Biofluorescence imaging as a valid alternative for dental calculus detection

Abstract

Background: Dental calculus is a major contributor to periodontal disease, and its effective removal depends on accurate detection. This study aimed to evaluate the detectability of dental calculus using quantitative biofluorescence imaging (BFI) and to assess its diagnostic accuracy compared to white-light imaging (WLI) and conventional visual-tactile (VT) examination.

Methods: Ten adults were enrolled, and 100 tooth surfaces from the buccal side of maxillary molars and the ligual side of mandibular anterior teeth were examined at three sites (mesial, central, distal), yielding 300 sites. After excluding 15 unsuitable sites, 285 were analyzed. Each site was imaged using WLI and BFI with a biofluorescence-enabled intraoral camera (Qraypen CⓇ, AIOBIO, Korea). VT examination served as the reference standard, and sites were categorized as No calculus, Initial calculus, or Advanced calculus. Color difference (ΔE) and red biofluorescence intensity (ΔR) were measured. Diagnostic accuracy, including sensitivity, specificity, false-positive, and false-negative rates, was compared between imaging modalities.

Results: BFI showed significantly higher ΔE values than WLI, with values increasing by calculus severity (p < 0.001). ΔR also rose with accumulation: 2.75% (No calculus), 6.06% (Initial), 15.58% (Advanced). Detection accuracy improved with WLI + BFI versus WLI alone: sensitivity (0.84 vs. 0.61), specificity (1.00 vs. 0.91), and false-negative rate (16.1% vs. 38.7%).

Conclusion: Biofluorescence imaging enables more distinct detection of dental calculus than white-light imaging, with higher sensitivity and specificity. This method not only identifies calculus presence but also allows quantitative assessment of its accumulation, enhancing diagnostic accuracy.