Detection of occlusal caries lesions using fluorescence: correlation between histology and obtained results for Diagnodent and spectroscopy

The aims of this study were to develop and test a method to detect caries lesions in vivo and in vitro, using a portable spectrometer (PS); to analyze the performance of PS as well as the commercial device Diagnodent (Dd); correlate them with the gold standard, their transversal section areas and lesions depth and between themselves. 66 occlusal pre-molars sites were examined in vivo with Dd. Sequentially, fluorescence (λexc ∼ 657 nm) was collected by an optical fiber, conducted to PS and then analyzed as spectra, which were normalized and had calculated the Ratios of their Areas Under the Curves (RAUC) of carious and sound tissues. Experiments were conducted in vitro in the same sites. Gold Standard was obtained by polarized light microscopy. Pearson correlation was used to compare the devices with transversal section area, lesions depth and between themselves. The area under ROC curve, sensitivity, specificity as well as accuracy were calculated and verified with McNemar test. Dd and RAUC showed statistically significant correlation with gold standard (p < 0.01 for Dd and p < 0.05 for RAUC) and between themselves (r = 0,83 in vivo and r = 0,87 in vitro). Although it was significant, the devices showed low correlation with depth of lesions in vivo and in vitro (r = ∼ 0.43). The transversal section area of the lesion had no influence on readings in both devices. Dd showed higher sensitivity (0.76) than PS (0.60) in vivo (p < 0.05), though this fact was not able to improve its performance. In turn, PS showed higher sensitivity (0.88) than Dd (0.79) in vitro, but this difference was not significantly. The other parameters did not show statistically significant differences (p < 0.05) between methods. PS showed positive correlation with Dd, equal correlation with lesions depth and higher ability of detecting the disease in vitro, what suggests that if accompanied with a conic and an angulated probe and a dedicated software, the PS method could be useful in clinics in the near future. (author)