Comparison of different diagnostic techniques in detecting smooth surface caries in primary molars using the histological gold standard: An in vitro study.

OBJECTIVE: This in vitro study evaluated the caries status of the smooth surfaces of primary molars using the DIAGNOdent pen, Vistacam iX, and Bitewing radiography as compared to histologic assessment. METHODS: 68 primary molars were selected, and their mesial or distal caries status were determined using DIAGNOdent pen, Bitewing radiography, and Vistacam iX. To achieve reference standards, the teeth were sectioned and directly assessed by a stereomicroscope. The Mc Nemar test was used to compare the sensitivity, specificity, and accuracy of the methods. The spearman rank correlation coefficient (r) was also determined to compare the extent of caries with histology. The statistical significance level was set at alpha = 0.05. RESULTS: Regarding D1 as a cut-off point for histological assessments, sensitivity, specificity, and accuracy of DIAGNOdent pen were 82 %, 75 %, and 80 % while the values were 63 %, 100 % and 62 % for bitewing radiography and 56 %, 100 % and 59 % for Vistacam iX. Regarding D3 as a cut-off point for histological analysis; Sensitivity, specificity, and accuracy rates of DIAGNOdent pen were 71 %, 86 % and 80 % while these values were 71 %, 73 % and 72 % for bitewing radiography and 50 %, 78 % and 67 % for Vistacam iX. CONCLUSION: In conclusion, the DIAGNOdent pen shows the highest performance and accuracy to detect smooth surface caries both at D1 and D3 among the three methods. Although VistaCam iX and bitewing radiography showed better performance at D3 compared to D1, their performances were lower than the DIAGNOdent pen.