Optimizing fluorescence-based caries detection: A diagnostic performance analysis of SmarTooth and DIAGNOdent pen

Abstract

Objectives: This study aimed to evaluate the diagnostic performance of DIAGNOdent (laser fluorescence [LF] pen; Kavo, Biberach, Germany), SmarTooth (SM; Smartooth, Korea), and the International Caries Detection and Assessment System II (ICDAS II) scoring system in detecting occlusal dental caries in permanent teeth, with micro-computed tomography (CT) as the gold standard. Furthermore, the optimal cut-off values for the two devices were determined. Methods: In total, 173 occlusal sites from extracted permanent teeth were assessed using the LF pen, SM, and ICDAS II. Radiographic values obtained using micro-CT were set as the gold standard. Sensitivity, specificity, accuracy, and optimal cut-off points were analyzed using receiver operating characteristic curve analysis. Significance was set at p < 0.05. Results: At the enamel demineralization (D1) and dentin demineralization (D2) thresholds, ICDAS II exhibited the highest sensitivity (D1: 0.966, D2: 0.897), whereas the LF pen exhibited the highest specificity (D1: 1.000, D2: 0.913). SM exhibited higher accuracy than did ICDAS II and the LF pen for both the D1 and D2 thresholds. The optimal cut-offs for the LF pen were as follows: sound: 0-9, enamel caries: 10-20, and dentin caries: 21-99; those for SM were as follows: sound: 0-8, enamel caries: 9-18, and dentin caries: 19-99. Conclusions: Both the LF pen and SM have high diagnostic performance for occlusal dental caries. However, SM achieves the best overall accuracy and thus has strong potential as an effective tool for caries detection.