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Schwendicke F, Mertens S, Cantu AG, Chaurasia A, Meyer-Lueckel H, Krois J. Cost-effectiveness of AI for Caries Detection: Randomized Trial. J Dent 2022; 119:104080. [PMID: 35245626 DOI: 10.1016/j.jdent.2022.104080] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES We assessed the cost-effectiveness of AI-supported detection of proximal caries in a randomized controlled clustered cross-over superiority trial. METHODS Twenty-three dentists were sampled to assess 20 bitewings; 10 were randomly evaluated supported by an AI-based software (dentalXrai Pro 1.0.4, dentalXrai Ltd, Berlin, Germany) and the other 10 without AI support. The reference test had been established by four independent experts and an additional review. We evaluated the proportion of true and false positive and negative detections and the treatment decisions assigned to each detection (non-invasive, micro-invasive, invasive). Cost-effectiveness was assessed using a mixed public-private-payer perspective in German healthcare. Using the accuracy and treatment decision data from the trial, a Markov simulation model was populated and posterior permanent teeth in initially 31-years old individuals followed over their lifetime. The model allowed extrapolation from the initial detection and therapy to treatment success, re-treatments and, eventually, tooth loss and replacement, capturing long-term effectiveness (tooth retention) and costs (cumulative in Euro). Costs were estimated using the German public and private fee catalogues. Monte-Carlo microsimulations were used and incremental cost-effectiveness at different willingness-to-pay ceiling thresholds assessed. RESULTS In the trial, AI-supported detection was significantly more sensitive than detection without AI. However, in the AI group, lesions were more often treated invasively. As a result, AI and no AI showed identical effectiveness (tooth retention for a mean (2.5-97.5%) 49 (48-51)) and nearly identical costs (AI: 330 (250-409) Euro, no AI: 330 (248-410) Euro). 41% simulations found AI and 43% no AI to be more cost-effective. The resulting cost-effectiveness remained uncertain regardless of a payer's willingness-to-pay. CONCLUSIONS Higher accuracy of AI did not lead to higher cost-effectiveness, as more invasive treatment approaches generated costs and diminished possible effectiveness advantages. CLINICAL SIGNIFICANCE The cost-effectiveness of AI could be improved by supporting not only caries detection, but also subsequent management.
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Affiliation(s)
- Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Germany.
| | - Sarah Mertens
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Germany
| | - Anselmo Garcia Cantu
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Germany
| | | | | | - Joachim Krois
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Germany
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Aguirre PEA, Lotto M, Strieder AP, Cruvinel T. Digital surveillance: Monitoring the activity of Internet users searching for information related to early childhood caries. Health Informatics J 2022; 28:14604582211073057. [PMID: 35196923 DOI: 10.1177/14604582211073057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study evaluated the behavior of Internet users from seven countries through the analysis of the monthly variation of the Relative Search Volume (RSV) for queries related to early childhood caries (ECC), retrieved by Google Trends application programming interface between January 2004 to December 2020. The association of RSV with years lived with disability (YLDs) for untreated dental caries in deciduous teeth and Internet penetration were tested by regression models. Forecasting models were developed to predict the interests until December 2021. Relevant topics linked to searches were assessed qualitatively. Increasing levels of interests were observed in most countries, regarding the comparison of periods 2004-2012 and 2013-2021, without influence of seasonality. These results were associated with YLDs only in France and with the Internet penetration in Mexico and France. Searches were mostly related to the definition, risk factors, and preventive care of ECC. The interests of Internet users in ECC-related information increased in the last years in all seven countries, although it was maintained low over time. It might indicate a lack of awareness about the negative consequences of the disease in the early stages of life. Specific policies should be developed toward the dissemination of oral health information and the prevention of the disease.
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Affiliation(s)
- Patricia Estefanía A Aguirre
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.,27890Universidad de Especialidades Espíritu Santo (UEES), Samborondón, Ecuador
| | - Matheus Lotto
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Anna Paola Strieder
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Thiago Cruvinel
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
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Srisomboon S, Kettratad M, Stray A, Pakawanit P, Rojviriya C, Patntirapong S, Panpisut P. Effects of Silver Diamine Nitrate and Silver Diamine Fluoride on Dentin Remineralization and Cytotoxicity to Dental Pulp Cells: An In Vitro Study. J Funct Biomater 2022; 13:16. [PMID: 35225979 PMCID: PMC8884014 DOI: 10.3390/jfb13010016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 02/01/2023] Open
Abstract
Silver diamine nitrate (SDN) is expected to help control caries similar to silver diamine fluoride (SDF). The aim of this study was to determine the mineral precipitation in demineralized dentin and the cytotoxicity of SDN and SDF to dental pulp cells. Demineralized dentin specimens were prepared, and SDF, SDN, or water (control) was applied. The specimens were then remineralized in simulated body fluid for 2 weeks. The mineral precipitation in the specimens was examined using FTIR-ATR, SEM-EDX, and synchrotron radiation X-ray tomographic microscopy (SRXTM). Additionally, the cytotoxicity of SDF and SDN to human dental pulp stem cells was analyzed using an MTT assay. The increase in FTIR spectra attributable to apatite formation in demineralized dentin in the SDF group was significantly higher compared to the SDN and control groups (p < 0.05). Dentinal tubule occlusion by the precipitation of silver salts was detected in both SDF and SDN groups. The mineral density as shown in SRXTM images and cytotoxicity of both SDN and SDF groups were comparable (p > 0.05). In conclusion, SDF demonstrated superior in vitro apatite formation compared to SDN. However, the degree of mineral precipitation and cytotoxic effects of both were similar.
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Affiliation(s)
- Surapong Srisomboon
- Department of Oral Health Care, Lamlukka Hospital, Pathum Thani 12150, Thailand;
| | - Matana Kettratad
- Faculty of Dentistry, Thammasat University, Pathum Thani 12120, Thailand; (M.K.); (S.P.)
| | | | - Phakkhananan Pakawanit
- Synchrotron Light Research Institute (Public Organization), Nakhon Ratchasima 30000, Thailand; (P.P.); (C.R.)
| | - Catleya Rojviriya
- Synchrotron Light Research Institute (Public Organization), Nakhon Ratchasima 30000, Thailand; (P.P.); (C.R.)
| | - Somying Patntirapong
- Faculty of Dentistry, Thammasat University, Pathum Thani 12120, Thailand; (M.K.); (S.P.)
- Thammasat University Research Unit in Dental and Bone Substitute Biomaterials, Thammasat University, Pathum Thani 12120, Thailand
| | - Piyaphong Panpisut
- Faculty of Dentistry, Thammasat University, Pathum Thani 12120, Thailand; (M.K.); (S.P.)
- Thammasat University Research Unit in Dental and Bone Substitute Biomaterials, Thammasat University, Pathum Thani 12120, Thailand
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Cascales ÁF, Moscardó AP, Toledano M, Banerjee A, Sauro S. An in-vitro investigation of the bond strength of experimental ion-releasing dental adhesives to caries-affected dentine after 1 year of water storage. J Dent 2022; 119:104075. [DOI: 10.1016/j.jdent.2022.104075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/12/2022] [Accepted: 02/22/2022] [Indexed: 11/15/2022] Open
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Kühnisch J, Meyer O, Hesenius M, Hickel R, Gruhn V. Caries Detection on Intraoral Images Using Artificial Intelligence. J Dent Res 2022; 101:158-165. [PMID: 34416824 PMCID: PMC8808002 DOI: 10.1177/00220345211032524] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Although visual examination (VE) is the preferred method for caries detection, the analysis of intraoral digital photographs in machine-readable form can be considered equivalent to VE. While photographic images are rarely used in clinical practice for diagnostic purposes, they are the fundamental requirement for automated image analysis when using artificial intelligence (AI) methods. Considering that AI has not been used for automatic caries detection on intraoral images so far, this diagnostic study aimed to develop a deep learning approach with convolutional neural networks (CNNs) for caries detection and categorization (test method) and to compare the diagnostic performance with respect to expert standards. The study material consisted of 2,417 anonymized photographs from permanent teeth with 1,317 occlusal and 1,100 smooth surfaces. All the images were evaluated into the following categories: caries free, noncavitated caries lesion, or caries-related cavitation. Each expert diagnosis served as a reference standard for cyclic training and repeated evaluation of the AI methods. The CNN was trained using image augmentation and transfer learning. Before training, the entire image set was divided into a training and test set. Validation was conducted by selecting 25%, 50%, 75%, and 100% of the available images from the training set. The statistical analysis included calculations of the sensitivity (SE), specificity (SP), and area under the receiver operating characteristic (ROC) curve (AUC). The CNN was able to correctly detect caries in 92.5% of cases when all test images were considered (SE, 89.6; SP, 94.3; AUC, 0.964). If the threshold of caries-related cavitation was chosen, 93.3% of all tooth surfaces were correctly classified (SE, 95.7; SP, 81.5; AUC, 0.955). It can be concluded that it was possible to achieve more than 90% agreement in caries detection using the AI method with standardized, single-tooth photographs. Nevertheless, the current approach needs further improvement.
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Affiliation(s)
- J. Kühnisch
- Department of Conservative Dentistry and Periodontology, University Hospital, School of Dentistry, Ludwig-Maximilians University of Munich, Munich, Germany
| | - O. Meyer
- Institute for Software Engineering, University of Duisburg-Essen, Essen, Germany
| | - M. Hesenius
- Institute for Software Engineering, University of Duisburg-Essen, Essen, Germany
| | - R. Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, School of Dentistry, Ludwig-Maximilians University of Munich, Munich, Germany
| | - V. Gruhn
- Institute for Software Engineering, University of Duisburg-Essen, Essen, Germany
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Memarpour M, Razmjouei F, Rafiee A, Vossoughi M. Remineralization effects of self-assembling peptide P 11 -4 associated with three materials on early enamel carious lesions: An in vitro study. Microsc Res Tech 2022; 85:630-640. [PMID: 34549853 DOI: 10.1002/jemt.23937] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/28/2021] [Accepted: 09/01/2021] [Indexed: 11/09/2022]
Abstract
The aim of this study was to assess the remineralization of enamel caries lesions using the self-assembling peptide P11 -4 associated with different materials. Artificial early enamel lesions were prepared on 154 primary teeth. The samples were randomly divided into eight groups: (1) control, (2) P11 -4, (3) fluoridate toothpaste (FT), (4) P11 -4 + FT, (5) casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), (6) P11 -4 + CPP-ACP, (7) fluoridate bioactive glass toothpaste (BT), and (8) P11 -4 + BT. The surface enamel microhardness (EMH) and energy-dispersive X-ray spectroscopy (EDS) of the teeth were then measured at the baseline, after demineralization, and after 28 days of remineralization. The enamel surfaces were assessed by field emission scanning electron microscopy (FESEM) and atomic force microscopy (AFM). The data were analyzed with one-way analysis of variance (ANOVA) (p < .05). EMH after demineralization was significantly lower than the baseline value (p < .001). The interventions led to an enhanced percentage of EMH recovery (%REMH), which was higher in Groups 6 and 7. There was no significant difference between Groups 3 and 4. Groups 1 and 2 had the lowest %REMH. The mean calcium/phosphate weight percentage ratio of P11 -4 was significantly lower than the others (p < .001). The FESEM and AFM images revealed mineral deposition on the eroded enamel and reductions in surface roughness in Groups 5 and 7.
