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Quantitative light-induced fluorescence images and digital photographs - Reproducibility of manually marked demineralisations

Bildgebung mit quantitativer lichtinduzierter Fluoreszenz und digitalen Aufnahmen - Reproduzierbarkeit manueller Demineralisationsmarkierungen

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Objective

Hard tooth tissue demineralisation is an undesirable side effect of orthodontic treatment with fixed appliances. Whereas both clinically and in digital photographs (DP), demineralisations appear as white spot lesions, WSLs appear as dark areas when quantitative light-induced fluorescence (QLF) imaging is used. This study aims at comparing the reproducibility of the detection of decalcified tooth areas in DP and QLF.

Materials and methods

DP and QLF pairs were acquired from 139 teeth of 32 patients after braces removal. Three raters manually marked the decalcified area on both DP and QLF images. The markings were repeated after 2 weeks. A ground truth was estimated for each tooth and modality using the simultaneous truth and performance level estimation (STAPLE) algorithm. The Dice coefficients (DC) of each rater marking to the ground truth were calculated for all teeth and modalities to quantify the spatial agreement. A three-way repeated measures analysis of variance (ANOVA) was used to compare the means of the DCs for both modalities (\( p\; < \;0.05 \)). Intra-observer and intercycle variabilities were assessed comparing the means across the raters and the cycles for both modalities.

Results

ANOVA revealed a statistical significant difference between the modalities [\( F (1, 138)\; = \; 62.89 \), \( p \; < \; 0.001 \)]. The standard deviation of the DC for the photographs are lower than those for the QLF images. Intra-observer and intercycle differences are rather small as compared to the intermodality differences.

Conclusions

The results indicate a higher spatial reproducibility in identifying a decalcified area on a tooth surface using visual inspection of DP rather than QLF images.

Zusammenfassung

Ziel

Zahnhartsubstanzschäden in Form von Demineralisationen (WSLs) gelten als unerwünschte Nebenwirkung der kieferorthopädischen Behandlung mit festsitzenden Apparaturen. Sowohl klinisch als auch in digitalen Fotografien (DF) stellen sich WSLs als weißlich-opake, bei der QLF-Diagnostik als dunkle Bereiche dar. Ziel der vorliegenden Studie ist es, die Reproduzierbarkeit von Demineralisationsmarkierungen auf Basis der DF- und QLF-Bildgebung zu vergleichen.

Material und Methoden

DP- und QLF-Aufnahmen wurden von 139 Zähnen bei 32 Patienten nach Entfernung einer festsitzenden Apparatur erstellt. Drei Untersucher markierten manuell die Demineralisationen in beiden Modalitäten. Die Markierungen wurden 14 Tage später wiederholt. Für jeden Zahn und jede Modalität wurde mithilfe des STAPLE (Simultaneous Truth and Performance Level Estimation)-Algorithmus eine Ground Truth ermittelt. Die örtliche Übereinstimmung der Untersuchermarkierungen zur Ground Truth wurde mit dem Dice-Koeffizient (DC) berechnet. Mittels mehrfaktorieller Varianzanalyse (ANOVA) wurden die Mittelwerte der DC-Werte für beide Modalitäten verglichen (p < 0,05). Die Intra-Untersucher- und die Inter-Zyklus-Variabilität wurden durch Vergleich der DC-Mittelwerte und Varianzen bewertet.

Ergebnisse

ANOVA zeigte einen statistisch signifikanten Unterschied zwischen den Modalitäten [F (1; 138) = 62,89, p < 0,001]. Die Standardabweichung des DC war bei den digitalen Bildern geringer als bei der QLF-Bildgebung. Die Unterschiede zwischen den Untersuchern und den Zyklen waren vergleichsweise gering.

Schlussfolgerung

Die Ergebnisse zeigen eine größere örtliche Reproduzierbarkeit der Demineralisationsmarkierung auf vestibulären Glattflächen auf den Fotographien als auf korrespondierenden QLF-Aufnahmen.

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Acknowledgements

The authors would like to thank Andras Keszei, Uniklinik RWTH Aachen, Germany, for his guidance in the statistical analysis. The authors at AICES RWTH Aachen University were funded in part by the Excellence Initiative of the German Federal and State Governments.

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Authors and Affiliations

  1. Aachen Institute for Advanced Study in Computational Engineering Science (AICES), RWTH Aachen University, Schinkelstr. 2, 52062, Aachen, Germany

    Rosalia Tatano &  Benjamin Berkels

  2. Uniklinik RWTH Aachen, Klinik für Kieferorthopädie, Pauwelsstr. 30, 52074, Aachen, Germany

    Eva E. Ehrlich & Ulrike B. Fritz

  3. Uniklinik RWTH Aachen, Institut für Medizinische Informatik, Pauwelsstr. 30, 52074, Aachen, Germany

    Ekaterina Sirazitdinova & Thomas M. Deserno

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  1. Rosalia Tatano
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  2. Eva E. Ehrlich
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  4. Ekaterina Sirazitdinova
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Correspondence to Rosalia Tatano.

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Tatano, R., Ehrlich, E.E., Berkels, . et al. Quantitative light-induced fluorescence images and digital photographs - Reproducibility of manually marked demineralisations. J Orofac Orthop 78, 137–143 (2017). https://doi.org/10.1007/s00056-016-0069-6

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