Abstract
Abstract
Objectives
To compare the diagnostic performance and interobserver agreement of visual examination, fluorescence evaluation using DIAGNOcam Vision Full HD, caries detector dye, and post dye fluorescence combined evaluation for detecting residual carious tissue following selective caries removal, and to assess associations with histological lesion extension.
Materials and Methods
Forty-four extracted human premolars and molars with carious lesions were assessed on four cavity walls by two calibrated observers using the four methods and a standardized 0–100 ordinal percentage scale. Histological lesion extension was measured microscopically after sectioning. Interobserver agreement was assessed using quadratic weighted Cohen’s kappa. Diagnostic scores were compared using the Friedman test and Bonferroni-adjusted Wilcoxon signed-rank tests. Baseline and post-dye fluorescence were compared and correlated using Spearman’s correlation. Associations between histological lesion extension and diagnostic scores were evaluated using linear regression and ordinal mixed-effects models.
Results
Overall interobserver agreement was substantial (κw = 0.686), with almost perfect agreement for fluorescence (κw = 0.861) and combined evaluation (κw = 0.873), moderate agreement for visual examination (κw = 0.563), and fair agreement for dye (κw = 0.392). Diagnostic scores differed significantly among methods for both observers (p < 0.001). Baseline and post-dye fluorescence scores also differed significantly (adjusted p < 0.001) but remained positively correlated (ρ = 0.499 and 0.644; both p < 0.001). Greater histological lesion extension was associated with higher scores for all methods, with no significant method-by-lesion-extension interaction (p = 0.075)
Conclusion
DIAGNOcam fluorescence demonstrated high reproducibility for assessing residual carious tissue. Caries detector dye significantly altered subsequent fluorescence measurements. Histological lesion extension was positively associated with diagnostic scores across methods.
Clinical Relevance:
The findings support the use of DIAGNOcam fluorescence imaging as a reliable assessment tool during selective caries removal, potentially helping clinicians assess residual carious tissue more consistently than visual assessment alone. However, clinicians using both fluorescence techniques should distinguish between baseline and post dye fluorescence when making decisions about residual carious tissue. These findings may help support more standardized clinical assessment while avoiding unnecessary additional dentin removal during minimally invasive caries management.