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Digmayer Romero VH, Signori C, Uehara JLS, Montagner AF, van de Sande FH, Maydana GS, Chaves ET, Schwendicke F, Braga MM, Huysmans MC, Mendes FM, Cenci MS. Diagnostic Strategies for Restorations Management: A 70-Month RCT. J Dent Res 2024; 103:697-704. [PMID: 38752325 DOI: 10.1177/00220345241247773] [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] [Indexed: 06/21/2024] Open
Abstract
We aimed to evaluate the impact of 2 visual diagnostic strategies for assessing secondary caries and managing permanent posterior restorations on long-term survival. We conducted a diagnostic cluster-randomized clinical trial with 2 parallel groups using different diagnostic strategies: (C+AS) based on caries assessment, marginal adaptation, and marginal staining aspects of the FDI (World Dental Federation) criteria and (C) based on caries assessment using the Caries Associated with Restorations or Sealants (CARS) criteria described by the International Caries Detection and Assessment System (ICDAS). The treatment for the restoration was conducted based on the decision made following the allocated diagnostic strategy. The restorations were then clinically reevaluated for up to 71 mo. The primary outcome was restoration failure (including tooth-level failure: pain, endodontic treatment, and extraction). Cox regression analyses with shared frailty were conducted in the intention-to-treat population, and hazard ratios (HRs) and 95% confidence intervals (95% CIs) were derived. We included 727 restorations from 185 participants and reassessed 502 (69.1%) restorations during follow-up. The evaluations occurred between 6 and 71 mo. At baseline, C led to almost 4 times fewer interventions compared with the C+AS strategy. A total of 371 restorations were assessed in the C group, from which 31 (8.4%) were repaired or replaced. In contrast, the C+AS group had 356 restorations assessed, from which 113 (31.7%) were repaired or replaced. During follow-up, 34 (9.2%) failures were detected in the restorations allocated to the C group and 30 (8.4%) allocated to the C+AS group in the intention-to-treat population, with no significant difference between the groups (HR = 0.83; 95% CI = 0.51 to 1.38; P = 0.435, C+AS as reference). In conclusion, a diagnostic strategy focusing on marginal defects results in more initial interventions but does not improve longevity over the caries-focused strategy, suggesting the need for more conservative approaches.
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Affiliation(s)
- V H Digmayer Romero
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
- Department of Dentistry, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C Signori
- Department of Restorative Dentistry, School of Dentistry, Uniavan University Center, Balneário Camboriú, Pelotas, Brazil
| | - J L S Uehara
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - A F Montagner
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - F H van de Sande
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - G S Maydana
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - E T Chaves
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
- Department of Dentistry, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - F Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin, Berlin, Berlin, Germany
| | - M M Braga
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - M-C Huysmans
- Department of Dentistry, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - F M Mendes
- Department of Dentistry, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - M S Cenci
- Department of Dentistry, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
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Mohamed OS, Almaz SI, Moustafa NR, Ibrahim AA, Hall MA, Karawia I. An In Vitro Validation of DIAGNOdent Versus Radiography for the Detection of Caries Underneath Different Types of Restorations. Cureus 2024; 16:e63689. [PMID: 39092343 PMCID: PMC11293794 DOI: 10.7759/cureus.63689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 08/04/2024] Open
Abstract
Objective This study aimed to assess the validity of DIAGNOdent as a diagnostic device for the detection of secondary dental caries underneath different types of restorations. Methods A total of 60 extracted human permanent molars were used in this experimental study (30 sound teeth and 30 teeth with proximal caries); 20 teeth (10 sound and 10 carious) were randomly allocated into one of three restoration groups: composite, amalgam, or resin-modified glass ionomer (RMGI). All teeth were examined using both KaVo DIAGNOdent Classic and digital radiographic sensors. Results In the composite-restored teeth, DIAGNOdent showed excellent sensitivity (90%) and specificity (90%). On the other hand, digital radiography had high sensitivity (80%) and poor specificity (20%). In amalgam-restored teeth, DIAGNOdent showed low sensitivity (30%) and excellent specificity (100%), while radiographs showed good sensitivity (70%) and low specificity (30%). In the RMGI-restored teeth, DIAGNOdent had excellent sensitivity (100%) and 70% specificity, while digital radiography had poor sensitivity (30%) and excellent specificity (90%). Conclusions DIAGNOdent showed superior results in detecting secondary caries lesions underneath composite and RMGI restorations when compared to digital radiography. On the other hand, radiography emerged as a preferable method for the detection of secondary caries underneath amalgam restorations. Based on our findings, DIAGNOdent can be used in dental clinics for the early diagnosis of hidden secondary caries underneath composite and RMGI restorations.
