Diagnóstico de cárie em dentes permanentes segundo critérios da Organização Mundial de Saúde, International Caries Detection and Assessment System II e NYVAD: estudo in vitro

Abstract

The objective of this study was to investigate inter and intra-examiner reproducibility of occlusal carious lesions diagnosis in permanent teeth using three codes and diagnostic criteria: WHO (1997), Nyvad (1999) and ICDAS-II (2002). The study consisted of two phases: 1) examiners training, 2) caries lesions assessment according to presented criterion followed by histological depth examination in stereomicroscope. A total of 30 teeth were examined during the training phase and 50 teeth on the visual examination phase with histological validation, predetermined by the master examiner. The examiners consensus was used for the diagnosis training validation. On second phase two ICDAS-II and Nyvad cutoff points were stablished: D2- lesion; D3/N1-cavity lesion. Thus, the ICDAS-II D2 thereshold considered lesion all those that reached enamel or dentin, the D3 thereshold classified as carious lesions those with enamel breakdown and the other sites were considered as "not decayed". Nyvad s N1 cutoff point re-ordered scores according to lesion severity. The ICDAS-II inter-examiner reproducibility ranged from 0.60 to 0.71. For Nyvad criteria, the reproducibility values ranged from 0.82 to 0.59, considered moderate and optimal values according to Landis and Koch (1977). The reproducibility according WHO index ranged from 0.74 to 0.94. The ICDAS-II D2 inter-examiner reproducibility was 0.54 and 0.57 at D3 cutoff point. The cutoff point Nyvad N1 values ranged from 0.70 to 0.83. The correlation coefficients for visual and histological assessment ranged from 0.48 (Nyvad N1) to 0.95 (ICDAS-II D3), both using Spearman correlation test. This study verified the inter and intra-examiner reproducibility of occlusal carious lesions diagnosis in permanente teeth using three codes and diagnostic criteria resulting in an acurate diagnostic.