Abstract
•The use of clinical photographs has better validity than the laser fluorescence device (DIAGNOdent pen™ 2190) in diagnosing the presence of WSLs (white spot lesions) and assessing the severity of WSLs around the brackets during multi-bracketed fixed orthodontic treatment.•The accuracy of clinical photographs is excellent in diagnosing and assessing the severity of WSLs during multi-bracketed fixed orthodontic treatment.•The accuracy of DIAGNOdent pen™ is good in diagnosing WSLs; but poor in assessing the severity of WSLs during multi-bracketed fixed orthodontic treatment.
To compare the validity of DIAGNOdent pen™ 2190 and clinical photographs in the diagnosis (presence or absence) and assessment of white spot lesions (WSLs) during multi-bracketed fixed orthodontic treatment.
A total of 1607 readings from 99 patients were obtained using DIAGNOdent pen™ 2190, clinical photographs, and visual assessment criteria to assess WSLs at 6 -, 12- and 18 months after bonding of brackets. Receiver operating characteristic curves were constructed, and areas under the curve (AUC) were calculated to assess the presence or absence of WSLs and distinguish the severity of WSLs as slight or severe. Sensitivities, specificities, and AUC were calculated for outcomes at an alpha of 0.05 and 95% confidence intervals (CIs).
The values of sensitivity and specificity of DIAGNOdent pen™ 2190 were found to be 0.78 and 0.83, respectively, to distinguish presence/absence of WSLs with good accuracy (AUC= 0.855; 95% CI: 0.820–0.889) and for digital photographs, accuracy was excellent (AUC= 0.973, 95% CI: 0.956–0.991) with sensitivity and specificity of 0.96 and 0.99, respectively. However, the accuracy of DIAGNOdent pen™ 2190 was poor (AUC= 0.543, 95% CI: 0.418–0.668) in delineating slight and severe WSLs with a sensitivity of 0.31 and specificity of 0.83; while the values of sensitivity and specificity for distinguishing slight or severe lesions for clinical photographs were 0.96 and 0.99, respectively with excellent accuracy (AUC=0.978, 95% CI: 0.936–1.000).
Clinical photographs had better validity than DIAGNOdent pen™ 2190 in diagnosis and assessment of severity of demineralized lesions during multi-bracketed fixed orthodontic treatment.