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Affiliation(s)
- Osama S Mohamed
- Dental Prosthesis Manufacture Technology Department, Faculty of Applied Health Sciences Technology, Pharos University in Alexandria, Alexandria, EGY
| | - Salma I Almaz
- Faculty of Dentistry, Pharos University in Alexandria, Alexandria, EGY
| | - Nouran R Moustafa
- Faculty of Dentistry, Pharos University in Alexandria, Alexandria, EGY
| | - Ahmed A Ibrahim
- Faculty of Dentistry, Pharos University in Alexandria, Alexandria, EGY
| | - Mohamed A Hall
- Alexandria Dental Research Center, Ministry of Health and Population, Alexandria, EGY
| | - Inas Karawia
- Pediatric and Community Dentistry Department, Faculty of Dentistry, Pharos University in Alexandria, Alexandria, EGY
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Chaves ET, Vinayahalingam S, van Nistelrooij N, Xi T, Romero VHD, Flügge T, Saker H, Kim A, Lima GDS, Loomans B, Huysmans MC, Mendes FM, Cenci MS. Detection of caries around restorations on bitewings using deep learning. J Dent 2024; 143:104886. [PMID: 38342368 DOI: 10.1016/j.jdent.2024.104886] [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: 12/04/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/13/2024] Open
Abstract
OBJECTIVE Secondary caries lesions adjacent to restorations, a leading cause of restoration failure, require accurate diagnostic methods to ensure an optimal treatment outcome. Traditional diagnostic strategies rely on visual inspection complemented by radiographs. Recent advancements in artificial intelligence (AI), particularly deep learning, provide potential improvements in caries detection. This study aimed to develop a convolutional neural network (CNN)-based algorithm for detecting primary caries and secondary caries around restorations using bitewings. METHODS Clinical data from 7 general dental practices in the Netherlands, comprising 425 bitewings of 383 patients, were utilized. The study used the Mask-RCNN architecture, for instance, segmentation, supported by the Swin Transformer backbone. After data augmentation, model training was performed through a ten-fold cross-validation. The diagnostic accuracy of the algorithm was evaluated by calculating the area under the Free-Response Receiver Operating Characteristics curve, sensitivity, precision, and F1 scores. RESULTS The model achieved areas under FROC curves of 0.806 and 0.804, and F1-scores of 0.689 and 0.719 for primary and secondary caries detection, respectively. CONCLUSION An accurate CNN-based automated system was developed to detect primary and secondary caries lesions on bitewings, highlighting a significant advancement in automated caries diagnostics. CLINICAL SIGNIFICANCE An accurate algorithm that integrates the detection of both primary and secondary caries will permit the development of automated systems to aid clinicians in their daily clinical practice.
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Affiliation(s)
- Eduardo Trota Chaves
- Department of Dentistry, Research Institute for Medical Innovation, Radboud University Medical Center, Philips van Leydenlaan 25, Nijmegen, EX 6525, the Netherlands; Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil.
| | - Shankeeth Vinayahalingam
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Postal Number 590, P.O. Box 9101, Nijmegen, HB 6500, the Netherlands
| | - Niels van Nistelrooij
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Postal Number 590, P.O. Box 9101, Nijmegen, HB 6500, the Netherlands; Department of Oral and Maxillofacial Surgery, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 1, Berlin 13353, Germany
| | - Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Postal Number 590, P.O. Box 9101, Nijmegen, HB 6500, the Netherlands
| | - Vitor Henrique Digmayer Romero
- Department of Dentistry, Research Institute for Medical Innovation, Radboud University Medical Center, Philips van Leydenlaan 25, Nijmegen, EX 6525, the Netherlands; Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Tabea Flügge
- Einstein Center for Digital Future, Wilhelmstraße 67, Berlin 10117, Germany
| | - Hadi Saker
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Postal Number 590, P.O. Box 9101, Nijmegen, HB 6500, the Netherlands
| | - Alexander Kim
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Postal Number 590, P.O. Box 9101, Nijmegen, HB 6500, the Netherlands
| | - Giana da Silveira Lima
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Bas Loomans
- Department of Dentistry, Research Institute for Medical Innovation, Radboud University Medical Center, Philips van Leydenlaan 25, Nijmegen, EX 6525, the Netherlands
| | - Marie-Charlotte Huysmans
- Department of Dentistry, Research Institute for Medical Innovation, Radboud University Medical Center, Philips van Leydenlaan 25, Nijmegen, EX 6525, the Netherlands
| | - Fausto Medeiros Mendes
- Department of Dentistry, Research Institute for Medical Innovation, Radboud University Medical Center, Philips van Leydenlaan 25, Nijmegen, EX 6525, the Netherlands; Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Maximiliano Sergio Cenci
- Department of Dentistry, Research Institute for Medical Innovation, Radboud University Medical Center, Philips van Leydenlaan 25, Nijmegen, EX 6525, the Netherlands
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Kühnisch J, Aps JK, Splieth C, Lussi A, Jablonski-Momeni A, Mendes FM, Schmalz G, Fontana M, Banerjee A, Ricketts D, Schwendicke F, Douglas G, Campus G, van der Veen M, Opdam N, Doméjean S, Martignon S, Neuhaus KW, Horner K, Huysmans MCD. ORCA-EFCD consensus report on clinical recommendation for caries diagnosis. Paper I: caries lesion detection and depth assessment. Clin Oral Investig 2024; 28:227. [PMID: 38514502 PMCID: PMC10957694 DOI: 10.1007/s00784-024-05597-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES The aim of the present consensus paper was to provide recommendations for clinical practice considering the use of visual examination, dental radiography and adjunct methods for primary caries detection. MATERIALS AND METHODS The executive councils of the European Organisation for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD) nominated ten experts each to join the expert panel. The steering committee formed three work groups that were asked to provide recommendations on (1) caries detection and diagnostic methods, (2) caries activity assessment and (3) forming individualised caries diagnoses. The experts responsible for "caries detection and diagnostic methods" searched and evaluated the relevant literature, drafted this manuscript and made provisional consensus recommendations. These recommendations were discussed and refined during the structured process in the whole work group. Finally, the agreement for each recommendation was determined using an anonymous Delphi survey. RESULTS Recommendations (N = 8) were approved and agreed upon by the whole expert panel: visual examination (N = 3), dental radiography (N = 3) and additional diagnostic methods (N = 2). While the quality of evidence was found to be heterogeneous, all recommendations were agreed upon by the expert panel. CONCLUSION Visual examination is recommended as the first-choice method for the detection and assessment of caries lesions on accessible surfaces. Intraoral radiography, preferably bitewing, is recommended as an additional method. Adjunct, non-ionising radiation methods might also be useful in certain clinical situations. CLINICAL RELEVANCE The expert panel merged evidence from the scientific literature with practical considerations and provided recommendations for their use in daily dental practice.
