Influence of examiners’ experience on the reproducibility of different gold standard techniques and histological criteria for validation of the diagnosis of occlusal caries lesions

The aims of this study were to evaluate the influence (1) of the examiner experience and (2) three histological classification criteria on the reproducibility of two gold standard techniques (non-dye or dye) for validation of the diagnosis of occlusal caries. This study comprised a sample of 210 digital images of 105 permanent teeth (105 rhodamine B dyed and 105 dyefree hemisections) and six examiners. Images were evaluated on a laptop computer and categorised according to three different histological classification criteria (proposed by Ekstrand, Lussi or Downer) and repeated in order to allow reproducibility calculation. For data analysis, the six participants were divided into two groups: G1: examiners with previous experience in histological evaluation and G2: examiners with no experience in histological evaluation. Statistical significance was set at 0.05. Results. The mean intraexaminer reproducibility values in G1 were higher than G2 in all variables. Intra-examiner reproducibility was lower for the dye-free technique in both groups. The mean values of inter-examiner reproducibility in G1 ranged from 0.60 to 0.68, and in G2 values ranged from 0.34 to 0.69. Conclusion. It can be concluded that: (1) the examiners’ experience seems to influence the reproducibility of the two gold standard techniques studied and reproducibility tends to be lower when the dye-free technique is used, and (2) the histological classification criterion does not appear to influence the reproducibility for validation of the diagnosis of occlusal caries

Optical magnification has no benefits on the detection of occlusal caries lesions in permanent molars using different visual scoring systems : an in vitro study

Some studies have addressed the influence of optical magnification on the detection of caries lesions using a visual scoring system. However, there is a lack of research related to the use of the CAST and ADA-CCS visual scoring systems. In addition, the reliability and accuracy of ADA-CCS index in permanent teeth were not studied yet. So, the aim of this study was to evaluate, in vitro, the influence of different levels of optical magnification on the detection of occlusal caries lesions in permanent molars using three visual scoring systems. One occlusal site per tooth was analyzed in 120 extracted permanent molars. Two trained examiners inspected the teeth using ICDAS (International Caries Detection and Assessment System), CAST (Caries Assessment Spectrum and Treatment), and ADA-CCS (American Dental Association-Caries Classification System) visual criteria, twice with each scoring system, with a one-week interval between examinations. The study was conducted in three phases: (A) without optical magnification, (B) using a binocular lens (3.5× magnification), and (C) using an operating microscope (16× magnification). Then, the teeth were sectioned longitudinally through the center of the selected site and the section with the more severe lesion was histological evaluated considering the D1 (lesions in enamel and dentin) and D3 (dentin lesions) thresholds. Kappa values for intra- and inter-examiner reproducibility were good to excellent for all systems. At the D1 threshold, sensitivity, accuracy, and area under the ROC curve were high for ICDAS and CAST in all phases. However, this was not the case for the ADA-CCS in phase C (0.05). The magnification does not improve the accuracy of the visual scoring systems in the detection of occlusal caries lesions in permanent molars

Physicochemical properties and filling capacity of an experimental iodoform-based paste in primary teeth

In this study, we evaluated the physicochemical properties (PCP; radiopacity, flow, pH, and solubility) and the quality of root canal filling provided by an experimental industrialized paste (EP), with the same active ingredients as those of the Guedes Pinto paste, compared with the Vitapex® paste. PCP were analyzed according to the ANSI/ADA laboratory testing methods for endodontic filling and sealing materials. To analyze filling capacity, 120 artificial primary teeth (60 maxillary incisors [MIs] and 60 mandibulary molars [MMs]) were endodontically treated. The teeth were divided into eight groups based on the dental group (MIs or MMs), filling material (Vitapex® or EP), and insertion method (syringe or lentulo). The Image J® software was used to analyze the initial an final digital radiographies of each tooth, measuring and comparing root canal and void areas. The percentage of filling failure areas was obtained. Data were submitted to ANOVA and Tukey test of mean comparison. Regarding PCP, both pastes presented results according the ANSI/ADA standards. Flow capacity: Vitapex: 19.6 mm, EP: 25 mm (p 0.05). Regarding filling capacity analysis, EP demonstrated 12.5% of failure against 31.5% of Vitapex (p < 0.01). Compared to Vitapex, EP presented statistically significantly better results in flow, radiopacity, pH, and filling capacity. Molars presented more filling failures than incisors. The insertion method using a syringe and a thin tip was significantly better than that using Lentulo spiral carriers.info:eu-repo/semantics/publishedVersio

