# Comparison of Intra-Examiner Agreement in the In Vivo Diagnosis of Carious Lesions With and Without Loupes Using the ICDAS II System

## TL;DR

This study compares how consistently dentists diagnose tooth decay using magnifying loupes versus regular visual inspection.

## Contribution

The study evaluates intra-examiner agreement for diagnosing carious lesions with and without magnification in real clinical settings.

## Key findings

- Diagnostic accuracy was comparable with and without loupes (Kappa = 0.88 vs. 0.81).
- Magnification loupes improved sensitivity for early carious lesions.
- Overall diagnostic accuracy with loupes was 0.85 (95% CI: 0.80-0.89).

## Abstract

Accurate early caries detection remains a major challenge in minimally invasive dentistry. While visual inspection remains the clinical gold standard, magnification loupes are increasingly used in dental practice. However, their diagnostic reliability under real clinical conditions remains unclear. Objective: To evaluate intra-examiner agreement in the diagnosis of occlusal carious lesions using the ICDAS II system with and without 3.5x magnification loupes.

A cross-sectional in vivo study was conducted on 143 teeth (572 measurements) from 15 patients. Each occlusal surface was examined twice with and twice without loupes, randomized by sequence and separated by at least seven days. The examiner was calibrated and blinded to prior results. Weighted Cohen's Kappa coefficients, sensitivity, and specificity were calculated for each lesion type.

Concordance between methods was moderate (weighted Kappa = 0.56; 95% CI: 0.43-0.69). Intra-examiner reproducibility was high for both loupes (Kappa = 0.88) and unaided inspection (Kappa = 0.81). Sensitivity and specificity were highest for incipient and severe lesions, while low prevalence limited estimates for moderate lesions. Overall diagnostic accuracy for the magnified method was 0.85 (95% CI: 0.80-0.89).

Magnification loupes provide comparable diagnostic accuracy to unaided visual inspection, with improved sensitivity for early lesions. Their systematic use may enhance diagnostic consistency and clinical training in preventive and minimally invasive dentistry.