Dental Caries Detection in Children Using Intraoral Scanners Featuring Fluorescence: Diagnostic Agreement Study.

Background: Dental caries is a common chronic disease in children. Digital tools such as intraoral scanners (IOSs) may offer an efficient, scalable alternative to conventional visual examination for dental caries detection. IOSs are handheld devices that generate 3-dimensional (3D) models of the teeth and surrounding structures. Recent advances incorporating fluorescence technology into scanner hardware offer the potential for supporting dental caries detection. However, the performance of digital caries detection methods using 3D models that include both color and fluorescence in children's teeth remains unknown. Objective: This study aimed to assess the diagnostic agreement between visual examination and on-screen assessment of 3D models generated by an IOS in color and supplemented with fluorescence for caries detection in primary teeth. Methods: Children participating in a clinical trial (n=216, mean age 5.6, SD 0.4 y) underwent visual examination using the International Caries Detection and Assessment System (ICDAS) and intraoral scanning using the TRIOS 4 IOS. Four trained registered dental practitioners independently assessed each participant's 3D models in color and then supplemented with fluorescence, using a previously validated ICDAS index modified for on-screen assessments of 3D models. All 3D models were assessed again after 4 weeks. The time taken for intraoral scanning and on-screen assessment was recorded. Multilevel logistic regression was used to estimate and compare the likelihood of detecting caries between methods, and Bland-Altman plots were used to visualize agreement. Analyses were performed at the initial (ICDAS ≥01), moderate (ICDAS ≥03), and extensive (ICDAS ≥05) dental caries thresholds. Intraclass correlation coefficient (ICC) estimated method agreement and examiner reliability. Results: Of 219 children enrolled, 216 completed dental assessments. A total of 9470 visible primary tooth surfaces were included in the analysis. The average time taken for on-screen assessment of each 3D model (color with fluorescence) was 3.5 (SD 2.3) minutes. The likelihood of detecting caries using color assessment of 3D models was similar to visual examination at all disease thresholds: initial (odds ratio [OR] 1.1, 95% CI 1.0-1.3), moderate (OR 0.9, 95% CI 0.7-1.1), and extensive (OR 1.0, 95% CI 0.7-1.3). When color assessments were supplemented with fluorescence, the likelihood of detecting caries was 30% higher at the initial threshold relative to visual examination (OR 1.3, 95% CI 1.1-1.5) and similar at the moderate (OR 0.9, 95% CI 0.7-1.1) and extensive thresholds (OR 0.9, 95% CI 0.7-1.3). Bland-Altman plots showed a high level of agreement at both moderate and extensive thresholds. Agreement between methods was high (ICC 0.9, 95% CI 0.9-1.0). Intra- and inter-examiner reliability using intraoral scans ranged from good to excellent (ICC 0.8-1.0). Conclusions: On-screen assessment of 3D models in color demonstrated the highest agreement with visual examination for caries detection across all disease thresholds.