Background/Aims: This study aimed to compare and contrast in vitro six methods to determine the most accurate method for detecting approximal carious lesions in primary molars. Methods: Extracted primary molars (n = 140) were stored in 0.02% chlorhexidine solution and mounted in light-cured resin in pairs. The six carious lesion detection methods used by the three examiners to assess approximal carious lesions were visual inspection, digital radiography, two transillumination lights (SDI and NSK), and two laser fluorescence instruments (CDD and DDP). Five damaged teeth were discarded. The teeth (n = 135) were sectioned, serially ground, and examined under light microscopy using Downer’s histological (HST) criteria as the gold standard. Intra- and inter-examiner reliability, agreement with HST, specificity, sensitivity, receiver operating characteristic (ROC) curves, and areas under the curve were calculated. Results: This study found visual inspection to be the most accurate method when validated by histology. Transillumination with NSK light had the highest specificity, and digital radiography had the highest sensitivity for detecting enamel and/or dentinal carious lesions. Combining specificity and sensitivity into the area under ROC curves, enamel plus dentinal lesions were detected most accurately by visual inspection followed by digital radiography; dentinal lesions were detected most accurately by digital radiography followed by visual inspection. Conclusions: None of the four newly developed methods can be recommended as suitable replacements for visual inspection and digital radiography in detecting carious lesions on approximal surfaces of primary molars, and further developmental work is needed.

1.
Arnold WH, Gaengler P, Kalkutschke L: Three-dimensional reconstruction of approximal subsurface caries lesions in deciduous molars. Clin Oral Investig 1998;2:174–190.
2.
Bader JD, Shugars DA, Bonito AJ: A systematic review of the performance of methods for identifying carious lesions. J Public Health Dent 2002;62:201–213.
3.
Braga MM, Morais CC, Nakama RC, Leamari VM, Siqueira WL, Mendes FM: In vitro performance of methods of approximal caries detection in primary molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108:e35–e41.
4.
Christensen GJ: Why switch to digital radiography? J Am Dent Assoc 2004;135:1437–1439.
5.
Cohen J: A coefficient of agreement for nominal scales. Educ Psychol Meas 1960;20:37–46.
6.
Downer MC: Concurrent validity of an epidemiological diagnostic system for caries with the histological appearance of extracted teeth as validating criterion. Caries Res 1975;9:231–246.
7.
Ekstrand KR, Kuzmina I, Bjørndal L, Thylstrup A: Relationship between external and histological features of progressive stages of caries in the occlusal fossa. Caries Res 1995;29:243–250.
8.
Fleiss JL: Statistical Methods for Rates and Proportions, ed 2. New York, Wiley, 1981.
9.
Francescut P, Lussi A: Correlation between fissure discoloration, Diagnodent measurements, and caries depth: an in vitro study. Pediatr Dent 2003:25;559–564.
10.
Hintze H, Wenzel A, Danielsen B, Nyvad B: Reliability of visual examination, fibre-optic transillumination, and bite-wing radiography and reproducibility of direct visual examination following tooth separation for the identification of cavitated carious lesions in contacting approximal surfaces. Caries Res 1998;32:204–209.
11.
Holt RD, Azevedo MR: Fibre optic transillumination and radiographs in diagnosis of approximal caries in primary teeth. Community Dent Health 1989;6:239–247.
12.
Ismail AI: Rationale and evidence for the international caries detection and assessment system (ICDAS II); in Stookey G (ed): Proc 7th Indiana Conf, Indianapolis, Bloomington, 2005, pp 161–122.
13.
Mejàre I, Gröndahl HG, Carlstedt K, Grever AC, Ottoson E: Accuracy at radiography and probing for the diagnosis of proximal caries. Scand J Dent Res 1985;93:178–184.
14.
Novaes TF, Matos R, Braga MM, Imparato JC, Raggio DP, Mendes FM: Performance of a pen-type laser fluorescence device and conventional methods in detecting approximal caries lesions in primary teeth – in vivo study. Caries Res 2009;43:36–42.
15.
Peers A, Hill FJ, Mitropoulos CM, Holloway PJ: Validity and reproducibility of clinical examination, fibre-optic transillumination, and bite-wing radiology for the diagnosis of small approximal carious lesions: an in vitro study. Caries Res 1993;27:307–311.
16.
Peltola J, Wolf J: Fibre optic transillumination in caries diagnosis. Proc Finn Dent Soc 1981;77:240–244.
17.
Purdell-Lewis DJ, Pot TJ: A comparison of radiographic and fibre optic diagnosis of approximal caries lesions. J Dent 1974;2:143–148.
18.
Rayner JA, Southam JC: Pulp changes in deciduous teeth associated with deep carious dentine. J Dent 1979;7:39–42.
19.
Šidàk Z: Rectangular confidence region for the means of multivariate normal distributions. J Am Stat Assoc 1967;62:626–633.
20.
Sidi AD, Naylor MN: A comparison of bitewing radiography and interdental transillumination as adjuncts to the clinical identification of approximal caries in posterior teeth. Br Dent J 1988;164:15–18.
21.
Simon S: Sample size for a diagnostic study. http://www.childrensmercy.org/stats/size/diag.asp, 2007.
22.
Soviero VM, Leal SC, Silva RC, Azevedo RB: Validity of MicroCT for in vitro detection of proximal lesions in primary molars. J Dent 2012;40:35–40.
23.
Syriopoulos K, Sanderink G, Velders X, van der Stelt P: Radiographic detection of approximal caries: a comparison of dental films and digital imaging systems. Dentomaxillofac Radiol 2000;29:312–318.
24.
Tranæus S, Shi XQ, Angmar-Månsson B: Caries risk assessment: methods available to clinicians for caries detection. Community Dent Oral Epidemiol 2005;33:265–273.
25.
Vaarkamp J, ten Bosch JJ, Verdonschot EH, Bronkhoorst EM: The real performance of bitewing radiography and fiber-optic transillumination in approximal caries diagnosis. J Dent Res 2000;79:1747–1751.
26.
Verdonschot EH, Wenzel A, Bronkhorst EM: Assessment of diagnostic accuracy in caries detection: an analysis of two methods. Community Dent Oral Epidemiol 1993;21:203–208.
27.
White S, Yoon D: Comparative performance of digital and conventional images for detecting proximal surface caries. Dentomaxillofac Radiol 1997;26:32–38.
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