Protocol for Low-level laser therapy in traumatic ulcer after troncular anesthesia : case report in pediatric dentistry

The aim of this study was to report a protocol of use for low-level laser therapy (LLLT) in traumatic ulcer in the lower lip after inferior alveolar nerve block anesthesia (IANBA). A 3-year-old patient, male, undergoing treatment of carious lesions was submitted to an indirect pulp capping in tooth 74 under IANBA. The procedure was completed without intercurrences, but on next day, the child presented extensive traumatic ulcer in the left lower lip, with complaint of pain. Two sequential applications with LLLT were applied in punctual mode under pressure around the lesion. After 1 week, the mother reported significant improvement. After 30 days, the lesion was fully healed. In conclusion, LLLT promoted rapid analgesia and healing, being a good treatment alternative for traumatic ulcer after troncular anesthesia

Conservative treatment of deep dentin lesions in primary molars: Case-series

Objective: To carry out a descriptive analysis of a case-series in which the indirect pulp capping (IPC) has been performed for treating primary molars with extensive caries lesions in dentin, in the Private of Specialization in Pediatric Dentistry. Material and Methods: A single calibrated examiner evaluated the medical records of 155 patients aged 2 to 13 years attended at the Foundation for Scientific and Technological Development of Dentistry (FUNDECTO) partnership the University of São Paulo (USP) in 2011-2013 in search of extensive caries lesions treated during this period. Were found only 20 deep caries lesions and with satisfactory clinical and radiographic documentation. Then, the materials and techniques used were collected, as well as instant success described after treatment and observation for no progression of the disease (pain, abscess or fistula). Results: The 20 lesions evaluated reached at least 2/3 of the dentin thickness and were active. In 70% of cases, the restorations were carried out with high viscosity or encapsulated glass ionomer cement, and in 30% of case with light-cured resin. In only one case was used calcium hydroxide cement as liner material before inserting resin. In the teeth treated, only three cases were considered failures. Conclusion: Regardless of the restorative material used and the technique employed, good immediate success rates of the conservative treatment in deep dentin lesions were found, which consequently reduces the risk of exposure and pulp intervention

Impact of the radiographic examination on diagnosis and treatment decision of caries lesions in primary teeth – the Caries Detection in Children (CARDEC-01) trial: study protocol for a randomized controlled trial

Abstract\ud \ud Background\ud Although most clinical guidelines throughout the world indicate that clinicians take two bitewings for detecting caries lesions in primary molars of all children, evidence for this recommendation is essentially based on cross-sectional studies performed in laboratory settings or using convenience samples. The benefits and impact of performing radiographs on diagnosis and treatment decision of caries lesions in primary teeth, mainly considering relevant outcomes for patients, have not been evaluated yet. Thus, the aim of this randomized clinical trial will be to evaluate the impact of performing radiographic examination adjunct to the visual inspection for detecting and making treatment decision regarding caries lesions in primary teeth compared with visual inspection performed alone. We will consider different outcomes related to children's health and welfare.\ud \ud \ud Methods/Design\ud To reach this objective, 250 children ages 3 to 6 years who sought dental treatment in our dental school will be randomly allocated in two groups according to the diagnostic strategy used for caries detection: visual inspection performed alone or visual inspection associated to radiographic examination. Two trained and calibrated examiners will carry out the examinations and elaborate the treatment decision plan. Then, children will be treated and followed up for 2 years, with evaluations after 12 and 24 months after the inclusion of children in the study. Children will also return after 6 and 18 months to reinforce the preventive orientations. Primary outcome will be the number of dental surfaces in need of dental treatment at the follow-up. Secondary outcomes will be the components of the primary outcome separately, as well as, proportion of false-positive results, the oral health-related quality of life, cost-efficacy, cost-adjusted life years, and number of new lesions in the first permanent molars.\ud \ud \ud Discussion\ud Our working hypothesis is that radiographic examination would actually exert little influence on patient-centered outcomes, and visual inspection would be enough as diagnostic strategy for caries detection in primary teeth.\ud \ud \ud Trial registration\ud \ud \ud NCT02078453\ud \ud . Registered 4 March 2015.This trial is funded by the Fundação de Amparo à Pesquisa do Estado de\ud São Paulo – FAPESP (Grant # 2012/24243-7), CNPQ (Grants # 471817/2012-0\ud and 471817/2012-0) and CAPES, Brazilian funding agencies. The authors\ud wish to thank the participants of the Post-Graduation in Pediatric Dentistry\ud Seminar of FOUSP for the critical comments

