Comparison of Intra-Examiner Agreement in the In Vivo Diagnosis of Carious Lesions With and Without Loupes Using the ICDAS II System.

BACKGROUND

Accurate early caries detection remains a major challenge in minimally invasive dentistry. While visual inspection remains the clinical gold standard, magnification loupes are increasingly used in dental practice. However, their diagnostic reliability under real clinical conditions remains unclear.

Objective

To evaluate intra-examiner agreement in the diagnosis of occlusal carious lesions using the ICDAS II system with and without 3.5x magnification loupes.

MATERIAL AND

METHODS

A cross-sectional in vivo study was conducted on 143 teeth (572 measurements) from 15 patients. Each occlusal surface was examined twice with and twice without loupes, randomized by sequence and separated by at least seven days. The examiner was calibrated and blinded to prior results. Weighted Cohen's Kappa coefficients, sensitivity, and specificity were calculated for each lesion type.

RESULTS

Concordance between methods was moderate (weighted Kappa = 0.56; 95% CI: 0.43-0.69). Intra-examiner reproducibility was high for both loupes (Kappa = 0.88) and unaided inspection (Kappa = 0.81). Sensitivity and specificity were highest for incipient and severe lesions, while low prevalence limited estimates for moderate lesions. Overall diagnostic accuracy for the magnified method was 0.85 (95% CI: 0.80-0.89).

CONCLUSIONS

Magnification loupes provide comparable diagnostic accuracy to unaided visual inspection, with improved sensitivity for early lesions. Their systematic use may enhance diagnostic consistency and clinical training in preventive and minimally invasive dentistry.