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Affiliation(s)
- Jan Kühnisch
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians Universität München, Poliklinik für Zahnerhaltung und Parodontologie, Goethestraße 70, 80336, München, Germany.
| | | | - Christian Splieth
- Preventive and Pediatric Dentistry, Center for Oral Health, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Adrian Lussi
- University Hospital for Conservative Dentistry and Periodontology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
| | | | - Fausto M Mendes
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Gottfried Schmalz
- Department of Conservative Dentistry and Periodontology, University Hospital Regensburg, Regensburg, Germany
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, Ann Arbor, USA
| | - Avijit Banerjee
- Conservative & MI Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - David Ricketts
- Unit of Restorative Dentistry, University of Dundee, Dundee, UK
| | - Falk Schwendicke
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians Universität München, Poliklinik für Zahnerhaltung und Parodontologie, Goethestraße 70, 80336, München, Germany
| | - Gail Douglas
- Department of Dental Public Health, University of Leeds Dental School, Leeds, UK
| | - Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Sassari, Italy
| | - Monique van der Veen
- Departments of Preventive Dentistry and Paediatric Dentistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, The Netherlands
- Oral Hygiene School, Inholland University of applied sciences, Amsterdam, The Netherlands
| | - Niek Opdam
- Department of Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sophie Doméjean
- Centre de Recherche en Odontologie Clinique EA 4847, UFR d'Odontologie, Département d'Odontologie Conservatrice, Université Clermont Auvergne, Clermont-Ferrand, France
- Service d'Odontologie, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
| | - Stefania Martignon
- UNICA - Caries Research Unit, Research Department, Universidad El Bosque, Bogotá, Colombia
| | - Klaus W Neuhaus
- Department of Pediatric Oral Health, University Center for Dental Medicine Basel (UZB), University of Basel, Basel, Switzerland
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Keith Horner
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Faria-e-Silva A, Heckel L, Belli R, Lohbauer U. Determination of Water Content in Direct Resin Composites Using Coulometric Karl Fischer Titration. MATERIALS (BASEL, SWITZERLAND) 2022; 15:8524. [PMID: 36500020 PMCID: PMC9739209 DOI: 10.3390/ma15238524] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
This study evaluated the water content and sorption of direct composites over 60 days using coulometric Karl Fischer titration (KFT). Plate-shaped specimens (10 × 10 × 1 mm3 of thickness) were built up using the composites Clearfil Majesty Posterior (CM), Grandio SO (GS), and Filtek Supreme XT (FS). Water contents were determined in non-stored specimens (control) or after storage in distilled water for up to 60 days (n = 5). The amount of water transferred from the specimens heated at 200 °C (isothermal mode) was measured in the Coulometer. The water content of non-stored specimens ranged from 0.28 to 1.69 wt% (5.6 to 31.2 μg/mm3) for GS and FS, respectively. The highest values of water sorption were observed for FS (25.3 μg/mm3 after 60 days). GS and CM showed similar water sorption after 60 days (≈9 μg/mm3), but an ultimate higher water content was observed for CM (0.9 wt%; 22.0 μg/mm3) than GS (0.7 wt%; 14.8 μg/mm3). Except for CM, no significant water sorption was observed between 21 and 60 days of storage. Since all composites presented some base water content, water sorption data alone do not account for the ultimate water content in direct resin-based composites.
