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Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Oct;108(4):e35-41. doi: 10.1016/j.tripleo.2009.05.017.

In vitro performance of methods of approximal caries detection in primary molars.

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Department of Pediatric Dentistry, Faculdade de Odontologia da Universidade de São Paulo, São Paulo, Brazil.



The aim was to compare the performance of different methods in detecting approximal caries lesions primary molars ex vivo.


One hundred thirty-one approximal surfaces were examined by 2 observers with visual inspection (VI) using the International Caries Detection and Assessment System, radiographic interpretation, and clinically using the Diagnodent pen (LFpen). To achieve a reference standard, surfaces were directly examined for the presence of white spots or cavitations, and lesion depth was determined after sectioning. The area under the receiver operating characteristic curve (A(z)), sensitivity, specificity, and accuracy were calculated, as well as the interexaminer reproducibility.


Using the cavitation threshold, all methods presented similar sensitivities. Higher A(z) values were achieved with VI at white spot threshold, and VI and LFpen had higher A(z) values at cavitation threshold. VI presented higher accuracy and A(z) than radiographic and LFpen at both enamel and dentin depth thresholds. Higher reliability values were achieved with VI.


VI performs better, but both radiographic and LFpen methods also show good performance in detecting more advanced approximal caries lesions.

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