Performance and discomfort of different methods in detecting approximal caries lesions in primary molars: in vivo study

Os objetivos do presente trabalho in vivo foram: (1) avaliar o desempenho do exame visual, radiográfico e fluorescência a laser (DIAGNOdent pen) na detecção de lesões de cárie proximais em molares decíduos; (2) avaliar o grau de desconforto relatado pelas crianças frente aos métodos testados; (3) avaliar a influência do desconforto relatado pelas crianças no desempenho de cada método. Para isso, foram selecionadas 76 crianças, de 4 a 12 anos, com pelo menos um molar decíduo em contato com o dente adjacente. Os participantes foram avaliados independentemente por dois examinadores por meio de inspeção visual (ICDAS II), exame radiográfico e método de fluorescência a laser. Um examinador repetiu todos os exames em 20% da amostra, numa outra ocasião. A validação dos métodos foi realizada por exame visual direto após separação temporária com elásticos ortodônticos. Para avaliação do desconforto foi utilizada a Escala de Faces de Wong-Baker. No cálculo da reprodutibilidade inter e intraexaminador, foram utilizados os valores dos escores obtidos e valores inteiros do método de fluorescência (coeficiente de correlação intraclasse). O teste de Kappa também foi empregado após a dicotomização das superfícies de acordo com dois diferentes limiares de detecção: (i) presença de lesões não cavitadas e (ii) presença de lesões cavitadas. Foram também realizadas análises ROC, sensibilidade, especificidade e acurácia, considerando os mesmos limiares, sendo esses dados comparados com o teste de McNemar. Teste de Friedman comparou o grau de desconforto relatado pelas crianças frente à aplicação dos métodos. Análise de Poisson e cálculo da rate ratio foram utilizados para avaliar a associação dos fatores sexo, idade e tipo de dentição com o grau de desconforto. Para avaliação da influência do desconforto sobre o desempenho dos métodos testados, análises de multinível foram realizadas, utilizando como desfecho o número de diagnósticos falso-positivos e falso-negativos. O exame visual apresentou melhor desempenho da detecção de lesões não cavitadas, enquanto que o exame radiográfico e o uso da fluorescência a laser demonstraram maior sensibilidade na detecção de lesões de cárie proximais cavitadas. O método radiográfico, de maneira geral, mostrou-se o mais reprodutível. O exame radiográfico, o método de fluorescência a laser e os elásticos ortodônticos no dia em que foram colocados, promoveram o maior desconforto. Entretanto, após 7 dias de uso dos afastadores, esse desconforto diminuiu significantemente. Crianças com maior idade e dentição mista relataram menor desconforto no uso do DIAGNOdent pen. Os pacientes mais velhos, por outro lado, relataram maior desconforto no uso dos elásticos ortodônticos. Na inspeção visual e uso da fluorescência a laser, crianças que relataram desconforto apresentaram maior número de erros de diagnóstico. Em conclusão, o método radiográfico e de fluorescência a laser apresentam efetividade semelhante na detecção de lesões proximais cavitadas em molares decíduos, e ambos os métodos apresentam desconforto semelhante para as crianças, e maior do que o exame visual. Além disso, pode-se concluir que esse desconforto relatado pode estar associado a alteração na performance dos métodos visual e de fluorescência a laser.The aims of the present in vivo study were: (1) to compare the performance of different methods in detecting approximal caries lesions in primary molars; (2) to assess the discomfort reported by the children related to these methods; (3) to evaluate the influence of the discomfort related by the children on the performance of each method. Seventy-six children, aged 412 years, with at least one primary molar in contact with the adjacent tooth were selected. The volunteers were independently evaluated by two examiners using visual inspection (ICDAS II), radiographic method and pen-type laser fluorescence device. One examiner repeated all the evaluations in 20% of the sample. As reference standard method, the teeth were visually examined in a direct way after separation with orthodontic rubbers. Wong-Baker faces scale was employed to assess the discomfort. To calculate inter and intraexaminer reproducibility, absolute values of indexes and of the fluorescence method were used (intraclass correlation coefficient). Kappa test was also employed after dichotomizing in two differents thresholds: (i) presence of non cavitated caries lesions and; (ii) presence of cavitations. ROC analyses, sensitivity, specificity and accuracy for the same thresholds were calculated and compared with McNemar test. Friedman test was used to compare the discomfort among the methods. Poisson regression analysis was used to evaluate the association between sex, age and type of teeth with the degree of discomfort. Multilevel analyses were performed to verify the influence of this discomfort on performance of the methods, considering the number of false positive and false negative diagnosis as outcomes. At the non cavitated threshold, the visual inspection showed a better performance. At the cavitated lesions threshold, the radiography and fluorescence device showed higher sensitivity. In general, the radiographic method showed higher reproducibility. The radiographic method, fluorescence method and the use of rubber rings promoted higher discomfort. However, this discomfort decreased significantly after 7 days of using of the orthodontic rubbers. Older children and children with mixed dentition reported less discomfort using DIAGNOdent pen. On the other hand, older patients reported more discomfort using rubber rings. The discomfort reported by the children after using of visual inspection and fluorescence methods showed a higher number of diagnostic errors. In conclusion, radiographic and fluorescence methods present similar performance in detecting approximal cavitated caries lesions in primary molars, and both methods present similar discomfort for the children, and higher than the visual inspection. Furthermore, we can concluded that this reported discomfort could be associated to changes in the performance of visual inspection and laser fluorescence methods

