criteria according to ICDAS and Nyvad for detecting activity of carious lesion on primary teeth. Furthermore, the reproducibility of the new system was tested. In addition, it was assessed whether a grid, which was put on the bioluminescence image for quantification, could better show the reproducibility.
Material and Method: 55 extracted primary teeth (34 primary molars, 21 primary front teeth) were available for this study. Teeth were cleaned and the areas that should be assessed were recorded with an intraoral camera. One or two measuring points were determined per tooth. All measuring points were classified visually by ICDAS and Nyvad. Subsequently all areas that should be assessed were identified with a prototype of CALCIVIS. Images were analyzed for presence of caries activity (bioluminescene). By creating a grid (0,5cm x 0,5cm) on the bioluminescene images, it should be investigated whether quantification of the results is possible. The images were re-analyzed after four weeks.
Statistics: The results were transferred in MS Excel and then transmitted in MedCalc 17.2. The frequency distribution of the visual examination was represented by cross tables. With the Chi-square four-field test according to McNemar, the first and second measurement series by CALCIVIS regarding to activity diagnosis have been be compared. The correlation between CALCIVIS and the visual procedures according to ICDAS and Nyvad was demonstrated by the rank correlation coefficient according to Spearman. To check the results of the grid evaluation on significant differences the Wilcoxon Test was used. The Intra-Class-Correlation Coefficient was used to evaluate the reproducibility of the measurements with the grid. Results: After visual examination of the available teeth, 27% of the measuring points were classified as inactive by Nyvad. By ICDAS, it was 28,6%. 73% of the measuring points were classified as active for Nyvad and 71,4% for ICDAS.
CALCVIS however classified 25,4% as inactive and 74,6% as active in the second measurement. Both series of measurements were not significantly different (p=1).
With k=0,79 the reproducibility of the bioluminescence method was high. The correlation were rs: Nyvad-ALCIVIS (1st measurement/2nd measurement) = 0,31/0,44 and ICDAS-CALCIVIS (1st measurement/2nd measurement) = 0,25/0,39.
There was no significant difference between the two investigations (p=0,47) when evaluating with the grid. The reproducibility was with ICC=0,66 high, too.
Conclusion: CALCIVIS demonstrated good results in the present in-vitro study for the detection of the activity of carious lesion on primary teeth. The correlations to the visual criteria ICDAS and Nyvad were in a moderate range. The bioluminescence method thus makes it possible to display the activity level of a carious lesion digitally. Thus, suitable therapeutic measures can be initiated based on the knowledge of the degree of the activity of a lesion. Due to the reliability of the findings, follow-up checks can be carried out and the success of performed therapeutic measures can be controlled. Although the evaluation of the bioluminescence images with a grid showed good results, no improvement for therapy decision could be identified.