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Affiliation(s)
- Mahtab Memarpour
- Oral and Dental Disease Research Center, Department of Pediatric Dentistry, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Faranak Razmjouei
- Oral and Dental Disease Research Center, Department of Pediatric Dentistry, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azade Rafiee
- Oral and Dental Disease Research Center, Department of Pediatric Dentistry, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrdad Vossoughi
- Oral and Dental Disease Research Center, Department of Dental Public Health, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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HONGBO Z, HASEBE A, ALAM A, YUNQING L, HOSHIKA S, YAMAUTI M, SANO H. Antibacterial potential of colloidal platinum nanoparticles against Streptococcus mutans . Dent Mater J 2022; 41:368-375. [DOI: 10.4012/dmj.2021-203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Zhang HONGBO
- Department of Restorative Dentistry, Division of Oral Health Science, Hokkaido University Graduate School of Dental Medicine
| | - Akira HASEBE
- Department of Oral Molecular Microbiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University
| | - Arefin ALAM
- Department of Restorative Dentistry, Division of Oral Health Science, Hokkaido University Graduate School of Dental Medicine
| | - Liu YUNQING
- Department of Restorative Dentistry, Division of Oral Health Science, Hokkaido University Graduate School of Dental Medicine
| | - Shuhei HOSHIKA
- Department of Restorative Dentistry, Division of Oral Health Science, Hokkaido University Graduate School of Dental Medicine
| | - Monica YAMAUTI
- Department of Restorative Dentistry, Division of Oral Health Science, Hokkaido University Graduate School of Dental Medicine
| | - Hidehiko SANO
- Department of Restorative Dentistry, Division of Oral Health Science, Hokkaido University Graduate School of Dental Medicine
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LEAL SC, DAME-TEIXEIRA N, BARBOSA CDB, KOMINAMI PAA, RAPOSO F, NAKAGAWA EMT, BANERJEE A. Minimum intervention oral care: defining the future of caries management. Braz Oral Res 2022; 36:e135. [DOI: 10.1590/1807-3107bor-2022.vol36.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
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Restorative treatment decisions for carious lesions: Do Russian dentists and dental students apply minimal intervention dentistry? BMC Oral Health 2021; 21:638. [PMID: 34911518 PMCID: PMC8672640 DOI: 10.1186/s12903-021-01978-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The concept of minimal intervention dentistry (MID) includes both delayed restorative treatment and conservative caries removal, and is now recognised as an evidence-based approach for dental caries management. In order to determine if dental professionals in Russia are incorporating this concept into their clinical practice, we investigated the restorative treatment decisions of Russian dentists and dental students, and the factors associated with these decisions. METHODS We included 171 general dental practitioners and dental therapists (collectively referred to here as "dentists") from North-West Russia, and 76 dental undergraduate students from the Northern State Medical University in Arkhangelsk (response rate of 11.5% and 67.9%, respectively). Participants completed a questionnaire, which collected background information (sex, region of work, place of dental school graduation, practice type, years of working experience, working in an urban or rural area, and specialisation in restorative dentistry) and information on restorative treatment decisions for proximal and occlusal carious lesions of permanent teeth. Treatment options in accordance with MID were defined as intervention at dentin level and minimally invasive cavity preparation. Multinomial logistic regression was used for statistical analysis. RESULTS For the proximal carious lesion, 9.4% of participants said they would employ both MID treatment options; 60.7% said they would choose only one; and 29.9% said they would use neither option. For the occlusal carious lesion, the corresponding figures were 37.2%, 52.1%, and 10.7%. No differences in restorative treatment options were observed among general dental practitioners, dental therapists, and dental students. For the proximal carious lesion, dentists from regions outside Arkhangelsk had 4.15 (95% confidence interval [CI] 1.13-15.27) times higher odds of following one versus both MID treatment options. For the occlusal carious lesion, working experience above 15 years was associated with higher odds of using only one versus both MID treatment options (adjusted odds ratio = 3.04, 95% CI 1.33-6.91). Almost all respondents preferred tooth-coloured materials for restorations; more than 75% chose resin-based composite. CONCLUSIONS The majority of Russian dentists and dental students do not apply the MID concept when treating dental caries in permanent teeth. Clinical protocols on dental caries treatment and dental school curriculums should be updated to place an enhanced focus on evidence-based practice and preventive strategies. Further studies with larger samples of Russian dentists and dental students and alternative methods of recruitment are needed to validate our results.
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Moreno T, Sanz JL, Melo M, Llena C. Overtreatment in Restorative Dentistry: Decision Making by Last-Year Dental Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312585. [PMID: 34886311 PMCID: PMC8656524 DOI: 10.3390/ijerph182312585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 11/16/2022]
Abstract
To evaluate the tendency for overdiagnosis and overtreatment upon different clinical situations among last-year students from the degree in dentistry from Valencia University (Spain) during the 2018-2019 course. A questionnaire consisting of 10 case exemplifications examining the diagnosis, treatment, and clinician's attitude towards different common clinical situations regarding restorative dentistry was designed. Fifty-two students were surveyed, from whom 42 completed the questionnaire (80.77%). Data were analyzed descriptively. A total of 58.8% of the students correctly identified an early carious lesion in the occlusal surface of a molar, while 63.2% would perform unnecessary complementary tests for its diagnosis. The treatment for carious lesions in different evolutive phases with a vital pulp was correct between 51.2 and 92.7% of the cases. The treatment for irreversible pulp pathology and the restoration of the tooth with root canal treatment were adequately selected in 56.1% and 78.3% of the cases, respectively. For the repair of a faulty restoration, an overtreatment was proposed by 87.8% of the students. A tendency to perform unnecessary complementary tests for caries diagnosis was observed. Treatment caries proposals were in accordance with available evidence in the majority of the cases. Students tended to overtreat defective restorations and would perform unnecessary treatments in medically compromised patients.
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Janjic Rankovic M, Kapor S, Khazaei Y, Crispin A, Schüler I, Krause F, Ekstrand K, Michou S, Eggmann F, Lussi A, Huysmans MC, Neuhaus K, Kühnisch J. Systematic review and meta-analysis of diagnostic studies of proximal surface caries. Clin Oral Investig 2021; 25:6069-6079. [PMID: 34480645 PMCID: PMC8531083 DOI: 10.1007/s00784-021-04113-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 07/29/2021] [Indexed: 12/26/2022]
Abstract
AIM This systematic review and meta-analysis aimed to assess the diagnostic accuracy and reliability of commonly used caries detection methods for proximal caries diagnostics. Visual examination (VE), bitewing radiography (BWR), laser fluorescence (LF), and fibre-optic transillumination (FOTI) were considered in detail. MATERIAL AND METHODS PRISMA guidelines for the reporting of systematic reviews and meta-analyses were applied. The mnemonic PIRDS (problem, index test, reference test, diagnostic and study type) concept was used to guide the literature search. Next, studies that met the inclusion criteria were stepwise selected and evaluated for their quality with a risk of bias (RoB) assessment tool. Studies with low/moderate bias and sufficient reporting were considered for meta-analysis. The pooled sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR), and area under the ROC curve (AUC) were calculated. RESULTS From 129 studies meeting the selection criteria, 31 in vitro studies and five clinical studies were finally included in the meta-analysis. The AUC values for in vitro VE amounted to 0.84 (caries detection) and 0.85 (dentin caries detection). BWR ranged in vitro from 0.55 to 0.82 (caries detection) and 0.81-0.92 (dentin caries detection). LF showed higher AUC values for overall caries detection (0.91) and dentin caries detection (0.83) than did other methods. Clinical data are limited. CONCLUSION The number of diagnostic studies with low/moderate RoB was found to be low and indicates a need for high-quality, well-designed caries diagnostic studies. CLINICAL RELEVANCE BWR and LF showed good diagnostic performance on proximal surfaces. However, because of the low number of includable clinical studies, these data should be interpreted with caution.
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Affiliation(s)
- Mila Janjic Rankovic
- Department of Orthodontics and Dentofacial Orthopedics, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany
| | - Svetlana Kapor
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany
| | - Yegane Khazaei
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany
- Institute of Medical Biometry and Epidemiology, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Alexander Crispin
- Institute of Medical Biometry and Epidemiology, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Ina Schüler
- Department of Orthodontics, Section of Preventive and Paediatric Dentistry, University Hospital, Jena, Germany
| | - Felix Krause
- Clinic for Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital RWTH Aachen, Aachen, Germany
| | - Kim Ekstrand
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - Stavroula Michou
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - Florin Eggmann
- Clinic of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Adrian Lussi
- Department of Operative Dentistry and Periodontology, Faculty of Dentistry, University Medical Centre, Freiburg, Germany
- School of Dental Medicine, University of Bern, Bern, Switzerland
| | | | - Klaus Neuhaus
- Clinic of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine Basel, University of Basel, Basel, Switzerland
- Department of Dermatology, Inselspital - Bern University Hospital, Bern, Switzerland
| | - Jan Kühnisch
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany.
- Poliklinik für Zahnerhaltung und Parodontologie, Klinikum der Universität München, LMU München, Goethestraße 70, 80336, Munich, Germany.