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Affiliation(s)
- André Faria-e-Silva
- Department of Dentistry, Federal University of Sergipe, Aracaju 49100-000, Brazil
| | - Lea Heckel
- Research Laboratory for Dental Biomaterials, Dental Clinic 1—Operative Dentistry and Periodontology, Friedrich-Alexander University in Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Renan Belli
- Research Laboratory for Dental Biomaterials, Dental Clinic 1—Operative Dentistry and Periodontology, Friedrich-Alexander University in Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Ulrich Lohbauer
- Research Laboratory for Dental Biomaterials, Dental Clinic 1—Operative Dentistry and Periodontology, Friedrich-Alexander University in Erlangen-Nürnberg, 91054 Erlangen, Germany
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Moro BLP, Pontes LRA, Maia HC, Freitas RDD, Tedesco TK, Raggio DP, Braga MM, Ekstrand KR, Imparato JCP, Cenci MS, Mendes FM. Clinical accuracy of two different criteria for the detection of caries lesions around restorations in primary teeth. Caries Res 2022; 56:98-108. [PMID: 35504257 DOI: 10.1159/000523951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/27/2022] [Indexed: 11/19/2022] Open
Abstract
This is a delayed-type cross-sectional prospective accuracy study nested in a randomized clinical trial. The aim was to investigate the diagnostic accuracy of two visual criteria for caries lesions detection around restorations in primary teeth: the International Dental Federation (FDI) criteria, considering adaptation, staining and presence of caries, and the Caries Associated with Restorations and Sealants (CARS) system. For this, one examiner made the diagnosis and subsequent treatment decision using visual assessment in 163 children (3 to 10 years old) with both FDI and CARS criteria. The order of criteria used was defined by randomization. The reference standard was composed of two approaches: (i) presence of carious tissue after restoration removal or (ii) presence of caries lesions after six and 12 months of follow-up. Sensitivity, specificity, and accuracy parameters were calculated at the dentin threshold. Poisson multilevel regression analyses were performed to evaluate the association of the diagnostic methods and other explanatory variables with the outcomes. Of the 651 restorations included, 480 were evaluated by the reference standard methods and were analyzed. The CARS system presented higher accuracy (0.721) than those obtained with FDI recurrence of caries (0.702), FDI marginal adaptation (0.700) and FDI marginal staining criteria (0.681). The FDI marginal staining showed the study's lowest sensitivity (0.280) and accuracy (0.681) values. The specificity values of FDI recurrence of caries and FDI marginal adaptation were lower than the CARS system. Restorations assessed after the follow-up period resulted in lower sensitivity but higher specificity than those replaced after initial evaluation. In conclusion, the CARS system is more accurate in detecting caries around restorations in primary teeth than the FDI system, in general. However, the FDI recurrence of caries and FDI marginal adaptation present similar performance to the CARS system when the dentin threshold is considered. On the other hand, marginal staining is not an accurate parameter to evaluate caries around restorations.
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Affiliation(s)
| | | | - Haline Cunha Maia
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Raíza Dias de Freitas
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | - Daniela Prócida Raggio
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Mariana Minatel Braga
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Kim Rud Ekstrand
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Fausto Medeiros Mendes
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Comparison of two clinical approaches based on visual criteria for secondary caries assessments and treatment decisions in permanent posterior teeth. BMC Oral Health 2022; 22:77. [PMID: 35300657 PMCID: PMC8931988 DOI: 10.1186/s12903-022-02112-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/10/2022] [Indexed: 12/14/2022] Open
Abstract
Background This cross-sectional study aimed to compare two clinical approaches based on visual criteria for secondary caries assessments and treatment decisions in permanent posterior teeth. Methods The two clinical visual criteria tested for the assessments of restored teeth were: FDI criteria—based on the caries presence, marginal adaptation and staining criteria, adapted from the FDI (International Dental Federation) criteria and CARS criteria—"Caries Associated with Restorations or Sealants" (CARS) criteria described by the International Caries Classification and Management System. Adults were randomized according to the criteria. One calibrated examiner assessed the restorations and assigned the treatment according to the criteria. The primary outcome was replacement indication. Results A total of 185 patients were included, totalling 718 restorations. The strongest correlation founded between the methods was for the presence of caries lesions (Rho = 0.829). A moderate correlation (Rho = 0.420) was founded between the treatment decisions proposed by the CARS and by the FDI criteria. The multilevel regression analysis showed that the FDI criteria indicated five times more replacements when compared to the CARS (< 0.001). Also, using the FDI criteria restorations were 2.7 times more related to caries around restorations (p < 0.001) compared to the other criterion. Conclusions The visual criteria used on the restoration's assessment directly influences the treatment decision to intervene or not on the restoration. The use of a minimally invasive based approach for assessing secondary caries may prevent overtreatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02112-6.
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He X, Yu S, Wang H, Tian Z, Zhang J, Zhao Y, Gong H, Shi Z, Cui Z, Zhu S. A novel resin cement to improve bonding interface durability. RSC Adv 2022; 12:24288-24300. [PMID: 36128534 PMCID: PMC9415027 DOI: 10.1039/d2ra04446c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022] Open
Abstract
