Clinical Performance of Diagnostic Methods in Third Molar Teeth with Early Occlusal Caries

The aim of this study was to compare the diagnostic performance of clinical visual examination (ICDAS II), digital periapical radiography (PR), near infrared light transillumination (NIR-LT), and laser fluorescence (LF) to microcomputed tomography (Micro-CT) which is the reference standard for the detection of non-cavitated occlusal enamel and dentin caries in third molar teeth. Potential participants were consecutively recruited. In this prospective study, 101 third molars of 101 patients were examined; the molars had non-cavitated occlusal caries which required extraction. ICDAS II, PR, NIR-LT and LF examinations were carried out by two blinded examiners. Reference standard was determined by micro-CT imaging seven days after extraction. Accuracy rate, sensitivity, specificity, predictive values and areas under receiver operating characteristic (ROC) curves (Az) were statistically analyzed. Nonparametric variables were subjected to the Kruskal–Wallis Test. Significance level was set as p < 0.05. NIR-LT had the highest sensitivity (99.67–99.67%) and accuracy (78.22–77.23%) for the determination of occlusal enamel caries according to examiners 1 and 2, respectively. LF method had the highest sensitivity (70.83–54.17%) and accuracy (66.34–59.41%) for determining occlusal dentin caries according to examiners 1 and 2, respectively. The ROC curve (Az) value ranged between 0.524 and 0.726 for the different methods tested. Most effective methods for the diagnosis of occlusal enamel and dentin caries were determined to be NIR-LT and LF pen methods, respectively. The present prospective clinical study showed that NIR-LT and LF-Pen were a reliable modality for the detection of occlusal enamel and dentin caries without ionizing radiation.