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Slimani A, Sauro S, Gatón Hernández P, Gurgan S, Turkun LS, Miletic I, Banerjee A, Tassery H. Commercially Available Ion-Releasing Dental Materials and Cavitated Carious Lesions: Clinical Treatment Options. MATERIALS 2021; 14:ma14216272. [PMID: 34771800 PMCID: PMC8585007 DOI: 10.3390/ma14216272] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 02/06/2023]
Abstract
The contemporary approach for operative caries management emphasizes personalized interventions for each patient, dependent upon the individual's caries susceptibility/risk, the stage of the carious lesion and its activity. The clinician's challenge is to optimize the extent of cavity preparation and the choice of dental restorative biomaterials, appreciating the benefits offered by ion-releasing restorative materials. There is a growing application of bioactive/bio-interactive materials in minimally invasive operative dentistry, as they may help with tissue recovery by ion release. In case of moderate or extensive occlusal cavitation, the clinical criteria include the individual caries susceptibility and carious lesion activity. In high caries risk cases, ion-releasing biomaterials (IRB) can be used, as well as for active carious lesions. In proximal lesions, the clinical criteria include the individual caries susceptibility, the lesion activity and presence of cavities with little or no enamel at the gingival margin. This article aims to discuss the restorative ion-releasing options, according to different clinical situations, and the caries susceptibility to manage cavitated carious lesions in permanent adult teeth.
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Affiliation(s)
- Amel Slimani
- LBN/Faculté d’Odontologie, Université de Montpellier, 34193 Montpellier, France;
| | - Salvatore Sauro
- Dental Biomaterials and Minimally Invasive Dentistry, Department of Dentistry, Cardenal Herrera-CEU University, CEU Universities, 46115 Valencia, Spain;
- Department of Therapeutic Dentistry, I. M. Sechenov First Moscow State Medical University, Moscow 119146, Russia
| | | | - Sevil Gurgan
- Department of Restorative Dentistry, Faculty of Dentistry, Hacettepe University, Ankara 06100, Turkey;
| | | | - Ivana Miletic
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Gunduliceva ul. 5, 10000 Zagreb, Croatia;
| | - Avijit Banerjee
- Conservative & MI Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London, London SE1 9RT, UK;
| | - Hervé Tassery
- LBN/Faculté d’Odontologie, Université de Montpellier, 34193 Montpellier, France;
- Ecole de Médecine Dentaire de Marseille, Université d’Aix-Marseille, 13385 Marseille, France
- Correspondence:
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Yu OY, Lam WYH, Wong AWY, Duangthip D, Chu CH. Nonrestorative Management of Dental Caries. Dent J (Basel) 2021; 9:121. [PMID: 34677183 PMCID: PMC8534976 DOI: 10.3390/dj9100121] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/10/2021] [Accepted: 10/12/2021] [Indexed: 11/30/2022] Open
Abstract
The World Dental Federation (FDI) policy statement in 2016 advocated evidence-based caries-control measures for managing dental caries. The caries management philosophy has shifted from the traditional surgical manners to minimal intervention dentistry. Minimal intervention dentistry aims to extend the longevity of natural teeth. It places the nonrestorative approaches as a priority. The nonrestorative approaches for caries management aim to tackle the etiological factors of dental caries. Caries can be prevented or reversed by restricting the sugar intake and its frequency in the diet, improving oral hygiene practices, and using fluoride toothpaste. This article aims to present strategies for the nonrestorative management of dental caries, which are divided into four components to address the different etiological factors of dental caries. The first component is controlling dental plaque. Strategies for plaque control include oral hygiene instruction, motivational interviewing, mechanical plaque control, and chemical plaque control. The second component for nonrestorative management is reducing the risk of caries by identifying caries risk factors and protective factors, assessing personal caries risk, and customizing a treatment plan. Evidence-based measures for caries prevention include using fluoride, and dental sealants should be provided. The third component includes topical treatment to remineralise early carious lesions. The last component is long-term follow-up. Appropriate strategy adoption for the nonrestorative management of dental caries prolongs the life span of the teeth and sustains the good oral health of patients.
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Affiliation(s)
- Ollie Yiru Yu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong; (W.Y.-H.L.); (A.W.-Y.W.); (D.D.); (C.-H.C.)
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Current Novel Caries Diagnostic Technologies: Restorative Dentists' Attitude and Use Preferences. Healthcare (Basel) 2021; 9:healthcare9101387. [PMID: 34683068 PMCID: PMC8535563 DOI: 10.3390/healthcare9101387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/02/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022] Open
Abstract
Early detection of caries lesions is key to a successful restorative dental treatment plan. The aim of this study was to investigate the preferences and attitude of graduate restorative dentistry residents (RDRs) regarding novel caries diagnostic technologies (NCDT) and to provide a brief overview of available technologies for both specialized and general dental practice. This cross-sectional study used an online questionnaire (17 questions) concerning RDRs’ attitude, preferences, and insights regarding five available NCDTs. It was distributed among twenty RDRs at a local government dental school following a review session about NCDTs. Collected responses were analyzed statistically using one-way analysis of variance (ANOVA), chi-squared with Bonferroni correction, and Kruskal-Wallis tests at a 0.05 significance level. Sixty-five percent of RDRs reported an interest in NCDTs as a discussion topic and almost half of them were positive towards their use, however, sixty percent of respondents were hesitant to diagnose caries solely using NCDTs. Fiber-optic-transillumination (FOTI) systems were ranked the best overall and with regard to all the investigated criteria (p < 0.05). Chosen reasons for FOTI included price followed by ease of use. In general, high price rated as the most perceived reason for not choosing a given NCDT followed by low practical applicability. Meanwhile, ease of use followed by relevant application ranked as the main reported reasons to choose an NCDTs.
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Heck K, Litzenburger F, Geitl T, Kunzelmann KH. Near-infrared reflection at 780 nm for detection of early proximal caries in posterior permanent teeth in vitro. Dentomaxillofac Radiol 2021; 50:20210005. [PMID: 33956491 PMCID: PMC8404521 DOI: 10.1259/dmfr.20210005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objectives: The aim of this in vitro study was to evaluate the diagnostic potential of near-infrared reflection at 780 nm (NIRR780nm) for early proximal caries detection on the occlusal, buccal and oral surfaces of molars and premolars under simulated, clinically relevant conditions. The findings were validated by micro-computed tomography (µCT). Methods: Bitewing radiography (BWR) was used as a comparative diagnostic method. 250 sound or decayed permanent teeth were examined using NIRR780nm and BWR. The NIRR780nm findings were evaluated using yes/no decisions depending on the presence of caries lesions, as the enamel-dentin junction was not detectable in the majority of samples. All NIRR780nm, BWR and µCT findings were obtained twice by two trained examiners. NIRR780nm images were evaluated both occlusally alone and combined occlusally, lingually and buccally. All findings were presented in a cross-table. Sensitivity, specificity and area under the curve (AUC) values were calculated. Reliability assessment was performed using κ statistics. Results: Underestimation of caries was observed for NIRR780nm in 26.0% of all surfaces and for BWR in 32.8% of all surfaces. Overestimation was 10.0% for NIRR780nm and 0.4% for BWR. Trilateral NIRR780nm assessment exhibited an overall accuracy of 67.2 %, an underestimation of 13.6% and an overestimation of 19.2%. Trilateral NIRR780nm exhibited 63.0% sensitivity and 69.6% specificity, while BWR exhibited 26.7% sensitivity but 100% specificity for proximal caries detection. Conclusion: NIRR780nm is not suitable for reliable detection of early proximal caries, even with the application of an ideal setup and optimized in vitro conditions.
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Affiliation(s)
- Katrin Heck
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Friederike Litzenburger
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Thomas Geitl
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Karl-Heinz Kunzelmann
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
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Owda R, Sancakli HS. Effects of Different Bleaching Agents on the Surface Topography and the Microhardness of Artificial Carious Lesions. Eur J Dent 2021; 15:687-693. [PMID: 34428848 PMCID: PMC8630965 DOI: 10.1055/s-0041-1728237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives
The aim of this study was to evaluate the effects of in-office and at-home bleaching agent applications on the surface topography and microhardness of artificially demineralized enamel.
Materials and Methods
A total of 224 enamel specimens were prepared using bovine sound central incisors. 4 mm × 4 mm enamel windows were exposed on the buccal surfaces covering the remaining surface with nail varnish. Samples were immersed in a demineralizing solution for 16 hours to produce artificial caries lesions, then divided into four groups according to the bleaching agent’s type and concentration. Group I; in-office bleaching 35% hydrogen peroxide (HP) (Whiteness HP Maxx; FGM, Brazil), Group II and Group III at-home bleaching 16 and 22% carbamide peroxide CP, respectively (Whiteness Perfect). Group IV; control (not bleached). The microhardness Vickers hardness number (VHN) was measured at the baseline, after demineralization, and after bleaching consequently. The micro-surface changes of the enamel surface after demineralization and bleaching were evaluated by scanning electron microscope (SEM).
Statistical Analysis
Data were evaluated by the one-way analysis of variance (ANOVA) test followed by Post Hoc Tukey’s and Fisher’s least significant difference. Tow- sided
p
-values were considered statistically significant at
p
≤ 0.05.
Results
A significant reduction was noticed in the enamel microhardness after demineralization
p
< 0.05. However, there is no statistically significant difference between the mean VHN of the demineralized and bleached enamel (
p
> 0.001). SEM images showed significant changes on the surface of the demineralized enamel after bleaching (pattern type III).
Conclusions
The low and high concentrations of HP and CP bleaching agents increased the demineralization severity of artificial caries lesions without significantly altering their microhardness values.
