OBJECTIVE: To evaluate the accuracy of remote caries lesion assessment using the CariesCare International (CCI) system applied to images captured with smartphones and professional cameras.
METHODS: A cross-sectional study was conducted with 30 children aged 5-10 years, who underwent clinical dental examinations and intraoral photography using both a digital single-lens reflex (DSLR) camera and a smartphone. Trained examiners, blinded to the imaging devices, assessed the photographs and in-person examinations, with the latter serving as the gold standard. Statistical analyses included weighted kappa () to evaluate inter-examiner reproducibility, along with sensitivity (Se), specificity (Sp), and area under the receiver operating characteristic curve (AUC) to determine detection accuracy. κ w
RESULTS: Inter-examiner reproducibility was excellent across all methods (> 0.94). The professional camera demonstrated superior accuracy (Se = 0.87, Sp = 0.98; AUC = 0.92), with strong performance even for initial lesions (AUC = 0.88). Smartphone images showed good overall accuracy (Se = 0.73, Sp = 0.92, AUC = 0.83), performing particularly well for moderate and extensive lesions (AUC ≥ 0.87) and acceptably for initial lesions (AUC = 0.77). Both imaging methods achieved high specificity, reflecting accurate identification of sound surfaces. κ w
CONCLUSIONS: These findings support the use of both professional and smartphone photography as effective tools for remote caries lesion assessment using the CariesCare International (CCI) system. Smartphone-based assessments represent a cost-effective and accessible alternative, especially in settings with limited resources. Integrating standardised systems like CCI into remote diagnostic workflows enhances diagnostic accuracy and can broaden access to dental care, helping reduce global oral health disparities.