Bonding failure is one of the main causes of failure of dental restorations. The bonding strength, aging resistance, and polymerization shrinkage of cement can affect the stability of the bonding interface and lead to marginal microleakage. To reduce the bonding failure rate of restorations, a novel polyurethane (PU) cement was designed to improve the mechanical properties, hydrophobicity, degree of conversion (DC), polymerization shrinkage, bond strength and aging resistance of cement by introducing isophorone diisocyanate (IPDI) and hydroxyethyl methacrylate (HEMA) and adjusting the polyester : polyether ratio to increase the degree of cross-linking. Experimental results verified that the novel PU could increase the mechanical properties and thermal stability of the cement, reduce polymerization shrinkage during the curing reaction, improve the bonding performance and DC, endow the cement with hydrophobic properties, and improve its ability to resist aging in the salivary environment to maintain the long-term stability of interfacial bonding under the influence of comprehensive factors. The results of this study provide a new direction and insights to reduce microleakage and improve the success rate of restorations. Bonding failure is one of the main causes of failure of dental restorations.![]()
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Affiliation(s)
- Xi He
- Department of Prosthetic Dentistry, Hospital of Stomatology, Jilin University, Changchun 130021, P. R. China
| | - Shiyang Yu
- Department of Prosthetic Dentistry, Hospital of Stomatology, Jilin University, Changchun 130021, P. R. China
| | - Huimin Wang
- Department of Prosthetic Dentistry, Hospital of Stomatology, Jilin University, Changchun 130021, P. R. China
| | - Zilu Tian
- Department of Prosthetic Dentistry, Hospital of Stomatology, Jilin University, Changchun 130021, P. R. China
| | - Jiahui Zhang
- Department of Prosthetic Dentistry, Hospital of Stomatology, Jilin University, Changchun 130021, P. R. China
| | - Ying Zhao
- Department of Prosthetic Dentistry, Hospital of Stomatology, Jilin University, Changchun 130021, P. R. China
| | - Haihuan Gong
- Department of Prosthetic Dentistry, Hospital of Stomatology, Jilin University, Changchun 130021, P. R. China
| | - Zuosen Shi
- State Key Lab of Supramolecular Structure and Materials, College of Chemistry, JilinUniversity, Changchun 130021, P. R. China
| | - Zhanchen Cui
- State Key Lab of Supramolecular Structure and Materials, College of Chemistry, JilinUniversity, Changchun 130021, P. R. China
| | - Song Zhu
- Department of Prosthetic Dentistry, Hospital of Stomatology, Jilin University, Changchun 130021, P. R. China
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Freitas RD, Moro BLP, Pontes LRA, Maia HCM, Passaro AL, Oliveira RC, Garbim JR, Vigano MEF, Tedesco TK, Deery C, Raggio DP, Cenci MS, Mendes FM, Braga MM. The economic impact of two diagnostic strategies in the management of restorations in primary teeth: a health economic analysis plan for a trial-based economic evaluation. Trials 2021; 22:794. [PMID: 34772437 PMCID: PMC8586840 DOI: 10.1186/s13063-021-05722-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Different approaches have been used by dentists to base their decision. Among them, there are the aesthetical issues that may lead to more interventionist approaches. Indeed, using a more interventionist strategy (the World Dental Federation - FDI), more replacements tend to be indicated than using a minimally invasive one (based on the Caries Around Restorations and Sealants-CARS). Since the resources related to the long-term health effects of these strategies have not been explored, the economic impact of using the less-invasive strategy is still uncertain. Thus, this health economic analysis plan aims to describe methodologic approaches for conducting a trial-based economic evaluation that aims to assess whether a minimally invasive strategy is more efficient in allocating resources than the conventional strategy for managing restorations in primary teeth and extrapolating these findings to a longer time horizon. METHODS A trial-based economic evaluation will be conducted, including three cost-effectiveness analyses (CEA) and one cost-utility analysis (CUA). These analyses will be based on the main trial (CARDEC-03/ NCT03520309 ), in which children aged 3 to 10 were included and randomized to one of the diagnostic strategies (based on FDI or CARS). An examiner will assess children's restorations using the randomized strategy, and treatment will be recommended according to the same criteria. The time horizon for this study is 2 years, and we will adopt the societal perspective. The average costs per child for 24 months will be calculated. Three different cost-effectiveness analyses (CEA) will be performed. For CEAs, the effects will be the number of operative interventions (primary CEA analysis), the time to these new interventions, the percentage of patients who did not need new interventions in the follow-up, and changes in children's oral health-related quality of life (secondary analyses). For CUA, the effect will be tooth-related quality-adjusted life years (QALYs). Intention-to-treat analyses will be conducted. Finally, we will assess the difference when using the minimally invasive strategy for each health effect (∆effect) compared to the conventional strategy (based on FDI) as the reference strategy. The same will be calculated for related costs (∆cost). The discount rate of 5% will be applied for costs and effects. We will perform deterministic and probabilistic sensitivity analyses to handle uncertainties. The net benefit will be calculated, and acceptability curves plotted using different willingness-to-pay thresholds. Using Markov models, a longer-term economic evaluation will be carried out with trial results extrapolated over a primary tooth lifetime horizon. DISCUSSION The main trial is ongoing, and data collection is still not finished. Therefore, economic evaluation has not commenced. We hypothesize that conventional strategy will be associated with more need for replacements of restorations in primary molars. These replacements may lead to more reinterventions, leading to higher costs after 2 years. The health effects will be a crucial aspect to take into account when deciding whether the minimally invasive strategy will be more efficient in allocating resources than the conventional strategy when considering the management of restorations in primary teeth. Finally, patients/parents preferences and consequent utility values may also influence this final conclusion about the economic aspects of implementing the minimally invasive approach for managing restorations in clinical practice. Therefore, these trial-based economic evaluations may bring actual evidence of the economic impact of such interventions. TRIAL REGISTRATION NCT03520309 . Registered May 9, 2018. Economic evaluations (the focus of this plan) are not initiated at the moment.
