Impact of Magnifying Loupes on Interexaminer Agreement in the Detection of Noncavitated Occlusal Carious Lesions

Purpose: This study aimed to assess the impact of using magnifying loupes on interexaminer agreement in the detection of noncavitated occlusal carious lesions. Materials and Methods: A total of 155 permanent molars with no frank cavitation were selected for the study. Five examiners with different specialties and experience each examined the occlusal surfaces twice using International Caries Assessment and Detection System (ICDAS) criteria. The first examination used no magnification. The second examination, performed 4 weeks after the first, used 2.5X magnifying loupes. Later, the teeth were sectioned and inspected for caries using a stereomicroscope. The data were analysed using statistical analysis software to calculate intra-examiner reproducibility and interexaminer agreement as well as univariate marginal distribution and marginal homogeneity maximum Kappa (Kmax) statistics with and without the loupes. Results: The Kmax scores for 4 of the 5 examiners showed bias compared to the histological results, with a greater likelihood of diagnosing a tooth as sound in the presence of caries (Kmax 0.26-0.73 and 0.19-0.65 with and without the loupes, respectively). For intra-examiner reproducibility, the linear weighted kappa ranged from (0.34-0.65) . Interexaminer agreement was poor both with and without the loupes. Conclusions: The use of magnifying loupes did not improve interexaminer agreement in ICDAS scores for noncavitated occlusal carious lesions. Keywords: agreement, ICDAS, magnifying loupes, reproducibility