CC BY-NC-ND 4.0 · Eur J Dent 2013; 07(02): 159-164
DOI: 10.4103/1305-7456.110157
Original Article
Dental Investigation Society

Reliability analysis of two methods for measuring active enamel demineralization: An in vitro study

Camila Nassur
1   Department of Pediatric Dentistry and Orthodontics, Dental School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
Luciana Pomarico
2   Department of Specific Formation, Dental School, Federal Fluminense University, Nova Friburgo, Brazil
Lucianne Cople Maia
1   Department of Pediatric Dentistry and Orthodontics, Dental School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
› Author Affiliations
Further Information

Publication History

Publication Date:
25 September 2019 (online)


Objective: The aim was to evaluate the intra- and inter-examiner reliability of two methods, namely, digital caliper [DC] and computerized image analysis software (Image Tool [IT] version 4.1) for measuring the area of an active enamel demineralization lesion. The effect on that measurement of a window that delimits the lesion was also assessed. Materials and Methods: Thirty-eight circular artificial enamel demineralization lesions (r = 2 mm) were produced on bovine teeth in vitro, which were then measured three times by three examiners, with and without the presence of a window delimiting the area to be measured. The data were analyzed by the intraclass correlation coefficient (ICC) with 95% confidence interval (CI) and by the Altman and Bland analysis. Results: The intra-examiner correlation using the IT method showed excellent reproducibility (mean ICC values 0.922-0.970 with the delimiting window and 0.915-0.990 without the window). However, the intra-examiner correlation using the DC method showed comparatively less reproducibility in the measurements (mean ICC values 0.458-0.648 with the delimiting window and 0.378-0.665 without the window). The inter-examiner correlations showed very good reproducibility of the measurements regardless of the presence or absence of the window for both the DC method (0.811-0.846) and IT method (0.953-0.994). However, the latter method showed less variability within the measurements. Conclusion: However, statistically no significant difference was found between both methodologies. Nevertheless, computerized image analysis with the Image Tool software demonstrated higher intra- and inter-examiner reliability than the digital caliper method, in estimating the area of the enamel demineralization lesion, regardless of the delimiting window.


  • 1 Featherstone JD. The continuum of dental caries-evidence for a dynamic disease process. J Dent Res 2004; 83 (special No C): C39-42
  • 2 Featherstone JD. Prevention and reversal of dental caries: role of low level fluoride. Community Dent Oral Epidemiol 1999; 27: 31-40
  • 3 Arends J, Christoffersen J. The nature of early caries lesions in enamel. J Dent Res 1986; 65: 2-11
  • 4 Featherstone JD. Caries detection and prevention with laser energy. Dent Clin North Am 2000; 44: 955-69
  • 5 Pereira AC, Verdonschot EH, Huysmans MC. Caries detection methods: Can they aid decision making for invasive sealant treatment?. Caries Res 2001; 35: 83-9
  • 6 Akarsu S, Koprulu H. In vivo comparison of the efficacy of DIAGNOdent by visual inspection and radiographic diagnostic techniques in the diagnosis of occlusal caries. J Clin Dent 2006; 17: 53-8
  • 7 Hamilton JC. Should a dental explorer be used to probe suspected carious lesions? Yes-an explorer is a time-tested tool for caries detection. J Am Dent Assoc 2005; 136: 1526-30
  • 8 Horowitz AM. A report on the NIH Consensus Development Conference on Diagnosis and Management of Dental Caries Throughout Life. J Dent Res 2004; 83 (Spec No C): C15: 7
  • 9 Reventlid M, Mörnstad H, Teivens AA. Intra- and inter-examiner variations in four dental methods for age estimation of children. Swed Dent J 1996; 20: 133-9
  • 10 Lay MC, Reis AT. Quantitative analysis in environment-behavior studies area. Ambient Constr 2005; 5: 21-36
  • 11 Kelly A, Antonio AG, Maia LC, Luiz RR, Vianna RB, Quintanilha LE. Reliability assessment of a plaque scoring index using photographs. Methods Inf Med 2008; 47: 443-7
  • 12 Willmot DR. Image analysis of enamel demineralization using conventional and digital electronic images. J Dent Res 1997; 76: 173
  • 13 Livas C, Kuijpers-Jagtman AM, Bronkhorst E, Derks A, Katsaros C. Quantification of white spot lesions around orthodontic brackets with image analysis. Angle Orthod 2008; 78: 585-90
  • 14 Damato FA, Strang R, Stephen KW. Effect of fluoride concentration on remineralization of carious enamel: An in vitro pH-cycling study. Caries Res 1990; 24: 174-80
  • 15 Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307-10
  • 16 Pitts NB. Modern concepts of caries measurement. J Dent Res 2004; 83 (Spec No C): C43-47
  • 17 Côrtes DF, Ellwood RP, Ekstrand KR. An in vitro comparison of a combined FOTI/visual examination of occlusal caries with other caries diagnostic methods and the effect of stain on their diagnostic performance. Caries Res 2003; 37: 8-16
  • 18 Lussi A, Imwinkelried S, Pitts N, Longbottom C, Reich E. Performance and reproducibility of a laser fluorescence system for detection of occlusal caries in vitro . Caries Res 1999; 33: 261-6
  • 19 Pardi V, Mialhe FL, Pereira AC, Meneghim MC. In vitro evaluation of the DIAGNOdent device for occlusal diagnosis. Pesqui Odontol Bras 2000; 14: 372-7
  • 20 Shi XQ, Welander U, Angmar-Månsson B. Occlusal caries detection with KaVo DIAGNOdent and radiography: An in vitro comparison. Caries Res 2000; 34: 151-8
  • 21 Donassollo TA, Romano AR, Demarco FF. Evaluation of the surface microhardness of the enamel and dentin of bovine and human teeth (permanent and deciduous). Dent Sci J 2007; 22: 311-6
  • 22 Imfeld T. Comparison of the mechanical effects of a toothbrush and standard abrasive on human and bovine dentine in vitro . J Clin Dent 2001; 12: 92-6
  • 23 Campos M, Campos CN, Vitral RW. The use of bovine teeth as substitutes of human teeth in dental research: A literature review. Braz Res in Pediatr Dent and Integrated Clinic 2008; 8: 127-32
  • 24 Pierro VS, de Souza IP, Luiz RR, Barcelos R, Moraes RS. Reliability of two methods for measurement of alveolar bone level in children. Dentomaxillofac Radiol 2008; 37: 34-9
  • 25 Benson PE, Pender N, Higham SM. Enamel demineralization assessed by computerized image analysis of clinical photographs. J Dent 2000; 28: 319-26
  • 26 Al-Khateeb S, ten Cate JM, Angmar-Månsson B, de Josselin de Jong E, Sundström G, Exterkate RA. et al. Quantification of formation and remineralization of artificial enamel lesions with a new portable fluorescence device. Adv Dent Res 1997; 11: 502-6
  • 27 Tranaeus S, Al-Khateeb S, Björkman S, Twetman S, Angmar-Månsson B. Application of quantitative light-induced fluorescence to monitor incipient lesions in caries-active children. A comparative study of remineralization by fluoride varnish and professional cleaning. Eur J Oral Sci 2001; 109: 71-5
  • 28 Willmot DR, Benson PE, Pender N, Brook AH. Reproducibility of quantitative measurement of white enamel demineralization by image analysis. Caries Res 2000; 34: 175-81