Comparison of visual inspection, radiographic examination, laser fluorescence and their combinations on treatment decisions for occlusal surfaces

Purpose: To compare visual inspection (VI), radiographic examination (RX) and the laser fluorescence device DIAGNOdent (L), as well as their combinations in vitro regarding treatment decisions for occlusal surfaces. Methods: 72 extracted human permanent teeth (molars and premolars) were used. Treatment decisions were recorded by three calibrated examiners, and the options available were fissure sealant and conservative restoration. For validation of treatment decisions, the teeth were sectioned and examined in a stereomicroscope. Thereafter, dental slices were scanned and the images were edited to facilitate classification of existing carious lesions. Intra and inter-examiner reproducibility for the determination of treatment plans were calculated using Cohen's kappa test (95%-CI). Sensitivity, specificity, positive and negative predictive values, and the area under the ROC curve were also calculated. Results: VI and L provided on average the greatest intra- and inter-examiner reproducibility, respectively. Although the combination of diagnostic methods may decrease both intra- and inter examiners reproducibility, combination of VI, L and RX resulted in the greatest sensitivity, being statistically superior to RX and L. There was more inter-examiner agreement for the option of restorative treatment, while the use of sealants as a treatment option yielded the lowest values. Negative predictive values were numerically inferior to positive predictive values, indicating that the examiners preferred not to restore a carious tooth than to proceed operatively in an intact tooth. The combination of the three methods studied showed the best results in determining treatment plans for occlusal surfaces, when compared to the other types of exams. on the other hand, radiographic examination and laser fluorescence were less efficient when used alone.

In Vitro Evaluation of ICDAS and Radiographic Examination of Occlusal Surfaces and Their Association With Treatment Decisions

This in vitro study evaluated the performance of visual (International Caries Detection and Assessment System [ICDAS]) and radiographic (bitewing [BW]) examinations for occlusal caries detection and their associations with treatment decision (TD). Permanent teeth (n=104) with occlusal surfaces varying from sound to cavitated were selected. Sites were identified from 10x occlusal surface photographs. Standardized bitewing (BW) radiographs were taken. Four dentists with at least five years of experience scored all teeth twice (one-week interval) for ICDAS (0-6), BW (0=sound, 1=caries restricted to enamel, 2=caries in outer third dentin, 3=caries in inner third dentin), and TD (0=no treatment, 1=sealant, 2=microabrasion and sealant, 3=round bur sealant, 4a=resin, 4b=amalgam). Histological validation was performed by observation under a light microscope, with lesions classified on a five-point scale. Intraexaminer and inter-examiner repeatability were assessed using two-way tables and intraclass correlation coefficients (ICCs). Comparisons between percentage correct, specificity, sensitivity, and area under the receiver-operating characteristic (ROC) curve were performed using bootstrap analyses. ICCs for intraexaminer and interexaminer repeatability indicated good repeatability for each examiner, ranging from 0.78 to 0.88, and among examiners, ranging from 0.74 to 0.81. Correlation between ICDAS and TD was 0.85 and between BW and TD was 0.78. Correlation between the methods and histological scores was moderate (0.63 for ICDAS and 0.61 for BW). The area under the ROC curve was significantly greater for ICDAS than for BW (p<0.0001). ICDAS had significantly lower specificity than BW did (p=0.0269, 79% vs 94%); however, sensitivity was much higher for ICDAS than for BW (p<0.0001, 83% vs 44%). Data from this investigation suggested that the visual examination (ICDAS) showed better performance than radiographic examination for occlusal caries detection. The ICDAS was strongly associated with TD. Although the correlation between the ICDAS and BW was lower, it is still valuable in the clinical decision-making process.

Coordinación de decisiones en economías mixtas: un desafío para la cooperación del PNUD con América Latina y el Caribe = Decisions co-ordination in mixed economies: a challenge for UNDP co-operation with Latin America and the Caribbean

Exposicion del Jefe de la Division del Programa Regional y del Caribe de Habla Inglesa del PNUD en la inauguracion del Coloquio, en la cual se refiere a la tarea encomendada a este organismo acerca de la coordinacion de la cooperacion en las nuevas tecnicas de planificacion del desarrollo y de la insercion de America Latina y el Caribe en la economia internacional, que la problematica actual requiere.

Algunas resoluciones y decisiones recientes emanadas de órganos de las Naciones Unidas, que se ponen en conocimiento de la Comisión = Some recent resolutions and decisions adopted by United Nations organs which require to be brought to the attention of the Commission = Résolutions et décisions récemment émanées d'organismes de Nations Unies portées à la connaissance de la Commission

Presenta varias resoluciones aprobadas durante el cuadragesimosegundo periodo de sesiones de la Asamblea General de las Naciones Unidas, Nueva York, 15 septiembre-21 diciembre de 1987, que guardan relacion con la labor de la CEPAL.

Algunas resoluciones y decisiones recientes emanadas de órganos de las Naciones Unidas, que se ponen en conocimiento de la Comisión = Some recent resolutions and decisions adopted by United Nations organs which require to be brought to the attention of the Commission = Résolutions et décisions récemment émanées d'organismes des Nations Unies et portées a la connaissance de la Commission

Incluye Bibliografía

Algunas resoluciones y decisiones recientes emanadas de órganos de las Naciones Unidas, que se ponen en conocimiento de la Comisión = Some recent resolutions and decisions adopted by United Nations organs which require to be brought to the attention of the Commission = Résolutions et décisions récemment émanées d'organismes des Nations Unies et portées a la connaissance de la Commission

Incluye Bibliografía

Algunas resoluciones y decisiones recientes emanadas de órganos de las Naciones Unidas, que se ponen en conocimiento de la Comisión = Some recent resolutions and decisions adopted by United Nations organs which require to be brought to the attention of the Commission = Résolutions et décisions récemment émanées d'organismes des Nations Unies et portées à la connaissance de la Commission

Incluye Bibliografía

Algunas resoluciones y decisiones recientes emanadas de órganos de las Naciones Unidas, que se ponen en conocimiento de la Comisión = Some recent resolutions and decisions adopted by United Nations organs which should be brought to the attention of the Commission = Résolutions et décisions récemment émanées d'organismes des Nations Unies et portées à la connaissance de la Commission

Incluye Bibliografía