Evaluation Of Diagnostic Tests Using Information Theory For Multi-Class Diagnostic Problems And Its Application For The Detection Of Occlusal Caries Lesions

Background: Several methods are available to evaluate the performance of the tests when the purpose of the diagnostic test is to discriminate between two possible disease states. However multi-class diagnostic problems frequently appear in many areas of medical science. Hence, there is a need for methods which will enable us to characterize the accuracy of diagnostic tests when there are more than two possible disease states. Aims: To show that two information theory measures, information content (IC) and proportional reduction in diagnostic uncertainty (PRDU), can be used for the evaluation of the performance of diagnostic tests for multi-class diagnostic problems that may appear in different areas of medical science. Study Design: Diagnostic accuracy study. Methods: Sixty freshly extracted permanent human molar and premolar teeth suspected to have occlusal caries lesions were selected for the study and were assessed by two experienced examiners. Each examiner performed two evaluations. Histological examination was used as the gold standard. The scores of the histological examination were defined as sound (n=11), enamel caries (n=22) and dentin caries (n=27). Diagnostic performance of i) visual inspection, ii) radiography, iii) laser fluorescence (LF) and iv) micro-computed tomography (M-CT) caries detection methods was evaluated by calculating IC and PRDU. Results: Micro-computed tomography examination was the best method among the diagnostic techniques for the diagnosis of occlusal caries in terms of both IC and PRDU. M-CT examination supplied the maximum diagnostic information about the diagnosis of occlusal caries in the first (IC: 1.056; p<0.05), (PRDU: 70.5%) and second evaluation (IC: 1.105; p<0.05), (PRDU: 73.8%) for the first examiner. M-CT examination was the best method among the diagnostic techniques for the second examiner in both the first (IC: 1.105; p<0.05), (PRDU: 73.8%) and second evaluation (IC: 1.061; p<0.05), (PRDU: 70.8%). IC and PRDU were lowest for visual inspection. Conclusion: The present study demonstrates that IC and PRDU can be used to evaluate diagnostic test performance when multiple disease states are being evaluated.WoSScopu

Morphological Evaluation Of Rat Incisor Enamel And Dentin Induced By Pregnancy And Lactation Using A Scanning Electron Microscope

This study assessed the effects of pregnancy and lactation oil the morphology of the dentine tubules and external enamel surface of rat incisor teeth using a scanning electron microscope (SEM) equipped with an energy dispersive x-ray (EDX) system. Twenty-four female Wistar rats were divided into three groups; group A rats were at the end of pregnancy, group B rats were in the post-lactation period and group C rats, the control group, were unmated. The outer enamel Surface and openings of the dentine tubules at the neck regions of the incisors were observed under the SEM and photographed. Examination of the incisor teeth of pregnant and post-lactation rats revealed scratches oil the enamel Surface. There were few eroded areas and slight changes and the dentine tubules of the pregnant group were fully or partially Occluded on the entire Surface of the enamel in the lactating rats. Almost all dentine tubules of the rats in this group were open. During the study, EDX analysis of calcium, phosphate and magnesium was also performed at 20 kV and 0 degree tilt. The results of EDX analyses of magnesium were significantly lower in the pregnant group compared with the lactation and control groups for the dentine in the neck region (p<0.05). The calcium values increased in the lactation group compared with those of the rats in the other two groups (p<0.05). These results might indicate that changes during pregnancy and lactation affect the content and morphology of mineralized denial hard tissue.WoSScopu

Validation of micro-computed tomography for occlusal caries detection: an in vitro study

Conventional methods of caries detection, including the gold standard of histological examination, have certain disadvantages that must be addressed prior to validating any other diagnostic technique—current or new. Here we evaluated the validity of micro-computed tomography (micro-CT) as an alternative gold-standard technique for caries detection. Sixty teeth with suspected occlusal caries were chosen from a pool of teeth extracted for orthodontic, periodontal, or surgical reasons. Identical reference points were marked on photographs taken for teeth and were used to evaluate each method. Dimensions of caries were assessed by two calibrated examiners using the ICDAS-II visual examination system, bitewing radiographs, and micro-CT. The teeth included in the study were selected randomly from solution before all measurements. For micro-CT, the device was set to 50 kV, 800 µA, pixel size 15 µm (at 1024 × 1024 resolution), and 1° rotation step. NRecon software (SkyScan) was used to obtain reconstructed images. For each diagnostic method, results were compared with histology results using the McNemar test. Receiver operator characteristic (ROC) analysis was also performed for each method (Z-test; p < 0.05). Besides showing a high correlation with histology results, micro-CT yielded the greatest values at the D3 threshold; moreover, accuracy and area under the ROC curve (AUC) values were greatest at the D1threshold. Our results indicate that micro-CT performs as well as or better than histological examination for the purpose of comparing methods for caries detection