Objectives: To determine whether Optical Coherence Tomography (OCT) is able to accurately detect the presence of natural caries under dental sealants and composite restorations in extracted teeth, and to compare OCTs Positive Predictive value (PPV) and Negative Predictive Value (NPV) with current standards of care: visual and radiographic exam.
Methods: 200 teeth in various stages of soundness including occlusal, proximal and radicular decay (determined clinically) were photographed, radiographed, and imaged with OCT (512 sequential 2D-OCT images). Teeth were either sealed (ClinproTM, Fuji TriageTM, Embrace Wet BondTM, and DeltonTM ) or restored (Prime&Bond® NT™ TPH®3 Dentsply Caulk, Milford DE 19963), then imaged again and radiographed. Blinded examiners reviewed radiographic and OCT images and assigned decay status. Decay status was confirmed with histological examination after sectioning and microscopic evaluation.
Results: OCT+ Visual performed better than the other methods in detecting early primary or recurrent decay (depths of ≤ 2.0mm ) prior to treatment and accurately detected caries under sealants/restoration. Clinician agreement (k) regarding tooth diagnosis for all data was 0.907 (SE=0.034). Pre and post treatment radiographs agreed very poorly with histology, however, radiographs outperformed OCT when decay was >2mm below the tooth surface. The PPV and NPV of OCT+Visual was significantly better than that of the current clinical gold standard. Though OCT was able to detect demineralization beneath each of the dental sealants, results varied considerably between materials, with DeltonTM the most amenable to imaging.
Conclusion: OCT+Visual exam misdiagnosed less than ½ the number of teeth that were misdiagnosed using conventional techniques (X-Ray+Visual) therefore demonstrating excellent positive predictive value for detecting and monitoring caries beneath dental sealants and composite restorations ex vivo.
Supported by: NIH EB-00293, RR-01192,
Area of the tooth | Detection method compared with histology | kappa (SE) | Positive Predictive Value (SE) | Negative Predictive Value (SE) |
Occlusal | OCT + Visual | 0.925 (0.021) | 1.000 (0.000) | 0.971 (0.028) |
| Xray+Visual | 0.798 (0.067) | 0.952(0.033) | 0.842 (0.059) |
|
|
|
|
|
Proximal | OCT + Visual | 0.750 (0.104) | 0.925 (0.042) | 0.925 (0.042) |
| Xray+Visual | 0.700 (0.112) | 0.878 (0.051) | 0.897 (0.049) |
|
|
|
|
|
Radicular | OCT + Visual | 0.925 (0.042) | 1.000 (0.000) | 0.930 (0.039) |
| Xray+Visual | 0.750 (0.074) | 0.841 (0.055) | 0.917 (0.046) |