Early occlusal caries detection using targeted fluorescent starch nanoparticles.
Early occlusal caries detection using targeted fluorescent starch nanoparticles.
复制标题
使用靶向荧光淀粉纳米颗粒进行早期咬合龋齿检测。
DOI：
10.1016/j.jdent.2022.104243
复制
发表时间：
2022
影响因子：
4.4
通讯作者：
González-Cabezas,Carlos
中科院分区：
文献类型：
--
作者：
Jones,NathanA;Bloembergen,Wendy;Tenuta,LiviaMA;Flannagan,SusanE;Jones,GlennW;Pan,Li-Chi;Newton,Mariah;Clarkson,BrianH;Lahann,Joerg;Bloembergen,Steven;González-Cabezas,Carlos
目的：我们先前已经证明荧光阳离子淀粉纳米颗粒（FCSNs）可以穿透活动性龋损的釉质表面孔隙，可能有助于其检测。方法选取离体牙100颗，其中50颗为有声龋牙，25颗为无龋牙，25颗为有龋牙。在浸入FCSN溶液、水冲洗和通过橙子UV滤光镜观察的牙科固化灯照射后，由两名独立的检查者评估咬合面上的感兴趣区域（ROI）的荧光。将ROI切片并通过组织学（Downer标准）进行评价，作为龋齿存在的金标准。测定检查者间和检查者内一致性的Cohen’s Kappa，并计算敏感性、特异性和受试者操作曲线（ROCAUC）曲线下面积。重复分析的子集的“早期”病变，定义为限于enamel.ResultsFCSN使用导致大量的用户间（k=0.74±0.07），和高用户内协议（k=0.80±0.06; 0.94±0.03，由考官）。FCSNs对所有患者的敏感性、特异性和ROROC分别为88.9%、94.6%和0.92±0.06;对早期病变的敏感性、特异性和ROROC分别为76.9%、94.6%和0.86±0.10。在事后分析，灵敏度似乎是更大的FCSN比专家的视觉exam，特别是对早期lesions.Conclusions/Clinical significanceFCSNs是一种可重复的和准确的新技术，用于咬合面龋检测，具有较高的灵敏度和特异性相比，组织学。未来的临床验证是必要的。FCSNs可以改善早期龋齿检测，并将治疗转向非侵入性方法，改善口腔健康。
ObjectivesWe have previously shown fluorescent cationic starch nanoparticles (FCSNs) penetrate enamel surface porosity of active carious lesions, potentially aiding their detection. Here, we evaluate thein vitrodiagnostic accuracy of FCSNs in detecting occlusal caries compared to histologic reference standard.Methods100 extracted human teeth were selected with sound (50), or either non-cavitated (25) or cavitated (25) lesions. A region of interest (ROI) on the occlusal surface was assessed for fluorescence by two independent examiners, after immersion in FCSN solution, water rinse, and illumination by dental curing lamp viewed through orange UV-filter glasses. ROIs were sectioned and evaluated by histology (Downer Criteria) as a gold standard for caries presence. Cohen's Kappa was determined for inter- and intra-examiner agreement, and sensitivity, specificity, and area under the curve of Receiver Operator Curves (ROCAUC) were calculated. The analysis was repeated for the subset of “early” lesions, defined as being limited to enamel.ResultsFCSN use resulted in substantial inter-user (k=0.74±0.07), and high intra-user agreement (k=0.80±0.06; 0.94±0.03, by examiner). Sensitivity, specificity and ROCAUCfor FCSNs were 88.9%; 94.6%; 0.92±0.06 for all, and 76.9%, 94.6%, and 0.86±0.10 for early lesions. In post hoc analysis, sensitivity seemed to be greater with the FCSN than the expert visual exam, particularly for early lesions.Conclusions/Clinical significanceFCSNs are a reproducible and accurate novel technology for occlusal caries detection, with high sensitivity and specificity compared to histology. Future clinical validation is necessary. FCSNs can improve early caries detection and shift treatment towards non-invasive approaches, improving oral health.