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Detection of early secondary caries, before obvious cavitation, has been proven difficult. Conventional techniques detect secondary caries when it is relatively advanced and a significant amount of tissue has been lost. Purpose: The purpose of this study was to determine the ability of new techniques - Early Visual Examination scale (VE), Quantitative Light-induced Fluorescence (QLF), and DIAGNOdent (IR) - to detect early secondary caries on extracted teeth. Methods: Eighty teeth with restorations (40 with amalgams/40 with resin composites) were selected from extracted human teeth. Every restoration margin was scored by the three different techniques. Twenty five percent of the teeth were re-examined twenty-four hours or more after the last exam. All restorations were careful removed using a high-speed hand piece with abundant water irrigation, and cavities were visually/tactilely examined under a dental unit light source using an explorer and a sharp spoon excavator. Each cavity wall was scored independently. Results: In the amalgam group, the QLF was the most sensitive technique, while VE showed the highest specificity. The percentages of correct (accuracy) diagnosis were 77, 70, and 68 for VE, QLF, and IR, respectively. Repeatability was moderate, except for VE, which was substantial (Kappa = 0.65). In the resin composite group, we found IR to be the most sensitive technique, while QLF was the most specific. QLF was correct 67% of the time, followed by VE (64%) and IR (59%). Repeatability was fair to moderate for all techniques. Conclusion: All three methodologies appear to have similar accuracy, being slightly higher in lesions around amalgam restorations. Significant differences were found in sensitivity and specificity among the techniques and they should be selected according to their intended clinical purpose (e.g. restoration replacement vs. preventive/remineralizing therapies). Supported by the Delta Dental Foundation. |