Clinical Oral Investigations

, Volume 18, Issue 3, pp 737–744 | Cite as

An in vivo and in vitro investigation of the use of ICDAS, DIAGNOdent pen and CarieScan PRO for the detection and assessment of occlusal caries in primary molar teeth

  • Terry Kuo-Yih TeoEmail author
  • Paul Francis Ashley
  • Chris Louca
Original Article



The aim of this study was to investigate the in vivo and in vitro validity of International Caries Detection and Assessment System (ICDAS), DIAGNOdent pen and CarieScan PRO in the detection and assessment of occlusal caries in primary teeth.


Sixty-four molars were assessed using all three systems under standardised in vivo conditions. They were then extracted and assessed by two examiners in vitro along with an additional 38 teeth (102 teeth in total from 45 children). Downer’s histological scoring criterion was the validation gold standard. Sensitivity, specificity, positive and negative likelihood ratios and area under the receiver–operator curves were calculated for all caries and dentine caries. Repeatability was analysed using Cohen’s Kappa and the performance of the systems between in vivo and in vitro settings by the same examiner were compared.


ICDAS showed the highest validity and repeatability. The DIAGNOdent pen’s overall clinical validity was comparable to that of ICDAS, but it demonstrated only moderate repeatability. CarieScan PRO had negligible validity in vivo, and there was no relationship between in vivo and in vitro parameters.


The in vivo results of ICDAS and DIAGNOdent pen were satisfactory and comparable to those obtained in vitro, with ICDAS performing better. The CarieScan PRO performed poorly under both conditions.

Clinical relevance

ICDAS should be the index of choice when detecting and assessing occlusal caries in the primary dentition, and in vitro data can be safely extrapolated in vivo. The DIAGNOdent pen must be employed with caution. Currently, the CarieScan PRO is unsuitable for use in the primary dentition.


Occlusal caries Primary molar ICDAS DIAGNOdent pen CarieScan PRO Caries detection 



We would like to thank Dr Graham Palmer, Dr Susan Parekh and Dr Adrian Moles for their contributions.

Conflict of interests

The authors declare that they have no conflict of interests.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Terry Kuo-Yih Teo
    • 1
    Email author
  • Paul Francis Ashley
    • 2
  • Chris Louca
    • 3
  1. 1.Restorative DentistryNational Dental CentreSingaporeSingapore
  2. 2.Paediatric DentistryUCL Eastman Dental InstituteLondonUK
  3. 3.UCL Eastman Dental InstituteLondonUK

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