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Affiliation(s)
- Rasha Owda
- Department of Restorative Dentistry, Faculty of Dentistry, Biruni University, Istanbul, Turkey
| | - Hande Sar Sancakli
- Department of Restorative Dentistry, Faculty of Dentistry, Istanbul University, Istanbul, Turkey
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Monomer Conversion, Dimensional Stability, Biaxial Flexural Strength, Ion Release, and Cytotoxicity of Resin-Modified Glass Ionomer Cements Containing Methacrylate-Functionalized Polyacids and Spherical Pre-Reacted Glass Fillers. Polymers (Basel) 2021; 13:polym13162742. [PMID: 34451281 PMCID: PMC8399068 DOI: 10.3390/polym13162742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to prepare RMGICs for pulp protection that contain polyacids functionalized with methacrylate groups (CMs) to enable light-activated polymerization without the need for toxic 2-hydroxyethyl methacrylate (HEMA) monomers. The effects of using CM liquids with 0 or 5 wt% HEMA on the physical/mechanical properties and cytotoxicity of the experimental RMGICs were assessed. Spherical pre-reacted glass fillers (SPG) were used as the powder phase. The experimental RMGICs were prepared by mixing SPG with CM liquid (0 wt% HEMA, F1) or CMH liquid (5 wt% HEMA, F2). Commercial materials (Vitrebond, VB; TheraCal LC, TC) were used for the comparisons. The degree of monomer conversion and fluoride release of both F1 and F2 were significantly lower than those of VB. F1 showed comparable biaxial flexural strength with VB but higher strength than TC. The dimensional stability (mass/volume changes) of the experimental materials was comparable with that of the commercial materials. F1 and F2 exhibited higher Sr/Ca ion release and relative cell viability than VB. The use of CMH liquid reduced the strength but enhanced the fluoride release of the experimental RMGICs. In conclusion, the experimental RMGICs showed comparable strength but lower cytotoxicity compared to the commercial RMGICs. These novel materials could be used as alternative materials for pulp protection.
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Kapor S, Rankovic MJ, Khazaei Y, Crispin A, Schüler I, Krause F, Lussi A, Neuhaus K, Eggmann F, Michou S, Ekstrand K, Huysmans MC, Kühnisch J. Systematic review and meta-analysis of diagnostic methods for occlusal surface caries. Clin Oral Investig 2021; 25:4801-4815. [PMID: 34128130 PMCID: PMC8342337 DOI: 10.1007/s00784-021-04024-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 06/01/2021] [Indexed: 02/01/2023]
Abstract
AIM This systematic review and meta-analysis aimed to assess the diagnostic performance of commonly used methods for occlusal caries diagnostics, such as visual examination (VE), bitewing radiography (BW) and laser fluorescence (LF), in relation to their ability to detect (dentin) caries under clinical and laboratory conditions. MATERIALS AND METHODS A systematic search of the literature was performed to identify studies meeting the inclusion criteria using the PIRDS concept (N = 1090). A risk of bias (RoB) assessment tool was used for quality evaluation. Reports with low/moderate RoB, well-matching thresholds for index and reference tests and appropriate reporting were included in the meta-analysis (N = 37; 29 in vivo/8 in vitro). The pooled sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR) and areas under ROC curves (AUCs) were computed. RESULTS SP ranged from 0.50 (fibre-optic transillumination/caries detection level) to 0.97 (conventional BW/dentine detection level) in vitro. AUCs were typically higher for BW or LF than for VE. The highest AUC of 0.89 was observed for VE at the 1/3 dentin caries detection level; SE (0.70) was registered to be higher than SP (0.47) for VE at the caries detection level in vivo. CONCLUSION The number of included studies was found to be low. This underlines the need for high-quality caries diagnostic studies that further provide data in relation to multiple caries thresholds. CLINICAL RELEVANCE VE, BW and LF provide acceptable measures for their diagnostic performance on occlusal surfaces, but the results should be interpreted with caution due to the limited data in many categories.
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Affiliation(s)
- Svetlana Kapor
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilian University, Munich, Germany
| | - Mila Janjic Rankovic
- Department of Orthodontics and Dentofacial Orthopedics, University Hospital, Ludwig-Maximilian Universität München, Munich, Germany
| | - Yegane Khazaei
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilian University, Munich, Germany
- Institute of Medical Biometry and Epidemiology, Ludwig-Maximilian University of Munich, Munich, Germany
| | - Alexander Crispin
- Institute of Medical Biometry and Epidemiology, Ludwig-Maximilian University of Munich, Munich, Germany
| | - Ina Schüler
- Department of Orthodontics, Section of Preventive and Paediatric Dentistry, University Hospital, Jena, Germany
| | - Felix Krause
- Clinic for Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital RWTH Aachen, Aachen, Germany
| | - Adrian Lussi
- Department of Operative Dentistry and Periodontology, Faculty of Dentistry, University Medical Centre, Freiburg, Germany
- School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Klaus Neuhaus
- Clinic of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine Basel, University of Basel, Basel, Switzerland
- Department of Dermatology, Inselspital-Bern University Hospital, Bern, Switzerland
| | - Florin Eggmann
- Clinic of Periodontology, Endodontology and Cariology, University Centre for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Stavroula Michou
- Department of Odontology, University Copenhagen, Copenhagen, Denmark
| | - Kim Ekstrand
- Department of Odontology, University Copenhagen, Copenhagen, Denmark
| | | | - Jan Kühnisch
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilian University, Munich, Germany.
- Poliklinik Für Zahnerhaltung Und Parodontologie, Klinikum Der Universität München, LMU München, Goethestraße 70, 80336, München, Germany.
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Kühnisch J, Janjic Rankovic M, Kapor S, Schüler I, Krause F, Michou S, Ekstrand K, Eggmann F, Neuhaus KW, Lussi A, Huysmans MC. Identifying and Avoiding Risk of Bias in Caries Diagnostic Studies. J Clin Med 2021; 10:3223. [PMID: 34362007 PMCID: PMC8347423 DOI: 10.3390/jcm10153223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
Caries diagnostic studies differ with respect to their design, included patients/tooth samples, use of diagnostic and reference methods, calibration, blinding and data reporting. Such heterogeneity makes comparisons between studies difficult and could represent a substantial risk of bias (RoB) when it is not identified. Therefore, the present report aims to describe the development and background of a RoB assessment tool for caries diagnostic studies. The expert group developed and agreed to use a RoB assessment tool during three workshops. Here, existing instruments (e.g., QUADAS 2 and the Joanna Briggs Institute Reviewers' Manual) influenced the hierarchy and phrasing of the signalling questions that were adapted to the specific dental purpose. The tailored RoB assessment tool that was created consists of 16 signalling questions that are organized in four domains. This tool considers the selection/spectrum bias (1), the bias of the index (2) and reference tests (3), and the bias of the study flow and data analysis (4) and can be downloaded from the journal website. This paper explores possible sources of heterogeneity and bias in caries diagnostic studies and summarizes the relevant methodological aspects.
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Affiliation(s)
- Jan Kühnisch
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians University Munich, 80336 Munich, Germany;
| | - Mila Janjic Rankovic
- Department of Orthodontics and Dentofacial Orthopaedics, University Hospital, Ludwig-Maximilians University Munich, 80336 Munich, Germany;
| | - Svetlana Kapor
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians University Munich, 80336 Munich, Germany;
| | - Ina Schüler
- Department of Orthodontics, Section of Preventive and Paediatric Dentistry, University Hospital, 07743 Jena, Germany;
| | - Felix Krause
- Clinic for Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital RWTH Aachen, 52074 Aachen, Germany;
| | - Stavroula Michou
- Department of Odontology, University Copenhagen, 2200 Copenhagen, Denmark; (S.M.); (K.E.)
| | - Kim Ekstrand
- Department of Odontology, University Copenhagen, 2200 Copenhagen, Denmark; (S.M.); (K.E.)
| | - Florin Eggmann
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine UZB, University of Basel, 4058 Basel, Switzerland; (F.E.); (K.W.N.)
| | - Klaus W. Neuhaus
- Department of Periodontology, Endodontology and Cariology, University Center for Dental Medicine UZB, University of Basel, 4058 Basel, Switzerland; (F.E.); (K.W.N.)
| | - Adrian Lussi
- School of Dental Medicine, University of Bern, 3012 Bern, Switzerland;
- Department of Operative Dentistry and Periodontology, University Medical Centre, 79098 Freiburg, Germany
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Pozos-Guillén A, Molina G, Soviero V, Arthur RA, Chavarria-Bolaños D, Acevedo AM. Management of dental caries lesions in Latin American and Caribbean countries. Braz Oral Res 2021; 35:e055. [PMID: 34076079 DOI: 10.1590/1807-3107bor-2021.vol35.0055] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/09/2021] [Indexed: 11/22/2022] Open
Abstract
Caries management at the lesion level is dependent on the lesion activity, the presence of a cavitation (either cleanable or non-cleanable), and lesion depth as evaluated via radiographic examination. A variety of non-invasive, micro-invasive, and minimally invasive treatment (with or without restoration) options are available for primary and permanent teeth. Non-invasive strategies include oral hygiene instructions, dietary counseling, and personal as well as professional use of fluoridated products that reduce demineralization and increase re-mineralization. Micro-invasive procedures include the use of occlusal resin sealants and resin infiltrants, while minimally invasive strategies comprise those related to selective removal of caries tissues and placement of restorations. Deep caries management includes indirect pulp capping, while exposed pulp may be treated using direct pulp capping and partial or complete pulpotomy. The aim of the present study was to review available evidence on recommended preventive and restorative strategies for caries lesions in Latin American/Caribbean countries, and subsequently develop evidence-based recommendations for treatment options that take into consideration material availability, emphasize ways to adapt available treatments to the local context, and suggest ways in which dentists and health systems can adopt these treatments.
