Histological validation of the automated caries detection system (ACDS) in classifying occlusal caries with the ICDAS II system in vitro

  • E. D. Berdouses
  • C. J. OulisEmail author
  • M. Michalaki
  • E. E. Tripoliti
  • D. I. Fotiadis
Original Scientific Article



To compare the diagnostic performance of the automated caries detection system (ACDS) for the detection and diagnosis of occlusal caries with the histological appearance of the lesions.


Eighteen posterior permanent teeth were used, out of which 40 sections were made and 53 areas were evaluated. Teeth with hypoplastic and/or hypomineralised areas or sealants on the occlusal surfaces were excluded from the study. The teeth that were used for this study were a subgroup of the teeth used in the study that introduced ACDS system. This subgroup consisted of teeth having in their occlusal surfaces early carious lesions classified as international caries detection and scoring system (ICDAS) 0, 1, 2 and 3 after clinical examination by the examiners. Histological preparations were classified by experienced examiners based on the Ekstrand, Ricketts and Kidd (ERK) system and for the respective occlusal surfaces by the ACDS system based on ICDAS II system. There were two threshold limits considered as carious in either system ICDAS ≥ 2 or ≥ 3 and ERK index ≥ 2 or ≥ 3 and all possible combinations were analysed. Statistical methods of weighted version of kappa coefficient, Kendall’s tau-b correlation coefficient and p-values using the Fisher’s exact method were used at the confidence level of 0.05.


Intra-examiner kappa coefficient agreement was 0.87 and 0.89 while the inter-examiner for the two trials were 0.87 and 0.92. The ICDAS3-ERK3 combination between the ACDS and histological sections presented the best agreement with kappa coefficient 0.76, agreement 92.5%, sensitivity 100% and specificity 91.1%. ICDAS3-ERK3 combination between the optical examination of the examiners compared to the histological preparations showed kappa coefficient 0.87, agreement 96.2%, sensitivity 100%, Specificity 95.6%.


The evidence supports the view that ACDS classification of occlusal surfaces based on the ICDAS system are comparable with classification to that of an examiner and with the histology of the lesion. The use of ACDS has the distinct advantage though of removing the subjectivity of the examiner since it performs the classification without any intervention by him.


Occlusal caries Caries diagnosis ICDASII Tooth histology Segmentation Microscopy Digital imaging 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© European Academy of Paediatric Dentistry 2018

Authors and Affiliations

  • E. D. Berdouses
    • 1
  • C. J. Oulis
    • 1
    • 3
    Email author
  • M. Michalaki
    • 1
  • E. E. Tripoliti
    • 2
  • D. I. Fotiadis
    • 2
  1. 1.Department of Paediatric Dentistry, Dental SchoolNational and Kapodistrian University of AthensAthensGreece
  2. 2.Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and EngineeringUniversity of IoanninaIoanninaGreece
  3. 3.EAPDAthensGreece

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