定量的光誘起蛍光法による虫歯や亀裂の検出をX線写真や目視と比較。A Retrospective Case Study

Detection of Dental Caries and Cracks with Quantitative Light-Induced Fluorescence in Comparison to Radiographic and Visual Examination: A Retrospective Case Study.

抄録

本研究の目的は，従来の検査と定量的光誘起蛍光法（QLF）を比較・分析することにより，最適な診断プロトコルを提示することである．153名の患者の297本の歯を選び，QLF画像とビットウイングX線写真を撮影した。咬合面齲蝕，近心面齲蝕，クラックをQLF，X線，目視の3つの方法で評価し，スコア化した．感度，特異性，および受信者動作特性分析の曲線下面積（AUC）を算出した．2つの蛍光パラメータ（｜ΔFmax｜および｜ΔRmax）を利用して，QLFやX線判定基準に基づく病変の重症度に応じた蛍光パターンを評価した。QLFは従来法と比較して，咬合面カリエスやクラックの検出に高いスコアを示した。ΔRmaxは，咬合面カリエスでΔFmaxよりも明確に増加した。咬合部齲蝕，近心部齲蝕および亀裂の｜ΔFmax｜値は，良好なAUCレベル（それぞれ0.84，0.81，0.83）を示した．咬合面齲蝕のΔRmaxはビットウイングX線写真と比較して最も高いAUC（0.91）を示し，近心齲蝕のΔRmaxは失敗レベル（0.59）を示した．QLF画像は，咬合面のう蝕や亀裂の程度を可視化し，推定することができた。その結果，QLF法は，従来の方法に加えて，咬合齲蝕や周辺のクラックを検出するための補助的なツールとなり得る。

The aim of this study was to present an optimal diagnostic protocol by comparing and analyzing a conventional examination and the quantitative light-induced fluorescence (QLF) technique. Selected were 297 teeth of 153 patients to take QLF images and bitewing radiographs. Occlusal dental caries, proximal dental caries and cracks were evaluated and scored using QLF, X-ray and/or visual criteria. The sensitivity, specificity, and area under the curve (AUC) of a receiver operating characteristic analysis were calculated. Two fluorescence parameters (|ΔFmax| and ΔRmax) were utilized to evaluate the fluorescence pattern according to the severity of lesions based on QLF or X-ray criteria. QLF showed higher scores for detecting occlusal dental caries and cracks than the conventional method. ΔRmax increased more clearly than ΔFmax did with occlusal dental caries. The |ΔFmax| values of occlusal dental caries, proximal dental caries and cracks showed good AUC levels (0.84, 0.81 and 0.83, respectively). The ΔRmax of occlusal dental caries showed the highest AUC (0.91) and the ΔRmax of proximal dental caries showed a fail level (0.59) compared to bitewing radiographs. The QLF image could visualize and estimate the degree of occlusal dental caries or cracks. Consequently, the QLF technique may be an adjunct tool to conventional methods for the detection of occlusal caries and peripheral cracks.