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Affiliation(s)
- Amaury Pozos-Guillén
- Universidad Autónoma de San Luis Potosí, Faculty of Dentistry, Basic Sciences Laboratory, San Luis Potosí, México
| | - Gustavo Molina
- Universidad Nacional de Córdoba, The Dental Faculty, Department of Dental Materials, Córdoba, Argentina
| | - Vera Soviero
- Universidade Estadual do Rio de Janeiro - UERJ, School of Dentistry, Department of Preventive and Community Dentistry, Rio de Janeiro, RJ, Brazil.,Centro Universitário Arthur Sá Earp Neto - Unifase, School of Dentistry, Petrópolis, RJ, Brazil
| | - Rodrigo Alex Arthur
- Universidade Federal do Rio Grande do Sul - UFRGS, Dental School, Department of Preventive and Community Dentistry, Porto Alegre, RS, Brazil
| | - Daniel Chavarria-Bolaños
- Universidad de Costa Rica, Faculty of Dentistry, Department of Diagnostic and Surgical Sciences, San José, Costa Rica
| | - Ana María Acevedo
- Universidad Central de Venezuela, Faculty of Dentistry, Institute of Dental Research "Raul Vincentelli", Caracas, Venezuela
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Seoane J, Warnakulasuriya S, Bagán JV, Aguirre-Urizar JM, López-Jornet P, Hernández-Vallejo G, González-Moles MÁ, Pereiro-Ferreiros M, Seoane-Romero J, Varela-Centelles P. Assembling a consensus on actinic cheilitis: A Delphi study. J Oral Pathol Med 2021; 50:962-970. [PMID: 33998055 DOI: 10.1111/jop.13200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/27/2021] [Accepted: 05/05/2021] [Indexed: 01/18/2023]
Abstract
AIMS To discuss the terminology to define and classify actinic cheilitis (AC) and to build a consensus on the diagnostic and therapeutic approaches to AC. METHODS Two-round Delphi study using a questionnaire including 34 closed sentences (9 on terminology and taxonomy, 5 on potential for malignant transformation, 12 on diagnostic aspects, 8 on treatment) and 8 open questions. Experts' agreement was rated using a Likert scale (1-7). RESULTS A consensus was reached on 24 out 34 statements (73.5%) and on 5 out of 8 (62.5%) close-ended questions. The response rate was identical in both rounds (attrition of 0%). AC is the term with the highest agreement (median of 7 (strongly agree; IQR: 6-7)) and the lowest dispersion (VC = 21.33). 'Potentially malignant disorder' was the preferred classification group for AC (median of 7) and 85.6% of participants showing some level of agreement (CV < 50). Experts (66.75%) consider AC a clinical term (median: 7; IQR: 4-7) and believe definitive diagnosis can be made clinically (median: 6; IQR: 5-7), particularly by inspection and palpation (median: 5; IQR: 4-6). Histopathological confirmation is mandatory for the management of AC (median: 5; IQR: 2.5-7), even for homogeneous lesions (median: 5; IQR: 3.5-6). Consensus was reached on all treatment statements (VC < 50). CONCLUSIONS AC is a potentially malignant disorder with a significant lack of agreement on diagnostic criteria, procedures, biopsy indications and the importance of techniques to assist in biopsy. A consensus was reached on nomenclature and management of this disorder.
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Affiliation(s)
- Juan Seoane
- Department of Surgery and Medical-Surgical Specialities, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | - Pía López-Jornet
- Department of Oral Medicine, University of Murcia, Hospital Morales Meseguer, Murcia, Spain
| | | | | | | | - Javier Seoane-Romero
- USC International School of Doctorate, Ciudad Real University Hospital, Ciudad Real, Spain
| | - Pablo Varela-Centelles
- Department of Surgery and Medical-Surgical Specialities, University of Santiago de Compostela, Santiago de Compostela, Spain.,CS Praza do Ferrol. EOXI Lugo, Cervo e Monforte, Department of Surgery and Medical-Surgical Specialities, Galician Health Service, Univeristy of Santiago de Compostela, Lugo, Spain
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Gasqui MA, Pérard M, Decup F, Monsarrat P, Turpin YL, Villat C, Gueyffier F, Maucort-Boulch D, Roche L, Grosgogeat B. Place of a new radiological index in predicting pulp exposure before intervention for deep carious lesions. Oral Radiol 2021; 38:89-98. [PMID: 33954908 DOI: 10.1007/s11282-021-00530-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND During interventions for deep caries lesions without severe symptoms, preserving pulpal vitality is important to ensure treatment success, improve organ prognosis, and decrease cost-effectiveness. Current pre-operative radiographs allow visual estimation but not accurate measurement of lesion depth. PURPOSE Investigate the ability of ratio 'remaining/total dentin thickness' (RDT/TDT, as determined on pre-operative radiographs) to predict pulp exposure during excavation. METHODS This retrospective study (January 2018-June 2020) analyzed data on 360 patients. Four independent raters examined standard pre-operative radiographs and their contrasted versions. Lines put at the dentino-enamel junction, the floor of the carious lesion, and the pulp chamber wall allowed deriving RDT/TDT. Inter-rater agreements and concordance were assessed. A logistic regression accounting for measurement errors provided odds ratios that estimated the ability of the RDT/TDT to predict pulp exposure. RESULTS The median RDT/TDT ratio ranges were 16.8-26.5% on standard and 16.2-24.6% on contrasted radiographs. Inter-rater agreements on RDT/TDT were rather poor and inter-rater reliability was low and similar in standard and contrasted radiographs: the concordance correlation coefficients (95% CIs) were estimated at 0.46 (0.40; 0.51) and 0.46 (0.40; 0.52), respectively. The risk of pulp exposure increased by 2.5 times [odds ratio (95% CI) 2.57 (2.06; 3.20)] per 10-point decrease of the ratio on standard radiographs vs. 4.15 (3.15; 5.46) on contrasted radiographs. CONCLUSION RDT/TDT ratio is potentially helpful in predicting pulp exposure. However, the measurement errors on RDT and TDT being non-negligible and the interrater agreements poor, there is still place for advances through development of an automated process that will improve reliability and reproducibility of pulp exposure risk assessment. CLINICAL TRIAL Trial registration number. ClinicalTrials.gov NCT04607395, October 29, 2020.
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Affiliation(s)
- Marie-Agnès Gasqui
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - Matthieu Pérard
- Faculté d'Odontologie, Université de Rennes 1, Rennes, France
- Institut des Sciences Chimiques de Rennes, UMR CNRS 6226, Rennes, France
- Pôle d'Odontologie, CHU Rennes, Rennes, France
| | - Franck Decup
- Faculté d'Odontologie, Université Paris Descartes, Montrouge, France
- Pathologie Imagerie et Biothérapies orofaciales, EA2496, Université Paris Descartes, 92120, Montrouge, France
- Service d'Odontologie, Assistance Publique des Hôpitaux de Paris, Hôpital Charles-Foix, Ivry, France
| | - Paul Monsarrat
- Faculté d'Odontologie, Université Paul Sabatier, Toulouse, France
- STROMALab, Université de Toulouse, CNRS ERL 5311, EFS, INP-ENVT, Inserm, UPS, Toulouse, France
- Centre Hospitalo-Universitaire, Toulouse, France
| | - Yann-Loïg Turpin
- Faculté d'Odontologie, Université de Rennes 1, Rennes, France
- Pôle d'Odontologie, CHU Rennes, Rennes, France
| | - Cyril Villat
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - François Gueyffier
- Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
- Hôpital cardiologique, Hospices Civils de Lyon, Lyon, France
| | - Delphine Maucort-Boulch
- Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Laurent Roche
- Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Brigitte Grosgogeat
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France.
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Muller-Bolla M, Aïem E, Coulot C, Velly AM, Doméjean S. Restorative thresholds for primary and permanent molars in children: French dentist decisions. Int J Paediatr Dent 2021; 31:299-310. [PMID: 33220074 DOI: 10.1111/ipd.12752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/13/2020] [Accepted: 10/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Worldwide, numerous surveys have investigated practices and knowledge about caries management in adults, but few are available for children. AIM The present cross-sectional survey aimed to assess the restorative thresholds (RTs) in primary and permanent molars in children used by a population of dentists treating children and practicing in France. DESIGN The study population consisted of French dentists treating children (Fr-DTCs) who were registered in the French Society of Pediatric Dentistry (n = 250). A specific questionnaire was developed. Descriptive and statistical analyses were performed. RESULTS Response rate was 80.4% (n = 201). Considering that an appropriate RT is at the stage of a moderate lesion (occlusal: International Caries Detection and Assessment System 4; approximal: lesion involving the external third of dentine), more than 50% of respondents showed a tendency for iatrogenic treatment, except for occlusal carious lesions in primary molars. Inappropriate invasive strategies were more often reported for occlusal lesions in permanent than primary molars. Moreover, for both molar types, these inappropriate RTs were more often chosen for approximal than occlusal lesions. CONCLUSIONS The present survey suggested that Fr-DTCs tend to overtreat in terms of caries management in both primary and permanent molars.
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Affiliation(s)
- Michèle Muller-Bolla
- UFR d'Odontologie de Nice Sophia Antipolis, Université Côte d'Azur, CHUN, Nice, France.,Laboratoire URB2i EA 4662, Paris Descartes, Montrouge, France
| | - Elody Aïem
- UFR d'Odontologie de Nice Sophia Antipolis, Université Côte d'Azur, CHUN, Nice, France.,Laboratoire MICORALIS UPR 7354, Faculté de Chirurgie Dentaire, Université Côte d'Azur, Nice, France
| | - Cyril Coulot
- UFR d'Odontologie de Nice Sophia Antipolis, Université Côte d'Azur, CHUN, Nice, France
| | | | - Sophie Doméjean
- Centre de Recherche en Odontologie Clinique EA 4847, Univ Clermont Auvergne, UFR d'Odontologie, Clermont-Ferrand, France.,CHU Estaing Clermont-Ferrand, Service d'Odontologie, Clermont-Ferrand, France
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74
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Park KJ, Voigt A, Schneider H, Ziebolz D, Haak R. Light-based diagnostic methods for the in vivo assessment of initial caries lesions: Laser fluorescence, QLF and OCT. Photodiagnosis Photodyn Ther 2021; 34:102270. [PMID: 33785442 DOI: 10.1016/j.pdpdt.2021.102270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate different light-based caries diagnostic methods for assessment of non-cavitated initial carious lesions on smooth surfaces. METHODS 39 participants were included. For each participant, three regions of interest (ROI) with ICDAS codes 0, 1 or 2 were defined. All ROIs (n = 117) were investigated/imaged with laser fluorescence (LF, DIAGNOdent 2095; KaVo dental GmbH), quantitative light-induced fluorescence (QLF; Biluminator 2+, Inspektor Research Systems B.V.) and spectral-domain optical coherence tomography (SD-OCT; Telesto II, Thorlabs GmbH). The values of LF, ΔF of QLF, and the lesion extent assessed by OCT were categorized. Frequency distribution of LF-/QLF- and OCT-scores was determined for each ICDAS code included. Inter- and intra-examiner reproducibility of QLF and OCT measurements were assessed by unweighted kappa coefficient (ĸ) and Wilcoxon test (α = 0.05). RESULTS Compared with LF and QLF, OCT showed various manifestations of carious lesions for visually sound ROIs and a larger variation of caries extent in depth within the same ICDAS code groups. Intra-examiner reproducibility ranged between 0.49 and 1.00 for the QLF analysis and between 0.95 and 0.99 for the OCT analysis. Inter-examiner reproducibility ranged between 0.17 and 0.32 for the QLF analysis and between 0.65 and 0.79 for the OCT analysis. CONCLUSION LF and QLF were insensitive to less pronounced smooth-surface lesions while OCT allowed differentiation based on the penetration depth of the carious lesions. This makes OCT a suitable method to complement conventional visual inspection in order to detect and assess (very) early lesions.