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Affiliation(s)
- Raíza Dias Freitas
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP 05508000 Brazil
| | - Bruna Lorena Pereira Moro
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP 05508000 Brazil
| | - Laura Regina Antunes Pontes
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP 05508000 Brazil
| | - Haline Cunha Medeiros Maia
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP 05508000 Brazil
| | - Ana Laura Passaro
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP 05508000 Brazil
| | - Rodolfo Carvalho Oliveira
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP 05508000 Brazil
| | - Jonathan Rafael Garbim
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP 05508000 Brazil
| | - Maria Eduarda Franco Vigano
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP 05508000 Brazil
| | | | - Christopher Deery
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul Brazil
| | - Daniela Prócida Raggio
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP 05508000 Brazil
| | | | - Fausto Medeiros Mendes
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP 05508000 Brazil
| | - Mariana Minatel Braga
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, Lineu Prestes Avenue, 2227, São Paulo, SP 05508000 Brazil
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10
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Zhang A, Ye N, Aregawi W, Zhang L, Salah M, VanHeel B, Chew HP, Fok ASL. A Review of Mechano-Biochemical Models for Testing Composite Restorations. J Dent Res 2021; 100:1030-1038. [PMID: 34365857 DOI: 10.1177/00220345211026918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Due to the severe mechano-biochemical conditions in the oral cavity, many dental restorations will degrade and eventually fail. For teeth restored with resin composite, the major modes of failure are secondary caries and fracture of the tooth or restoration. While clinical studies can answer some of the more practical questions, such as the rate of failure, fundamental understanding on the failure mechanism can be obtained from laboratory studies using simplified models more effectively. Reviewed in this article are the 4 main types of models used to study the degradation of resin-composite restorations, namely, animal, human in vivo or in situ, in vitro biofilm, and in vitro chemical models. The characteristics, advantages, and disadvantages of these models are discussed and compared. The tooth-restoration interface is widely considered the weakest link in a resin composite restoration. To account for the different types of degradation that can occur (i.e., demineralization, resin hydrolysis, and collagen degradation), enzymes such as esterase and collagenase found in the oral environment are used, in addition to acids, to form biochemical models to test resin-composite restorations in conjunction with mechanical loading. Furthermore, laboratory tests are usually performed in an accelerated manner to save time. It is argued that, for an accelerated multicomponent model to be representative and predictive in terms of both the mode and the speed of degradation, the individual components must be synchronized in their rates of action and be calibrated with clinical data. The process of calibrating the in vitro models against clinical data is briefly described. To achieve representative and predictive in vitro models, more comparative studies of in vivo and in vitro models are required to calibrate the laboratory studies.
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Affiliation(s)
- A Zhang
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - N Ye
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - W Aregawi
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - L Zhang
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.,The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - M Salah
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.,Faculty of Dentistry, Ain-Shams University, Cairo, Egypt
| | - B VanHeel
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - H P Chew
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - A S L Fok
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
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11
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de Geus JL, Maran BM, Cabral KA, Dávila-Sánchez A, Tardem C, Barceleiro MO, Heintze SD, Reis A, Loguercio AD. Clinical Performance of Filled/Nanofilled Versus Nonfilled Adhesive Systems in Noncarious Cervical Lesions: A Systematic Review and Meta-analysis. Oper Dent 2021; 46:E34-E59. [PMID: 33529313 DOI: 10.2341/19-252-l] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2020] [Indexed: 11/23/2022]
Abstract
CLINICAL RELEVANCE The use of filled adhesive systems does not influence the clinical performance of the adhesive restoration in noncarious cervical lesions. SUMMARY
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12
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Signori C, Moro BLP, Uehara JLS, Romero VHD, de Oliveira EF, Braga MM, Mendes FM, Cenci MS. Study protocol for a diagnostic randomized clinical trial to evaluate the effect of the use of two clinical criteria in the assessment of caries lesions around restorations in adults: the Caries Cognition and Identification in Adults (CaCIA) trial. BMC Oral Health 2020; 20:317. [PMID: 33172449 PMCID: PMC7656731 DOI: 10.1186/s12903-020-01307-z] [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: 12/16/2019] [Accepted: 10/31/2020] [Indexed: 11/30/2022] Open
Abstract
Background The assessment of restored teeth in dentistry remains a challenge, mainly related to the detection of caries around restorations. There is a diversity of clinical criteria available to assess the caries lesions, resulting in differences in the dentists’ diagnosis and treatment decisions. In addition, there is a lack of evidence regarding the best criteria to detect caries lesions around the restorations. Thus, the present protocol aims to evaluate the effect of using 2 visual criteria to assess restored teeth on the outcomes related to oral health in adults.
Methods The design protocol of the Caries Cognition and Identification in Adults trial correspond to a triple-blind randomized, controlled clinical trial with parallel-groups. Two groups will be compared: patients who will receive the diagnosis and treatment decision according to FDI (World Dental Federation) criteria—FDI group; and patients who will receive diagnosis and treatment decision according to the “Caries Associated with Restorations or Sealants” criteria defined by the International Caries Classification and Management System (ICCMS group). The participants will be followed up after 6, 12, 18, 24, and 60 months, and the restoration failure will be the primary outcome. The analysis will be conducted through Cox regression with shared frailty. The impact of oral health on quality of life and the cost-effectiveness of the methods used will be the secondary outcomes. Two-tailed analyzes will be used, considering a level of significance of 5%. Discussion This is the first clinical trial to assess the effect of using two visual methods to detect caries lesions around restorations on the outcomes related to oral health in adults. The findings of this study will define what is the best diagnostic strategy for the assessment of caries around restorations in permanent teeth. Trial registration NCT03108586 (registered 11 April 2017).