Use of Fluorescence-based methods to assess the caries activity on occlusal surfaces of primary molars

O objetivo do presente estudo in vivo foi avaliar a associação de parâmetros obtidos por diferentes métodos baseados em fluorescência com a detecção da atividade de cárie em superfície oclusal de molares decíduos, incluindo a avaliação da fluorescência vermelha emitida pelo biofilme nesse processo diagnóstico. Para tanto, foram selecionadas 606 molares decíduos de 113 crianças entre 4 e 14 anos. As crianças foram avaliadas quanto à presença de biofilme, experiência de cárie e número de lesões ativas. A presença de biofilme fluorescente no vermelho foi também avaliada com um aparelho de quantificação da fluorescência induzida por luz (QLF do inglês, Quantitative Light-induced Fluorescence). Após profilaxia, também com o QLF, foram avaliados a fluorescência do dente no verde (F e Q) e no vermelho (R), além da avaliação com o DIAGNOdent pen. Para determinação do primeiro padrão de referência, todos os dentes foram avaliados por 2 examinadores utilizando o sistema ICDAS associado à avaliação da atividade de cárie baseado nas características clínicas das lesões. Para a segunda etapa da pesquisa, foram selecionados 50 molares decíduos exfoliados ou extraídos logo após os exames. Esse dentes foram seccionados e validados histologicamente por 2 examinadores de acordo com a profundidade e atividade das lesões, esse último avaliado com auxílio de um corante indicador de pH. Análises de regressão linear de multinível foram realizadas para a comparação entre as medidas obtidas com os métodos baseados na fluorescência nos dentes classificados pelo exame visual como sadios ou com lesões ativas ou inativas. Para avaliação da associação dos parâmetros avaliados pelos métodos baseados na fluorescência e de outras variáveis explanatórias, foram realizadas análises de multinível de Poisson. Na segunda etapa, após determinação dos melhores pontos de corte, valores de sensibilidade, especificidade, acurácia e as áreas sob as curvas ROC (Az) de cada método foram calculados em três limiares de detecção. Para avaliação do desempenho dos métodos em detectar a atividade de cárie, os parâmetros de Diagnostic Odds Ratio (DOR), acurácia e Az foram calculados. A reprodutibilidade das avaliações do padrão de referência obtiveram valores de kappa maiores que 0,86. Os valores de F e Q do QLF (fluorescência verde) foram significantemente maiores nas lesões inativas do que nas ativas, tanto em lesões não-cavitadas, como nas cavitadas. Com o DIAGNOdent pen, somente na avaliação de lesões cavitadas, as medidas em lesões ativas diferiram significantemente das lesões inativas. No geral, a presença de biofilme visível sobre a superfície oclusal dos molares decíduos e R do dente (fluorescência vermelha obtida com o QLF) mostraram associação significante com a atividade de cárie. O exame visual, o DIAGNOdent pen e os valores de Q mostraram maior sensibilidade na detecção de lesões iniciais em esmalte. Para lesões em dentina o QLF mostrou menor especificidade do que o exame de inspeção visual. Os valores de DOR e Az mostraram similaridade entre os métodos para diferenciação de lesões