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Affiliation(s)
- Kyung-Jin Park
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany.
| | - Aline Voigt
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Hartmut Schneider
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
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75
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Litzenburger F, Schäfer G, Hickel R, Kühnisch J, Heck K. Comparison of novel and established caries diagnostic methods: a clinical study on occlusal surfaces. BMC Oral Health 2021; 21:97. [PMID: 33663454 PMCID: PMC7934514 DOI: 10.1186/s12903-021-01465-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 02/25/2021] [Indexed: 11/25/2022] Open
Abstract
Background The purpose of this prospective clinical diagnostic study with validation was to compare the diagnostic accuracy of near-infrared transillumination (NIRT), laser fluorescence measurement (LF), alternating current impedance spectroscopy (ACIS) and their combinations as adjunct methods to visual examination (VE) for occlusal caries detection using a hybrid reference standard. Methods Ninety-six first and second non-cavitated permanent molars from 76 individuals (mean age 24.2) were investigated using (VE) (ICDAS) and bitewing radiography (BWR), as well as NIRT, LF and ACIS. The findings of BWR and NIRT were evaluated by two examiners while the other examinations were conducted by one calibrated dentist. The hybrid reference standard consisted of non-operative validation based on the results of VE and BWR and operative validation. Statistical analysis included cross-tabulations, calculation of sensitivity, specificity and area under the receiver operating characteristic curve at three diagnostic thresholds: caries in general, enamel caries and dentin caries. Results NIRT, LF and ACIS exhibited high sensitivity for caries in general [1.00 (1.00–1.00), 0.77 (0.65–0.88), 0.75 (0.63–0.87)) and for dentin caries (0.97 (0.91–1.03), 0.76 (0.76–0.90), 0.64 (0.47–0.80)]. Sensitivity values for enamel caries were weak (0.21, 0.11, 0.37). Specificity values did not fall below 0.65 (NIRT) for all categories and methods, except for NIRT at the caries detection threshold (0.27). A combination of LF and ACIS with VE improved the diagnostic performance at the overall and the enamel caries threshold. The other methods showed fair to excellent discrimination at the overall caries threshold (NIRT 0.64, LF 0.89 and ACIS 0.86) and acceptable discrimination at the dentin caries threshold (NIRT 0.82, LF 0.81 and ACIS 0.79). AUROC for enamel caries exhibited the weakest discrimination. Accuracy was 65.6% for VE, 69.8% for BWR, 50.0% for NIRT, 53.1% for LF and 74.0% for ACIS. Reliability assessment for BWR and NIRT showed at least substantial agreements for all analyses. Conclusions The methods, NIRT, LF and ACIS, revealed different potential but no impeccable performance for occlusal caries detection. All are suitable instruments to detect hidden carious lesion in dentin. As auxiliaries to VE, LF and ACIS showed an increase in diagnostic performance.
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Affiliation(s)
- Friederike Litzenburger
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany.
| | - Gerrit Schäfer
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Jan Kühnisch
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Katrin Heck
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
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76
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Chen Y, Chen D, Lin H. Infiltration and sealing for managing non-cavitated proximal lesions: a systematic review and meta-analysis. BMC Oral Health 2021; 21:13. [PMID: 33413327 PMCID: PMC7791990 DOI: 10.1186/s12903-020-01364-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/10/2020] [Indexed: 11/25/2022] Open
Abstract
Background Infiltration and sealing are micro-invasive treatments for arresting proximal non-cavitated caries lesions; however, their efficacies under different conditions remain unknown. This systematic review and meta-analysis aimed to evaluate the caries-arresting effectiveness of infiltration and sealing and to further analyse their efficacies across different dentition types and caries risk levels. Methods Six electronic databases were searched for published literature, and references were manually searched. Split-mouth randomised controlled trials (RCTs) to compare the effectiveness between infiltration/sealing and non-invasive treatments in proximal lesions were included. The primary outcome was obtained from radiographical readings. Results In total, 1033 citations were identified, and 17 RCTs (22 articles) were included. Infiltration and sealing reduced the odds of lesion progression (infiltration vs. non-invasive: OR = 0.21, 95% CI 0.15–0.30; sealing vs. placebo: OR = 0.27, 95% CI 0.18–0.42). For both the primary and permanent dentitions, infiltration and sealing were more effective than non-invasive treatments (primary dentition: OR = 0.30, 95% CI 0.20–0.45; permanent dentition: OR = 0.20, 95% CI 0.14–0.28). The overall effects of infiltration and sealing were significantly different from the control effects based on different caries risk levels (OR = 0.20, 95% CI 0.14–0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI 0.01–8.27), there were significant differences between micro-invasive and non-invasive treatments (low risk: OR = 0.24, 95% CI 0.08–0.72; low to moderate risk: OR = 0.38, 95% CI 0.18–0.81; moderate to high risk: OR = 0.17, 95% CI 0.10–0.29; and high risk: OR = 0.14, 95% CI 0.07–0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI 0.01–8.27), infiltration was superior (low risk: OR = 0.24, 95% CI 0.08–0.72; low to moderate risk: OR = 0.38, 95% CI 0.18–0.81; moderate to high risk: OR = 0.20, 95% CI 0.10–0.39; and high risk: OR = 0.14, 95% CI 0.05–0.37). Conclusion Infiltration and sealing were more efficacious than non-invasive treatments for halting non-cavitated proximal lesions.
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Affiliation(s)
- Yuanyuan Chen
- Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Department of Preventive Dentistry, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Guangdong Key Laboratory for Dental Disease Prevention and Control, Sun Yat-Sen University, Guangzhou, China
| | - Dongru Chen
- Department of Orthodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Department of Preventive Dentistry, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Guangdong Key Laboratory for Dental Disease Prevention and Control, Sun Yat-Sen University, Guangzhou, China
| | - Huancai Lin
- Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, China. .,Department of Preventive Dentistry, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China. .,Guangdong Key Laboratory for Dental Disease Prevention and Control, Sun Yat-Sen University, Guangzhou, China.
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77
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Cagetti MG, Angelino E. Could SARS-CoV-2 burst the use of Non-Invasive and Minimally Invasive treatments in paediatric dentistry? Int J Paediatr Dent 2021; 31:27-30. [PMID: 32748562 PMCID: PMC7436454 DOI: 10.1111/ipd.12679] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/09/2020] [Accepted: 05/20/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Maria Grazia Cagetti
- Department of BiomedicalSurgical and Dental SciencesUniversity of MilanMilanItaly
| | - Eleonora Angelino
- Department of BiomedicalSurgical and Dental SciencesUniversity of MilanMilanItaly
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78
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Flores-Orozco E, Rogelio DP, Barron-Crespo V, Rovira-Lastra B, Martinez-Gomis J. Prevalence of distal caries in the second mandibular molar among the general population in Mexico and its relationship with the position and angulation of the adjacent third molar. JOURNAL OF ORAL AND MAXILLOFACIAL RADIOLOGY 2021. [DOI: 10.4103/jomr.jomr_27_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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79
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Paris S, Banerjee A, Bottenberg P, Breschi L, Campus G, Doméjean S, Ekstrand K, Giacaman RA, Haak R, Hannig M, Hickel R, Juric H, Lussi A, Machiulskiene V, Manton D, Jablonski-Momeni A, Santamaria R, Schwendicke F, Splieth CH, Tassery H, Zandona A, Zero D, Zimmer S, Opdam N. How to Intervene in the Caries Process in Older Adults: A Joint ORCA and EFCD Expert Delphi Consensus Statement. Caries Res 2020; 54:1-7. [PMID: 33291110 DOI: 10.1159/000510843] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 11/19/2022] Open
Abstract
AIM To provide recommendations for dental clinicians for the management of dental caries in older adults with special emphasis on root caries lesions. METHODS A consensus workshop followed by a Delphi consensus process were conducted with an expert panel nominated by ORCA, EFCD, and DGZ boards. Based on a systematic review of the literature, as well as non-systematic literature search, recommendations for clinicians were developed and consented in a two-stage Delphi process. RESULTS Demographic and epidemiologic changes will significantly increase the need of management of older adults and root caries in the future. Ageing is associated with a decline of intrinsic capacities and an increased risk of general diseases. As oral and systemic health are linked, bidirectional consequences of diseases and interventions need to be considered. Caries prevention and treatment in older adults must respond to the patient's individual abilities for self-care and cooperation and often involves the support of caregivers. Systemic interventions may involve dietary counselling, oral hygiene instruction, the use of fluoridated toothpastes, and the stimulation of salivary flow. Local interventions to manage root lesions may comprise local biofilm control, application of highly fluoridated toothpastes or varnishes as well as antimicrobial agents. Restorative treatment is often compromised by the accessibility of such root caries lesions as well as the ability of the senior patient to cooperate. If optimum restorative treatment is impossible or inappropriate, long-term stabilization, e.g., by using glass-ionomer cements, and palliative treatments that aim to maintain oral function as long and as well as possible may be the treatment of choice for the individual.
