Acurácia do método diagnóstico fotográfico para detecção de lesões cariosas associadas ao uso de aparelho ortodôntico fixo

Abstract

The present dissertation consists of a scientific article whose objective was to evaluate the accuracy of the photographic diagnostic method for detecting caries lesions associated with the use of orthodontic appliances. The sample consisted of 38 patients with fixed orthodontic appliance in both arches (UT group, “under treatment”), 16 male (42%) and 22 female (58%), with a mean age (±standard deviation [sd]) of 23 (±8.6) years and 10 patients without a fixed device, addressed immediately after their removal (IAT group, “immediately after treatment”), 8 female and 2 male, with a mean age (±sd) of 22 (±10) years. The sample was recruited among individuals under treatment in the Specialization Course in Orthodontics, Faculty of Ingá (UNINGA) - Santa Maria Unit (RS) or in the dental service of Santa Maria Air Base – BASM. First, a visual-tactile clinical examination was performed to detect caries lesions, after professional tooth cleaning and drying, at a dental unit, with a clinical mirror and a probe from the World Health Organization. A professional trained to take dental photographs performed all standardized photographic records. With the aid of photographic retractors and after drying the teeth, the photographs were taken with a digital camera in five views: frontal, left lateral, right lateral, lower occlusal, and upper occlusal. A single trained and calibrated examiner for the caries index performed all clinical and photographic assessments, using the same criterion. The diagnostic parameters of sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated for the photographic method considering the clinical examination as the gold standard. Of the 38 patients in the UT group, the prevalence of active caries was 92%. Only 3 individuals did not show caries activity. The digital photographs were able to correctly identify 29 of the 35 individuals with active caries according to the gold standard. On the other hand, only 1 of the 3 healthy patients was correctly identified by this method. These findings are expressed in the diagnostic parameters: sensitivity 83%, specificity 33%, accuracy 79%, positive predictive value 93% and negative predictive value 14%. All the 10 patients in the IAT group had active caries lesions, of whom only 5 were identified by the digital photographs taken with the camera. In conclusion, this study showed that the photographic examination had a satisfactory accuracy to detect caries-active patients during the fixed orthodontic therapy, showing a high sensitivity. However, when the method was used after the removal of the orthodontic appliance, it was unable to identify the presence of active caries lesions.