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Affiliation(s)
- Cácia Signori
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | | | | | | | | | - Mariana Minatel Braga
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Fausto Medeiros Mendes
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
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13
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Moro BLP, Freitas RD, Pontes LRA, Pássaro AL, Lenzi TL, Tedesco TK, Ekstrand KR, Braga MM, Raggio DP, Cenci MS, Mendes FM. Influence of different clinical criteria on the decision to replace restorations in primary teeth. J Dent 2020; 101:103421. [PMID: 32615237 DOI: 10.1016/j.jdent.2020.103421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This cross-sectional study is nested in a randomized clinical trial. It was designed to evaluate the influence of using two different clinical criteria to assess caries lesion around restorations on the decision to replace restorations in primary posterior teeth. Variables that might influence this decision were also considered. METHODS One trained and calibrated examiner assessed 550 restorations of 160 children (3-10 years old). Children were randomized to have their restorations evaluated and subsequently treated according to World Dental Federation (FDI) or Caries Associated with Restorations and Sealants (CARS) criteria. After reaching the treatment decision, the same examiner performed another evaluation using the other criteria. Spearman's correlation coefficients and 95 % confidence intervals (95 %CI) between the scores obtained with both criteria and respective treatment decisions were calculated. Poisson multilevel regression analysis were performed between the exploratory variables related to children, restored tooth and restoration assessment; the outcome variables were decisions related to restoration replacement, any operative intervention and presence of secondary caries. RESULTS The strongest correlation observed between the methods was for recurrence of caries. A total of 94 restorations (17.1 %) were indicated for replacement with FDI criteria and 30 (5.5 %) were indicated for replacement with CARS. Besides the diagnostic method used, number of decayed teeth and restorations with two and three restored surfaces were associated with the decision of replacement and presence of recurrent caries lesions. CONCLUSIONS The decision to replace posterior restorations in primary teeth is influenced by the criteria used for the restorations assessment and also by the children's caries experience and multisurface restorations. The restoration material did not influence the decision of restorations replacement. CLINICAL SIGNIFICANCE The decision to replace posterior restoration in primary teeth is strongly related to the evaluation method and not only by patients' risk factors.
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Affiliation(s)
| | - Raiza Dias Freitas
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.
| | | | - Ana Laura Pássaro
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.
| | | | | | - Kim Rud Ekstrand
- Section of Cariology and Endodontics, University of Copenhagen, Copenhagen, Denmark.
| | - Mariana Minatel Braga
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.
| | - Daniela Prócida Raggio
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.
| | - Maximiliano Sérgio Cenci
- Federal University of Pelotas, Graduate Program in Dentistry, Pelotas, Rio Grande do Sul, Brazil.
| | - Fausto Medeiros Mendes
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.
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14
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Moro BLP, Signori C, Freitas RD, Pontes LRA, Lenzi TL, Tedesco TK, Raggio DP, Braga MM, Ekstrand KR, Cenci MS, Mendes FM. The effect of two clinical criteria in the assessment of caries lesions around restorations in children (CARDEC-03): study protocol for a diagnostic randomized clinical trial. F1000Res 2020; 9:650. [PMID: 33520191 PMCID: PMC7818095 DOI: 10.12688/f1000research.23801.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: The detection of caries lesions around restoration can be challenging. Therefore, the use of some criteria has been proposed in order to give more objectivity to the diagnosis process. Two of them are the International Dental Federation (FDI) and the Caries Associated with Restorations and Sealants (CARS) criteria. Both methods have a different approach to caries, and it is not possible to know which one of them is the best to use in clinical practice to assess restorations in children. Thus, the present protocol aims to evaluate the effect of the use of the FDI and CARS criteria in the assessment of caries lesions around restorations in primary teeth on outcomes related to oral health in children and costs resulting from the assessments. Methods and analysis: A total of 626 restorations of children from three to 10 years were randomly assessed and are being treated following the FDI criteria (FDI group) or CARS criteria (CARS group). Participants will be followed-up after six, 12, 18, and 24 months. The primary outcome will be the need for a new intervention in the evaluated restorations. This outcome consists of several components, and each of these events will be analyzed separately as secondary outcomes. The changes in children’s oral health-related quality of life and the cost of the restoration dental treatments will also be analyzed as secondary outcomes. The methods will be compared using the Cox regression model with shared frailty. A significance level of 5% will be adopted for all statistical analyses. Discussion: This will be the first randomized clinical study carried out regarding the detection of caries lesions around restorations in primary teeth. Trial registration: The study underwent registration in Clinicaltrials.gov (
NCT03520309) on 9 May 2018.