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Affiliation(s)
- Sebastian Paris
- Department of Operative and Preventive Dentistry, Center for Dental and Craniofacial Sciences, Charité - Universitätsmedizin Berlin, Berlin, Germany,
| | - Avijit Banerjee
- Conservative & MI Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom
| | - Peter Bottenberg
- Oral Health Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lorenzo Breschi
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna - Alma Mater Studiorum, Bologna, Italy
| | - Guglielmo Campus
- Department of Restorative, Preventive and Paediatric Dentistry, Zahnmedizinische Kliniken (ZMK), University of Bern, Bern, Switzerland
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Sassari, Italy
| | - Sophie Doméjean
- Département d'Odontologie Conservatrice, Université Clermont Auvergne, UFR d'Odontologie, Centre de Recherche en Odontologie Clinique Clermont-Ferrand, Clermont-Ferrand, France
| | - Kim Ekstrand
- Cariology and Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University Leipzig, Leipzig, Germany
| | - Matthias Hannig
- Clinic of Operative Dentistry and Periodontology, Saarland University, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany
| | - Hrvoje Juric
- Department of Paediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Adrian Lussi
- School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Operative Dentistry and Periodontology, Faculty of Dentistry, University Medical Centre, Freiburg, Germany
| | - Vita Machiulskiene
- Clinic of Dental and Oral Pathology, Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - David Manton
- Centrum van Tandheelkunde en Mondzorgkunde, Universitair Medisch Centrum Groningen, University of Groningen, Groningen, The Netherlands
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Ruth Santamaria
- Preventive and Pediatric Dentistry, Center for Oral Health, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Falk Schwendicke
- Department of Oral Diagnosis, Digital Health and Health Services Research, Center for Dental and Craniofacial Sciences, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian H Splieth
- Preventive and Pediatric Dentistry, Center for Oral Health, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Hervé Tassery
- Faculté d'Odontologie Marseille, Preventive and Restorative Department, Aix-Marseille-Université, Marseille, France
- EA 4203 Laboratory, Université de Montpellier, Montpellier, France
| | - Andrea Zandona
- Department of Comprehensive Care, School of Dental Medicine, Tufts University, Boston, Massachusetts, USA
| | - Domenick Zero
- Department of Cariology, Operative Dentistry and Dental Public Health, Oral Health Research Institute, School of Dentistry, Indiana University, Indianapolis, Indiana, USA
| | - Stefan Zimmer
- Department of Operative and Preventive Dentistry, Dental School, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Niek Opdam
- Radboud University Medical Centre, Department of Dentistry, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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80
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Schwendicke F, Rossi JG, Göstemeyer G, Elhennawy K, Cantu AG, Gaudin R, Chaurasia A, Gehrung S, Krois J. Cost-effectiveness of Artificial Intelligence for Proximal Caries Detection. J Dent Res 2020; 100:369-376. [PMID: 33198554 PMCID: PMC7985854 DOI: 10.1177/0022034520972335] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Artificial intelligence (AI) can assist dentists in image assessment, for example, caries detection. The wider health and cost impact of employing AI for dental diagnostics has not yet been evaluated. We compared the cost-effectiveness of proximal caries detection on bitewing radiographs with versus without AI. U-Net, a fully convolutional neural network, had been trained, validated, and tested on 3,293, 252, and 141 bitewing radiographs, respectively, on which 4 experienced dentists had marked carious lesions (reference test). Lesions were stratified for initial lesions (E1/E2/D1, presumed noncavitated, receiving caries infiltration if detected) and advanced lesions (D2/D3, presumed cavitated, receiving restorative care if detected). A Markov model was used to simulate the consequences of true- and false-positive and true- and false-negative detections, as well as the subsequent decisions over the lifetime of patients. A German mixed-payers perspective was adopted. Our health outcome was tooth retention years. Costs were measured in 2020 euro. Monte-Carlo microsimulations and univariate and probabilistic sensitivity analyses were conducted. The incremental cost-effectiveness ratio (ICER) and the cost-effectiveness acceptability at different willingness-to-pay thresholds were quantified. AI showed an accuracy of 0.80; dentists’ mean accuracy was significantly lower at 0.71 (minimum–maximum: 0.61–0.78, P < 0.05). AI was significantly more sensitive than dentists (0.75 vs. 0.36 [0.19–0.65]; P = 0.006), while its specificity was not significantly lower (0.83 vs. 0.91 [0.69–0.98]; P > 0.05). In the base-case scenario, AI was more effective (tooth retention for a mean 64 [2.5%–97.5%: 61–65] y) and less costly (298 [244–367] euro) than assessment without AI (62 [59–64] y; 322 [257–394] euro). The ICER was −13.9 euro/y (i.e., AI saved money at higher effectiveness). In the majority (>77%) of all cases, AI was less costly and more effective. Applying AI for caries detection is likely to be cost-effective, mainly as fewer lesions remain undetected. Notably, this cost-effectiveness requires dentists to manage detected early lesions nonrestoratively.
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Affiliation(s)
- F Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J G Rossi
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - G Göstemeyer
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - K Elhennawy
- Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - A G Cantu
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - R Gaudin
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - A Chaurasia
- Department of Oral Medicine and Radiology, King George's Medical University, Lucknow, India
| | - S Gehrung
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J Krois
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
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81
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Restorative thresholds for carious lesions in primary molars: French dentist's decisions. Eur Arch Paediatr Dent 2020; 22:441-448. [PMID: 33185858 DOI: 10.1007/s40368-020-00577-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Questionnaire surveys have been undertaken worldwide to investigate practices and knowledge related to carious lesion management, particularly in adults. The primary objective of this cross-sectional survey was to investigate restorative thresholds (RTs) used for carious lesions in primary molars by dentists practising paediatric dentistry in France. Dentists were surveyed by a specifically developed questionnaire based on clinical and radiographic caries classifications. The secondary objective was to explore restorative management strategies in primary molars. METHODS A structured questionnaire assessing RTs and management strategies for occlusal and approximal carious lesions of primary molars was anonymously and electronically administered via SurveyMonkey® to dentists who were members of the Société Française d'Odontologie Pédiatrique. Descriptive analyses, Chi-square test, McNemar test, and logistic regression analyses considering dependent RT variables for occlusal and approximal carious lesions were performed. RESULTS Among 250 dentists surveyed, 201 responded (response rate 80.4%). Overall, 43% (n = 87) and 75% (n = 151) of respondents would place their RTs in enamel for occlusal and approximal lesions, respectively. Dentists with an exclusive practice of paediatric dentistry more frequently would choose a RT in dentine for approximal lesions than did other dentists (p = 0.010). A preparation technique including sound dental tissues was less frequent for occlusal than approximal lesions (n = 31; 15% vs n = 60; 30%). Overall, 75% (n = 151) of respondents used the same restorative material for occlusal and approximal lesions. CONCLUSION In general, dentists practising paediatric dentistry in France overtreated lesions on primary molars, which contradicts minimal intervention recommendations. RTs are too often indicated for enamel-confined carious lesions.
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82
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Foxton RM. Current perspectives on dental adhesion: (2) Concepts for operatively managing carious lesions extending into dentine using bioactive and adhesive direct restorative materials. JAPANESE DENTAL SCIENCE REVIEW 2020; 56:208-215. [PMID: 32983288 PMCID: PMC7502031 DOI: 10.1016/j.jdsr.2020.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/24/2020] [Indexed: 11/27/2022] Open
Abstract
This article reviews the current concepts for operatively managing carious lesions extending into dentine with minimal removal of tooth structure and restoring with dentine adhesives and direct composite resin. It looks sequentially at the operative steps involved including remineralisation with bioactive cements, bonding to caries-affected dentine including smear-layer modification using HOCl, creation of an acid-base resistance zone,steps to optimise the performance of all-in-one adhesives, and incremental placement of direct composite resin to improve bond strengths to cavity floor dentine. It explores how understanding the phenomenon of colour-shifting at the composite resin-enamel/dentine restoration borders can help in creating near "invisible" restoration margins through a "chameleon" effect. With the increased risks of transmission of Covid-19 when aerosol generating procedures are carried out in Dentistry, following a minimally invasive approach to managing dental caries should be given serious consideration.
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Affiliation(s)
- Richard M Foxton
- Centre for Dental Education, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, United Kingdom
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83
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Minimum intervention oral healthcare for people with dental phobia: a patient management pathway. Br Dent J 2020; 229:417-424. [PMID: 33037361 PMCID: PMC7546148 DOI: 10.1038/s41415-020-2178-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/10/2020] [Indexed: 11/30/2022]
Abstract
Dental phobia is relatively common among adults and often associated with poorer oral health as a consequence of delaying dental treatment until advanced disease has caused intolerable symptoms. The increased rates of active disease may also have an impact on oral health-related quality of life (OHR QoL). Minimum intervention oral healthcare (MIOC) combines four key domains: detection and diagnosis, prevention and control of oral disease, minimally invasive (MI) operative interventions and review/recall. Team delivery and patient-focused care are the underpinning tenets to these four domains. The MIOC approach offers advantages to both patients with dental phobia and the oral healthcare team involved in their long-term management. This paper presents an adaptation of MIOC for patients with dental phobia, which is founded on a comprehensive assessment approach followed by the provision of dental care with behavioural management techniques in combination with conscious sedation. This approach has the potential to provide a comprehensive personalised patient management pathway for delivering better oral health for this vulnerable patient group in a primary care setting. People with dental phobia often present with a poorer oral health status which compromises their oral health-related quality of life. An outline of the application of the minimum intervention oral healthcare (MIOC) framework for patients with dental phobia is described, which has the potential to be particularly beneficial for the oral healthcare of this group of patients. An assessment tool is presented which provides an overview of important points for a practitioner to consider when assessing patients with dental phobia using MIOC.
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84
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Alkhalaf R, Neves ADA, Banerjee A, Hosey MT. Minimally invasive judgement calls: managing compromised first permanent molars in children. Br Dent J 2020; 229:459-465. [PMID: 33037366 DOI: 10.1038/s41415-020-2154-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/11/2020] [Indexed: 12/23/2022]
Abstract
This paper aims to update the reader on how minimally invasive (MI) techniques may be used to improve the longevity of carious or defective/compromised first permanent molars (cFPMs) in young children. Clinical and radiographic diagnosis and the prognostic factors will be discussed in view of recent studies showing that these teeth can be kept in function and have an improved prognosis as the child gets older. Clinical protocols for their care, based on the latest evidence and techniques for MI restorations, together with longevity information of possible restorative options, are described. This paper also explores the rationale behind enforced extractions and related morbidity, in order to help oral healthcare practitioners to determine the optimal management of these key elements in the dentition for the benefit of the patients.
