Assessment of caries activity using the Calcivis® Caries Activity Imaging System

Objective: An adequate diagnosis of dental caries means not only assessment of the change and the spread of change in the lesion, but also making a decision concerning its possible activity. Caries activity is primarily assessed using visual-tactile criteria that help estimate the probability of a carious lesion to progress. The aim of the present study was to test the capability of a new approach to ascertain lesion activity by means of bioluminescence (CalcivisⓇ Caries Activity Imaging System, Calcivis) in-vitro. Subjects and Methods: 46 extracted permanent posterior teeth were included in the study (30 occlusal surfaces, 16 smooth surfaces). The investigation sites were classified by two examiners using ICDAS and NYVAD criteria for lesion activity (activity yes/no) and consensus score of each site was determined as reference value. The sites were photographed using a prototype Calcivis System and the images were evaluated by both examiners for the presence of activity (bioluminescence, blue spots at the investigation sites). Correlation of methods was calculated using Spearman's rank correlation coefficient (rs). Agreement between methods was assessed by kappa statistics. ROC curves were created for Calcivis and both visual methods and the areas under the Curve (AUC) were compared (α=0.05). Results: Significant positive correlation was found between Calcivis and the visual detection methods: rs ICDAS=1.0, rs Nyvad criteria=0.776 (p<0.001). Kappa-values were: Calcivis/ICDAS=1.0, Calcivis/Nyvad=0.78. AUC for Calcivis was 1.0 (ICDAS as reference value) and 0.89 (Nyvad criteria as reference value).No significant differences were observed between the AUCs (p=0.30). Conclusion: The in-vitro use of the bioluminescence method showed good agreement with visual findings in assessment of the activity of a carious lesion in the area of occlusal and smooth surfaces.