Aim: To check the reliability and validity of International Caries Detection and Assessment System (ICDAS) II coding in occlusal caries detection under unaided visual and enhanced visual examination.
Materials and methods: This study included 100 extracted premolars and molars. Two examiners independently scored occlusal caries using ICDAS II criteria without magnification and under 6x magnification in the dental operating microscope. The examination was repeated after one month to check the intraexaminer reliability. The examined samples were sectioned and the carious lesions were scored using Ekstrand–Ricketts–Kidd (ERK) histological criteria under 20x magnification in stereomicroscope. The ICDAS II scores given by the examiners were compared with the histological scores.
Results: The κ values for interexaminer reproducibility of unaided and enhanced visual examinations were 0.695 and 0.626, respectively (substantial agreement), and 0.984 (almost perfect agreement) for histological examination. Intraexaminer reproducibility for unaided and enhanced visual examinations were 0.835 and 0.910, respectively (almost perfect agreement). Spearman's correlation coefficients of ICDAS II unaided visual and enhanced visual examinations to ERK histological scores were 0.724 and 0.689, respectively, which infers that there is a strong correlation between unaided visual and histological examination and a moderate correlation between enhanced visual and histological examination. For unaided visual examination, specificity is 100% and sensitivity is 92%, whereas for enhanced visual examination, specificity is 50%, and sensitivity is 100%.
Conclusion: Unaided visual examination demonstrated good reliability and validity for ICDAS II coding, whereas enhanced visual examination exhibited good reliability but relatively lower validity.
Clinical significance: This study reveals that magnification did not have any added benefits in occlusal caries diagnosis using ICDAS II coding compared to unaided visual examination. The use of magnification did not improve the validity and led to a drop in the specificity, which indicates higher chances of false positive results.
Gugnani N, Pandit IK, Srivastava N, et al. International caries detection and assessment system (ICDAS): a new concept. Int J Clin Pediatr Dent 2011;4(2):93–100. DOI: 10.5005/jp-journals-10005-1089
Dikmen B. Icdas II criteria (international caries detection and assessment system). J Istanb Univ Fac Dent 2015;49(3):63–72. DOI: 10.17096/jiufd.38691
Mitropoulos P, Rahiotis C, Kakaboura A, et al. The impact of magnification on occlusal caries diagnosis with implementation of the ICDAS II criteria. Caries Res 2012;46(1):82–86. DOI: 10.1159/000335988
Centers for Disease Control and Prevention. Guidelines for Infection Control in Dental Health-Care Settings -- 2003. MMWR 2003;52 (No. RR-17):33.
Braga MM, Mendes FM, Martignon S, et al. In vitro comparison of Nyvad's system and ICDAS-II with lesion activity assessment for evaluation of severity and activity of occlusal caries lesions in primary teeth. Caries Res 2009;43(5):405–412. DOI: 10.1159/000239755
Srilatha A, Doshi D, Kulkarni S, et al. Conventional diagnostic aids in dental caries. J Glob Oral Heal 2019;2(1):53–58. DOI: 10.25259/JGOH_42_2019
Mallikarjun SA, Devi PR, Naik AR, et al. Magnification in dental practice: how useful is it? J Health Res Rev 2015;2(2):39–44. DOI: 10.4103/2394-2010.160903
Jablonski-Momeni A, Stachniss V, Ricketts DN, et al. Reproducibility and accuracy of the ICDAS-II for detection of occlusal caries in vitro. Caries Res 2008;42(2):79–87. DOI: 10.1159/000113160
Ari T, Kofman SH, Ari N. In vitro evaluation of magnification and LED illumination for detection of occlusal caries in primary and permanent molars using ICDAS Criteria. Dent J 2013;1(3):19–30. DOI: 10.3390/dj1030019
Sathyanarayanan R, Usha C, Sudhagar R. Reliability and validity of ICDAS II coding for occlusal caries using magnification: an in-vitro study. Int J 2017;3(6):149–155. DOI: 10.18203/issn.2454-2156.IntJSciRep20172031
Rodrigues JA, Hug I, Diniz MB, et al. Performance of fluorescence methods, radiographic examination and ICDAS II on occlusal surfaces in vitro. Caries Res 2008;42(4):297–304. DOI: 10.1159/000148162
T LB, Jayadevan A, Chakravarthy D, et al. Inter examiner reproducibility in the detection of occlusal caries using international caries detection and assessment system (ICDAS) II by unaided visual and enhanced visual examination - an in vivo study. Int J Appl Dent Sci 2019;5(2):08–12.
Sisodia N, Manjunath MK. Impact of low level magnification on incipient occlusal caries diagnosis and treatment decision making. Journal of clinical and diagnostic research. J Clin Diagn Res 2014;8(8):ZC32–ZC35. DOI: 10.7860/JCDR/2014/8533.4742
Halligan S, Altman DG, Mallett S. Disadvantages of using the area under the receiver operating characteristic curve to assess imaging tests: a discussion and proposal for an alternative approach. Eur Radiol 2015;25(4):932–939. DOI: 10.1007/s00330-014-3487-0