目的:评价近红外光透照技术(near-infrared light transillumination,NILT,商品名DIAGNOcam)诊断乳磨牙早期邻面龋的应用价值。方法:对北京大学口腔医院儿童口腔科4~9岁疑有乳磨牙早期邻面龋的患儿进行视诊、咬合翼片和DIAGNOcam检查,龋齿指数记录为0(无龋)、1(釉质浅层龋)、2(釉质深层龋不超出釉牙本质界)、3(牙本质龋)。相邻2颗乳磨牙中至少1颗牙齿符合侵入性治疗标准方可纳入研究,即要求至少两项检查的龋齿指数≥2。对龋齿指数≥2的牙齿行侵入性治疗,直视下观察相邻乳磨牙的情况,若龋坏成洞,则也行侵入性治疗。将直视下龋洞深度与釉牙本质界的关系作为金标准,比较3种检查方法诊断乳磨牙早期邻面龋的灵敏度、特异度和准确度。结果:共纳入36例患儿104个乳磨牙邻面,其中,5个牙面最终诊断为无龋,20个牙面诊断为釉质浅层龋,79个牙面进行了侵入性治疗,包括22个牙面龋洞达釉牙本质界,57个牙面龋洞达牙本质层内。视诊、咬合翼片和DIAGNOcam诊断乳磨牙早期邻面龋的灵敏度为68.69%、81.82%、78.79%,特异度为100.00%、100.00%、80.00%,准确度为75.96%、85.65%、78.85%。对于釉质浅层龋,视诊诊断的灵敏度最低,仅为10.00%,DIAGNOcam的灵敏度(60.00%)高于咬合翼片(40.00%);对于釉质深层龋的诊断灵敏度,咬合翼片(86.36%)>DIAGNOcam(72.73%)>视诊(68.18%);对于牙本质龋,3种方法的诊断灵敏度均超过85%,咬合翼片最高为94.74%。结论:DIAGNOcam诊断乳磨牙早期邻面龋具有接近于咬合翼片的准确度,且使用安全、简便、无辐射,适用于儿童口腔临床。

Objective: To evaluate the practical value of near-infrared light transillumination (NILT, DIAGNOcam) on detection of incipient proximal caries in primary molars. Methods: In this study, 4-9-year-old children with suspicious proximal lesions in primary molars were recruited. The target teeth were examined with clinical examination, bitewing radiograph and DIAGNOcam. And the caries indexes were rated as 0 (no caries), 1 (caries reaching outer 1/2 enamel), 2 (caries reaching inner 1/2 ena-mel), and 3 (dentine caries). Those primary molars with at least one of the adjacent molars according with the criteria of invasive treatment, i.e. the teeth were diagnosed as caries reaching inner 1/2 enamel or dentine with at least two detection methods, were included. The target teeth with caries index ≥2 accepted the invasive treatment. And the caries status of the adjacent teeth was observed under direct vision and those teeth of caries index ≥2 would also accept the invasive treatment. The relationship of lesions to enamel-dentine junction (EDJ) were recorded and used as reference standard to compare the sensitivity, specificity and accuracy of those three methods in detecting the incipient proximal caries in primary molars. Results: In this study, 36 children with 104 suspicious proximal lesions in primary molars were recruited, of which 5 were diagnosed as no caries, 20 were diagnosed as superficial enamel caries, and 79 accepted invasive treatment, of which 22 were diagnosed as EDJ caries, and 57 as dentine caries. The sensitivity of clinical examination, bitewing radiograph, and DIAGNOcam were 68.69%, 81.82%, 78.79%, respectively. The specificity were 100.00%, 100.00%, 80.00%, and the accuracy were 75.96%, 85.65%, 78.85%, respectively. As for superficial enamel caries, the sensitivity of cli-nical examination was lowest, only 10%, while DIAGNOcam was 60%, higher than 40% of bitewing radiograph. As for EDJ caries, the sensitivity of bitewing radiograph was highest as 86.36%, followed by DIAGNOcam 72.73% and clinical examination 68.18%. As for dentine caries, the sensitivity of the three detection methods were higher than 85%, of which bitewing radiograph was the highest as 94.74%. Conclusion: The accuracy of DIAGNOcam in detecting incipient proximal caries in primary molars was comparable to that of bitewing radiograph. It was safe, and convenient with no exposure to radiation, which was applicable to be used in pediatric dentistry.