Supplementary Material for: An in vitro Comparison of Detection Methods for Approximal Carious Lesions in Primary Molars

<i>Background/Aims:</i> This study aimed to compare and contrast in vitro six methods to determine the most accurate method for detecting approximal carious lesions in primary molars. <i>Methods:</i> Extracted primary molars (n = 140) were stored in 0.02% chlorhexidine solution and mounted in light-cured resin in pairs. The six carious lesion detection methods used by the three examiners to assess approximal carious lesions were visual inspection, digital radiography, two transillumination lights (SDI and NSK), and two laser fluorescence instruments (CDD and DDP). Five damaged teeth were discarded. The teeth (n = 135) were sectioned, serially ground, and examined under light microscopy using Downer’s histological (HST) criteria as the gold standard. Intra- and inter-examiner reliability, agreement with HST, specificity, sensitivity, receiver operating characteristic (ROC) curves, and areas under the curve were calculated. <i>Results:</i> This study found visual inspection to be the most accurate method when validated by histology. Transillumination with NSK light had the highest specificity, and digital radiography had the highest sensitivity for detecting enamel and/or dentinal carious lesions. Combining specificity and sensitivity into the area under ROC curves, enamel plus dentinal lesions were detected most accurately by visual inspection followed by digital radiography; dentinal lesions were detected most accurately by digital radiography followed by visual inspection. <i>Conclusions:</i> None of the four newly developed methods can be recommended as suitable replacements for visual inspection and digital radiography in detecting carious lesions on approximal surfaces of primary molars, and further developmental work is needed.背景与目的：本研究旨在通过体外实验对比六种检测方法，以确定检测乳磨牙邻面龋损的最优方案。方法：本研究纳入140颗拔除的乳磨牙，将其保存于0.02%氯己定溶液中，并成对包埋于光固化树脂内。由3名检查者采用6种方法评估乳磨牙邻面龋损，分别为目视检查、数字化X线摄影、2种透照灯（SDI与NSK）以及2种激光荧光检测仪（CDD与DDP）。剔除5颗受损牙后，剩余135颗牙均进行离体切块、连续磨片，并以光学显微镜结合唐纳组织病理学（HST）标准作为金标准进行检测。随后计算检查者组内与组间信度、与HST标准的一致性、特异度、灵敏度、受试者工作特征（Receiver Operating Characteristic，ROC）曲线及曲线下面积。结果：经组织病理学验证后，本研究发现目视检查为检测准确率最高的方法。NSK透照灯的检测特异度最高，而数字化X线摄影对牙釉质及/或牙本质龋损的检测灵敏度最高。结合特异度与灵敏度计算ROC曲线下面积后，目视检查对牙釉质合并牙本质龋损的检测准确率最高，其次为数字化X线摄影；针对牙本质龋损的检测，则以数字化X线摄影准确率最高，目视检查次之。结论：本研究所涉及的4种新开发检测方法，均无法替代目视检查与数字化X线摄影用于乳磨牙邻面龋损的检测，仍需开展进一步的研发工作。