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Affiliation(s)
- Reem Alkhalaf
- Centre of Oral, Clinical & Translational Science, Faculty of Dentistry, Oral and Craniofacial Research, King's College London, London, UK
| | - Aline de Almeida Neves
- Clinical Lecturer in Paediatric Dentistry, Centre of Oral, Clinical and Translational Research, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK; Adjunct Professor in Paediatric Dentistry, Federal University of Rio de Janeiro, Brazil.
| | - Avijit Banerjee
- Professor of Cariology & Operative Dentistry, Honorary Consultant/Clinical Lead, Restorative Dentistry, Conservative & MI Dentistry/Centre of Oral, Clinical and Translational Research, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Marie Therese Hosey
- Professor of Paediatric Dentistry, Honorary Consultant, Chair of Paediatric Dentistry, Centre of Oral, Clinical and Translational Research, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
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85
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Carious lesion detection technologies: factual clinical approaches. Br Dent J 2020; 229:432-442. [DOI: 10.1038/s41415-020-2116-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/05/2020] [Indexed: 11/09/2022]
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86
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Bomfim DI, Rahim NM, Austin RS. Biomechanical planning for minimally invasive indirect restorations. Br Dent J 2020; 229:425-429. [PMID: 33037362 DOI: 10.1038/s41415-020-2170-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/13/2020] [Indexed: 11/09/2022]
Abstract
This paper explores the planning and execution of indirect partial-coverage restorations and will outline practical recommendations for maximising the outcomes for minimally invasive (MI) approaches to indirect restorations, with a special focus on vital teeth, endodontically-treated teeth and worn dentitions. Throughout the paper, the supporting evidence for each rationale for partial-coverage restorations will be considered, as well as the risks and benefits of adopting an MI approach to indirect restorations.
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Affiliation(s)
- Deborah I Bomfim
- Restorative Dentistry, UCLH Royal National ENT and Eastman Dental Hospitals, 47-49 Huntley Street, London, WC1E 6DG, UK
| | | | - Rupert S Austin
- King's College London, Prosthodontics, Guy's Hospital, London, SE1 9RT, UK.
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87
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Affiliation(s)
- Avijit Banerjee
- Guest Editor BDJ Minimum Intervention Themed Issue and Professor of Cariology & Operative Dentistry; Hon. Consultant, Restorative Dentistry; Head of Department, Conservative & MI Dentistry; Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guy's Dental Hospital, London, SE1 9RT, UK
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88
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3D imaging of proximal caries in posterior teeth using optical coherence tomography. Sci Rep 2020; 10:15754. [PMID: 32978464 PMCID: PMC7519687 DOI: 10.1038/s41598-020-72838-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 09/07/2020] [Indexed: 11/08/2022] Open
Abstract
Optical coherence tomography (OCT) can create cross-sectional images of tooth without X-ray exposure. This study aimed to investigate the diagnostic accuracy of 3D imaging of OCT for proximal caries in posterior teeth. Thirty-six human molar teeth with 51 proximal surfaces visibly 6 intact, 16 slightly demineralized, and 29 distinct carious changes were mounted to take digital radiographs and 3D OCT images. The sensitivity, specificity and area under the receiver operating characteristic curve (AUC) for the diagnosis of enamel caries and dentin caries were calculated to quantify the diagnostic ability of 3D OCT in comparison with digital radiography. Diagnostic accuracy was evaluated by the agreement with histology using weighted Kappa. OCT showed significantly higher sensitivity, AUC and Kappa values than radiography. OCT can be a safer option for the diagnosis of proximal caries in posterior teeth that can be applied to the patients without X-ray exposure.
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89
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Rodrigues Chibinski AC. Silver diamine fluoride. Br Dent J 2020; 229:328. [DOI: 10.1038/s41415-020-2189-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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90
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Fernández CE, Chanin M, Appice GM, Culver AM, Stein A. Conceptualization of dental caries by dental students is related to their preventive oral care routine. J Dent Educ 2020; 84:1426-1437. [PMID: 32805773 DOI: 10.1002/jdd.12357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Whether the understanding of dental caries influences how future dentists manage the disease themselves has not been previously studied. Thus, this study evaluated whether the conceptualization (understanding) of dental caries by dental students is related to their own preventive oral care routine. METHODS Dental students at a U.S. dental school (n = 517) were invited to voluntarily respond to an anonymous electronic survey in spring 2018. Demographic characteristics, caries conceptualization (CC), dental care habits, and self-caries risk determination were asked. Discursive responses to CC were analyzed by content analysis technique, and categories [c] were created. Chi-square and Fisher's exact tests were used for analysis. RESULTS Overall response rate was 54.5% (n = 282, 48.2% female). Three researchers independently analyzed discursive answers and classified them into 1 of 6 caries concept categories [c]: [c1] only signs of the disease (10.3%), [c2] bacterial disease-not specifying bacterial metabolism (38.3%), [c3] bacterial byproducts-not specifying substrate (13.8%), [c4] biological or multifactorial concept (24.8%), [c5] comprehensive multifactorial disease (8.2%), or [c6] other (4.6%). Only 33% completely defined dental caries according to the modern understanding of the disease (c4-c5). Statistical differences were found between: CC and diet modification, CC and rinsing after brushing, year of school (YS) and self-determined caries-risk, YS and brushing at school, and YS and rinsing after brushing (P < 0.05). CONCLUSION Our data suggest that the students' understanding of the disease can influence how they will manage the disease in terms of diet modification and behavior after brushing. Moreover, self-caries risk determination influenced students' brushing behavior.
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Affiliation(s)
- Constanza E Fernández
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Marisa Chanin
- College of Dental Medicine-Illinois (CDMI), Midwestern University, Illinois, USA
| | - Gabriella M Appice
- College of Dental Medicine-Illinois (CDMI), Midwestern University, Illinois, USA
| | - Ashley M Culver
- College of Dental Medicine-Illinois (CDMI), Midwestern University, Illinois, USA
| | - Amy Stein
- Office of Research and Sponsored Programs, Midwestern University, Arizona, USA
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91
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Splieth CH, Kanzow P, Wiegand A, Schmoeckel J, Jablonski-Momeni A. How to intervene in the caries process: proximal caries in adolescents and adults-a systematic review and meta-analysis. Clin Oral Investig 2020; 24:1623-1636. [PMID: 32306093 DOI: 10.1007/s00784-020-03201-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/07/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES For an ORCA/EFCD consensus, this systematic review assessed the question "How to intervene in the caries process in proximal caries in adolescents and adults". MATERIAL AND METHODS Separating between the management of initial and cavitated proximal caries lesions, Medline via PubMed was searched regarding non-operative/non-invasive, minimally/micro-invasive and restorative treatment. First priority was systematic reviews or randomized controlled trials (RCTs), otherwise cohort studies. After extraction of data, the potential risk of bias was estimated depending on the study type, and the emerging evidence for conclusions was graded. RESULTS Regarding non-invasive/non-operative care (NOC), no systematic reviews or RCTs were found. In cohort studies (n = 12) with a low level of evidence, NOC like biofilm management and fluoride was associated with a low proportion and slow speed of progression of initial proximal lesions. Minimally/micro-invasive (MI) treatments such as proximal sealants or resin infiltration (four systematic reviews/meta-analyses) were effective compared with a non-invasive/placebo control at a moderate level of evidence. Data on restorative treatment came with low evidence (5 systematic reviews, 13 RCTs); with the limitation of no direct comparative studies, sample size-weighted mean annual failure rates of class II restorations varied between 1.2 (bulk-fill composite) and 3.8% (ceramic). Based on one RCT, class II composite restorations may show a higher risk of failure compared with amalgam. CONCLUSIONS Proximal caries lesions can be managed successfully with non-operative, micro-invasive and restorative treatment according to lesion stage and caries activity. CLINICAL RELEVANCE Proximal caries treatment options like non-operative, micro-invasive and restorative care should be considered individually.
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Affiliation(s)
- C H Splieth
- Clinic for Preventive and Paediatric Dentistry, University of Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany.
| | - P Kanzow
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
| | - A Wiegand
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
| | - J Schmoeckel
- Clinic for Preventive and Paediatric Dentistry, University of Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - A Jablonski-Momeni
- Department of Orthodontics, Dental School, Philipps-University Marburg, Marburg, Germany
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92
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Kocak N, Cengiz-Yanardag E. Clinical performance of clinical-visual examination, digital bitewing radiography, laser fluorescence, and near-infrared light transillumination for detection of non-cavitated proximal enamel and dentin caries. Lasers Med Sci 2020; 35:1621-1628. [PMID: 32333336 DOI: 10.1007/s10103-020-03021-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/16/2020] [Indexed: 11/28/2022]
Abstract
The aim of this study was to compare the clinical performance of clinical-visual examination using the International Caries Detection and Assessment System (ICDAS) II, digital bitewing radiography, near-infrared light transillumination (NIR-LT), and laser fluorescence (LF) for the detection of non-cavitated proximal enamel and dentin caries. The study included 335 patients, aged 12-18 years, with no cavities in the posterior teeth. Clinical-visual inspections of 335 non-cavitated proximal caries were performed by two examiners. For enamel caries, clinical validation included a combination of clinical-visual and digital bitewing radiography assessments. For dentin caries, the clinical validation was opening the cavity. The accuracy rate, sensitivity, specificity, predictive values, and areas under receiver operating characteristic curves were determined. The agreement between the examiners' measurements was calculated using the kappa coefficient. The sensitivity, specificity, and accuracy of the methods were compared using the McNemar test. The significance level was set at p < 0.05. Digital bitewing radiography had the highest sensitivity (0.96) and accuracy (0.96), and LF had the lowest sensitivity (0.38) and accuracy (0.39). After separation of the lesions into enamel and dentin caries, clinical-visual examination had the highest sensitivity (0.98) and accuracy (0.98) for enamel caries, while digital bitewing radiography had the highest sensitivity (0.97) and accuracy (0.97) for dentin caries. The NIR-LT method had a higher sensitivity for enamel caries (0.86). Each method also differed significantly from the others (p < 0.001). Digital bitewing radiography gave the best prediction of proximal enamel and dentin caries. NIR-LT showed good potential for detection of proximal caries.
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Affiliation(s)
- Nazan Kocak
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Mersin University, Ciftlikkoy Campus, Yenisehir, 33150, Mersin, Turkey.
| | - Esra Cengiz-Yanardag
- Department of Restorative Dentistry, Faculty of Dentistry, Mersin University, Mersin, Turkey
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Discussion on the paper: "When to intervene in the caries process? An expert Delphi consensus statement". Clin Oral Investig 2020; 24:1865-1867. [PMID: 32300982 DOI: 10.1007/s00784-020-03271-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
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94
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Carious lesions and first restorative treatment: Adopted by the General Assembly: September 2019, San Francisco, United States of America. Int Dent J 2020; 70:5-6. [PMID: 31985817 DOI: 10.1111/idj.12551] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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95
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Differences in caries management strategies among dentists. Br Dent J 2019; 227:881. [DOI: 10.1038/s41415-019-1031-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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