Impact of different magnification levels on visual caries detection with ICDAS

Neuhaus, Klaus; Jost, Fabian Nicolas; Perrin, Philippe; Lussi, Adrian (2015). Impact of different magnification levels on visual caries detection with ICDAS. Journal of dentistry, 43(12), pp. 1559-1564. Elsevier Science 10.1016/j.jdent.2015.09.002

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OBJECTIVES The aim of this in vitro study was to examine the effect of different levels of magnification on the accuracy and reliability of visual caries detection using ICDAS criteria. METHODS Occlusal surfaces of 100 extracted molars were assessed by 14 examiners (3rd and the 4th year dental students and dentists) using no magnification aids, a 2.5× Galilean loupe, a 4.5× Keplerian loupe, or a surgical microscope with 10× magnification. The assessments were repeated on a different day. Sensitivity, specificity, AUC and reliabilities were calculated according to the gold standard of histology. RESULTS We found that with increasing magnification, the number of surfaces rated as "sound" (ICDAS code 0) decreased, while the number of surfaces with a localized enamel breakdown (ICDAS code 3) increased. While the sensitivities increased, the values of the specificities decreased to an unacceptably low level irrespective of the clinical experience of the examiners. CONCLUSIONS ICDAS seems to be optimized for natural vision up to 2.0× magnification and not for high magnifications. The use of powerful magnification in visual caries detection involves the risk of unnecessary and premature invasive treatment. CLINICAL SIGNIFICANCE This paper discusses when it does and does not make sense to use magnification devices for visual caries detection using ICDAS criteria. Strong magnifications should be refrained from for this purpose.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > School of Dental Medicine > Department of Preventive, Restorative and Pediatric Dentistry

UniBE Contributor:

Neuhaus, Klaus; Jost, Fabian Nicolas; Perrin, Philippe and Lussi, Adrian


600 Technology > 610 Medicine & health




Elsevier Science




Eveline Carmen Schuler

Date Deposited:

17 Mar 2016 15:19

Last Modified:

11 Sep 2017 07:32

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Caries Diagnostics, Dental Loupes, Reliability, Sensitivity Specificity




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