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Background <p>Early detection of occlusal caries in posterior teeth is important for minimally invasive care. Visual systems such as the International Caries Detection and Assessment System (ICDAS II) standardize clinical scoring, but adjunctive fluorescence-based tools may improve objectivity. This clinical cross-sectional diagnostic accuracy study evaluated DIAGNOdent Pen and QrayCam Pro metrics (ΔFmax and ΔRmax) relative to ICDAS II-derived lesion categories in permanent posterior teeth.</p> Methods <p>This clinical cross-sectional diagnostic accuracy study included 64 adults who contributed 145 unrestored posterior teeth; the tooth was the analytical unit because all measurements were site-specific. After prophylaxis and air-drying, calibrated examiners assigned ICDAS II scores, obtained DIAGNOdent Pen peak readings, and captured QrayCam Pro images at the same sites. QrayCam Pro analysis yielded maximum fluorescence loss (ΔFmax) and maximum red fluorescence gain (ΔRmax, %). ICDAS II scores were grouped as E0 (0), E1 (1), E2 (2–3), and D1 (4–5). Spearman correlation and ROC analyses were performed.</p> Results <p>Thirty sound surfaces and 115 ICDAS II-detected lesions were analysed. Median DIAGNOdent values increased from 10.5 in E0 to 74.0 in D1, ΔFmax decreased from 0.0% to − 60.0%, and ΔRmax increased from 0.0% to 70.0%. ICDAS II correlated strongly with DIAGNOdent (ρ = 0.91) and ΔFmax (ρ = −0.80) and moderately with ΔRmax (ρ = 0.67) (all p &lt; 0.001). For E0 vs. (E1 + E2+D1), AUCs were 0.94 for DIAGNOdent, 0.97 for ΔFmax, and 0.74 for ΔRmax. For E2 vs. D1, AUCs were 0.93, 0.85, and 0.80, respectively.</p> Conclusions <p>In this exploratory tooth-level analysis, DIAGNOdent Pen and QrayCam Pro metrics showed descriptive agreement with ICDAS II-derived clinical categories. Because analyses were not adjusted for within-participant clustering and formal pairwise AUC comparisons were not performed, the observed AUC patterns should be interpreted cautiously. The devices appear to provide complementary adjunctive information, and proposed cut-offs require external validation before clinical use.</p>

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Clinical cross-sectional diagnostic accuracy study of DIAGNOdent Pen and QrayCam Pro quantitative fluorescence for occlusal caries detection and ICDAS II-derived lesion categorization in permanent posterior teeth

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月4日

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  • Ahmad Bittar,
  • Elif Alkan,
  • Dilek Tağtekin

摘要

Background

Early detection of occlusal caries in posterior teeth is important for minimally invasive care. Visual systems such as the International Caries Detection and Assessment System (ICDAS II) standardize clinical scoring, but adjunctive fluorescence-based tools may improve objectivity. This clinical cross-sectional diagnostic accuracy study evaluated DIAGNOdent Pen and QrayCam Pro metrics (ΔFmax and ΔRmax) relative to ICDAS II-derived lesion categories in permanent posterior teeth.

Methods

This clinical cross-sectional diagnostic accuracy study included 64 adults who contributed 145 unrestored posterior teeth; the tooth was the analytical unit because all measurements were site-specific. After prophylaxis and air-drying, calibrated examiners assigned ICDAS II scores, obtained DIAGNOdent Pen peak readings, and captured QrayCam Pro images at the same sites. QrayCam Pro analysis yielded maximum fluorescence loss (ΔFmax) and maximum red fluorescence gain (ΔRmax, %). ICDAS II scores were grouped as E0 (0), E1 (1), E2 (2–3), and D1 (4–5). Spearman correlation and ROC analyses were performed.

Results

Thirty sound surfaces and 115 ICDAS II-detected lesions were analysed. Median DIAGNOdent values increased from 10.5 in E0 to 74.0 in D1, ΔFmax decreased from 0.0% to − 60.0%, and ΔRmax increased from 0.0% to 70.0%. ICDAS II correlated strongly with DIAGNOdent (ρ = 0.91) and ΔFmax (ρ = −0.80) and moderately with ΔRmax (ρ = 0.67) (all p < 0.001). For E0 vs. (E1 + E2+D1), AUCs were 0.94 for DIAGNOdent, 0.97 for ΔFmax, and 0.74 for ΔRmax. For E2 vs. D1, AUCs were 0.93, 0.85, and 0.80, respectively.

Conclusions

In this exploratory tooth-level analysis, DIAGNOdent Pen and QrayCam Pro metrics showed descriptive agreement with ICDAS II-derived clinical categories. Because analyses were not adjusted for within-participant clustering and formal pairwise AUC comparisons were not performed, the observed AUC patterns should be interpreted cautiously. The devices appear to provide complementary adjunctive information, and proposed cut-offs require external validation before clinical use.