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Affiliation(s)
| | - Cácia Signori
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Raiza Dias Freitas
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | - Tathiane Larissa Lenzi
- Department of Surgery and Orthopedics, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Daniela Prócida Raggio
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Mariana Minatel Braga
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Kim Rud Ekstrand
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maximiliano Sérgio Cenci
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Fausto Medeiros Mendes
- Department of Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
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15
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Ortiz MIG, de Melo Alencar C, De Paula BLF, Magno MB, Maia LC, Silva CM. Accuracy of near-infrared light transillumination (NILT) compared to bitewing radiograph for detection of interproximal caries in the permanent dentition: A systematic review and meta-analysis. J Dent 2020; 98:103351. [PMID: 32380136 DOI: 10.1016/j.jdent.2020.103351] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To evaluate the accuracy of the near-infrared light transillumination (NILT) for the detection of interproximal dental caries in permanent dentition when compared to bitewing X-ray (BW). DATA In vivo studies that detected interproximal primary caries in permanent teeth by using NILT and BW were selected. QUADAS-2 was used to assess the risk of bias. Pooled sensitivity and specificity forest plots were calculated, summary receiver operator characteristics (SROC) curves were constructed. The certainty of the evidence was rated using the GRADE system. SOURCES Pubmed, Cochrane Library, Web of Science, Scopus, Lilacs/BBO and grey literature databases were surveyed. STUDY SELECTION From 1594 retrieved articles, 13 studies were included. Six studies had a low risk of bias and a low level of concern regarding applicability. Four studies had an unclear risk of bias, while three presented a high risk of bias. The meta-analysis of six studies demonstrated that NILT presented good overall accuracy. Of 6110 teeth, 92.3 % (5639) were accurately classified (776 as true positive and 4863 as true negative). The pooled sensitivity was 0.97 (0.96 to 0.98; p = 0.0000; I2 = 93.2 %) with moderate certainty of evidence, and the pooled specificity was 0.91 (0.91 to 0.92; p = 0.0000; I2 = 98.3 %) with high certainty of evidence. Symmetric (0.9837) and asymmetric (0.9836) SROC showed a high discrimination and determination effect of NILT. CONCLUSION The current literature, with moderate certainty and a middling quality of evidence, demonstrates that NILT presents a reasonably comparable accuracy to that of BW for detecting interproximal carious lesions in the permanent dentition. CLINICAL SIGNIFICANCE Since NILT presented good overall accuracy for the detection of interproximal primary caries, it could be routinely used in dental check-ups, especially in high-risk caries populations and in patients where the use of radiation should be reduced, like pregnant women or children.
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Affiliation(s)
| | - Cristiane de Melo Alencar
- Department of Restorative Dentistry, School of Dentistry, Federal University of Para, Belém, Pará, Brazil
| | | | - Marcela Baraúna Magno
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Cecy Martins Silva
- Department of Restorative Dentistry, School of Dentistry, Federal University of Para, Belém, Pará, Brazil.
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16
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Dettwiler C, Eggmann F, Matthisson L, Meller C, Weiger R, Connert T. Fluorescence-aided Composite Removal in Directly Restored Permanent Posterior Teeth. Oper Dent 2019; 45:62-70. [PMID: 31373886 DOI: 10.2341/19-032-l] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM The aim of this study was to quantitatively compare conventional composite removal and composite removal supported by the fluorescence-aided identification technique (FIT) regarding the completeness, selectivity, and duration of the procedure in directly restored permanent posterior teeth. METHODS AND MATERIALS Two operators removed standardized direct class II composite restorations (n=32 per operator) in human tooth models under simulated clinical conditions. According to a randomized allocation scheme, removal was performed with either the conventional technique (contra-angle handpiece) or supported by FIT. The duration of each removal procedure was recorded. The completeness and selectivity were volumetrically assessed through superimposition of three-dimensional surface scans. Statistical significance was tested by examining the overlap of 95% confidence intervals (CI). Multiple comparison was performed with Tukey tests for each variable. RESULTS Compared with the conventional technique, composite removal with FIT was faster (329 seconds [95% confidence interval (CI): 268-390 seconds] vs 179 seconds [95% CI: 150-208 seconds]), generated less tooth substance loss (4.53 mm3 [95% CI: 3.77-5.30 mm3] vs 2.77 mm3 [95% CI: 2.11-3.43 mm3]), and left behind less composite residue (1.58 mm3 [95% CI: 1.23-1.94 mm3] vs 0.53 mm3 [95% CI: 0.39-0.67 mm3]). CONCLUSION Within the limitations of this in vitro study, FIT facilitated the selective and expeditious removal of tooth-colored composites in directly restored posterior teeth.
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17
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Decision-making of general practitioners on interventions at restorations based on bitewing radiographs. J Dent 2018; 76:109-116. [PMID: 30004002 DOI: 10.1016/j.jdent.2018.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare decision-making based on bitewing analysis of restored proximal surfaces by general dental practitioners (GDPs) with diagnossis and clinical decisions made by experts in cariology and restorative dentistry. METHODS This practice-based study used a database of 7 general dental practices. Posterior bitewing radiographs were selected from the electronic patient files of patients, and 770 cases of proximal restored surfaces were selected. Fifty percent of the cases which lead to the restorative decision, and the other half were cases decided for monitoring by the GDPs. Three experts performed radiographic assessment. The outcome variables were agreement of diagnosis and decision of treatment. Cohen's kappa statistic was used. RESULTS For the experts, moderate to substantial intraexaminer agreement was observed for the diagnostic criteria, and kappa values of 0.77, 0.79, and 0.88 were obtained for each expert regarding the treatment assignment. Agreement between GDPs and the majority of experts for secondary caries varied between 67 and 83%. One hundred seventy-three out of 385 cases that were treated by GDPs were decided for monitoring by the experts, while 8 cases that were decided for monitoring by the GDPs were decided for treatment. The agreement between experts and GDPs was moderate for secondary caries detection, and fair for treatment decision. CONCLUSION The GDPs tend to have a less conservative approach regarding the decision to intervene or not concerning the reassessment of restorations, showing moderate agreement with the experts for secondary caries detection and fair agreement regarding the treatment decision. CLINICAL SIGNIFICANCE This study highlights that GDPs tend to have a less conservative approach to the decision to intervene or not in posterior restorations, compared to experts in cariology and restorative dentistry. Efforts should be made to reduce these differences based on minimally invasive dentistry.
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