RELIABILITY OF VISUAL EXAMINATION, FIBEROPTIC 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

The aim of this study was to evaluate the diagnostic accuracy of visua l, fibre-optic transillumination (FOTI), and bite-wing radiographic ex amination performed by 4 observers for the identification of cavitated carious lesions in contacting approximal surfaces, and to assess the inter-observer agreement with these methods and with direct visual exa mination conducted after tooth separation, the method used as validati on for definitive determination of cavitation. A total of 338 unrestor ed approximal surfaces in 53 students were examined independently by 4 dentists using the diagnostic methods under study. The results from t he diagnostic methods were compared with the results from the validati on method for each observer. The sensitivities for identification of c avitated lesions using visual examination ranged from 0.12 to 0.50. Fo r FOTI and radiography, the sensitivities ranged from 0.00 to 0.08 and from 0.56 to 0.69, respectively. The specificities exceeded 0.90 for all observers with all methods. Kappa values expressing inter-observer reproducibility were lowest for FOTI, followed by visual and radiogra phic examination. On the basis of these results, it was concluded that FOTI was the least reliable of the diagnostic methods tested. For the validation method, the inter-observer agreement was only 'substantial '. This implies that the method cannot be used as a validation for oth er diagnostic methods applied for the identification of cavitated cari ous lesions in contacting approximal surfaces. However, visual inspect ion after tooth separation may serve as a supplementary diagnostic too l to conventional visual and radiographic examination for clinical man agement of aproximal carious lesions.