ativas e inativas. Embora o QLF e DIAGNOdent pen mostrem bom desempenho na avaliação da atividade de cárie em molares decíduos, não mostram vantagens quando comparados à utilização da inspeção visual ou à simples avaliação da presença de biofilme visível.The aim of this in vivo study was to evaluate the association of parameters obtained with fluorescence-based methods and the assessment of caries lesions activity in occlusal surfaces of primary molars, including the evaluation of red fluorescence emitted by the biofilm in this diagnosis process. Occlusal surfaces of 606 primary molars from 113 children aged 4-14 years were selected. The presence of biofilm, caries experience and the number of active lesions were evaluated. The presence of red fluorescent biofilm was also assessed by QLF (Quantitative Light-induced Fluorescence). After dental cleaning procedure, the green (F e Q) and red (R) fluorescence were evaluated with the QLF. The DIAGNOdent pen was also employed. For the first reference standard, all teeth were evaluated by 2 examiners using ICDAS associated with the caries activity assessment based on clinical characteristics of the lesions. For the second phase, 50 exfoliated or extracted primary molars were selected. Then, these teeth were sectioned and histologically validated by 2 examiners regarding depth and activity of the lesions; the latter using a pH detector dye. Multilevel linear regression analyses were carried out to compare the values of the fluorescence-based methods on the teeth classified by visual inspection as sound, with active or inactive lesions. Multilevel Poisson analysis evaluated the association of the parameters assessed by the fluorescencebased methods and explanatory variables. On the second phase, after obtaining the best cut-off points, the sensitivity, specificity, accuracy and area under ROC curve (Az) were calculated at three thresholds. The performance of the methods in detecting caries activity was evaluated by Diagnostic Odds Ratio (DOR), accuracy and Az values calculated. The reference methods presented good reproducibility, with kappa values higher than 0.86. The F and Q values obtained with QLF (green fluorescence) were higher in inactive than in active lesions, at cavitated and non-cavitated lesions. Using the DIAGNOdent pen in cavitated lesions, the evaluations of active and inactive lesions were significantly different. In general, the presence of visible biofilm on occlusal surfaces of primary molars and the R values of the teeth (red fluorescence obtained with the QLF) were significantly associated with caries activity. The visual inspection, DIAGNOdent pen and Q values demonstrated higher sensitivities in detecting initial enamel lesions. Considering dentine lesions, the QLF presented lower specificity than the visual inspection. The DOR and Az values were similar for all methods in distinguishing active and inactive caries lesions. In conclusion, although the QLF and DIAGNOdent pen perform well in assessing the caries activity lesions in primary molars, they do not present any advantage when compared to the visual inspection or to the simple evaluation of the presence of visible biofilm