The effect of multiple examinations on the diagnosis of approximal caries and the restoration of approximal surfaces

Concordance between responses to questionnaire scenarios and actual treatment to repair or replace dental restorations in the National Dental PBRN

OBJECTIVE

To quantify the agreement between treatment recommended during hypothetical clinical scenarios and actual treatment provided in comparable clinical circumstances.

METHODS

A total of 193 practitioners in the National Dental Practice-Based Research Network participated in both a questionnaire and a clinical study. The questionnaire included three hypothetical scenarios about treatment of existing restorations. Clinicians then participated in a clinical study about repair or replacement of existing restorations. We quantified the overall concordance between their questionnaire responses and what they did in actual clinical treatment.

RESULTS

Practitioners who recommended repair (instead of replacement) of more scenario restorations also had higher repair percentages in clinical practice. Additionally, for each of the three hypothetical scenario restorations, practitioners who recommended repair had higher repair percentages in clinical practice.

CONCLUSIONS

The questionnaire scenarios were a valid measure of clinicians' tendency to repair or replace restorations in actual clinical practice.

CLINICAL IMPLICATIONS

Although there was substantial variation in practitioners' tendency to repair or replace restorations, responses to questionnaire scenarios by individual practitioners were concordant with what they did in actual clinical practice.

Agreement among dentists' restorative treatment planning thresholds for primary occlusal caries, primary proximal caries, and existing restorations: findings from The National Dental Practice-Based Research Network

OBJECTIVES

The aim of this study was to quantify the agreement among individual National Dental Practice-Based Research Network dentists' self-reported treatment decisions for primary occlusal caries, primary proximal caries, and existing restorations.

METHODS

Five hypothetical clinical scenarios were presented: primary occlusal caries; primary proximal caries; and whether three existing restorations should be repaired or replaced. We quantified the probability that dentists who recommended later restorative intervention for primary caries were the same ones who recommended that existing restorations be repaired instead of replaced.

RESULTS

Dentists who recommended later restorative treatment of primary occlusal caries and proximal caries at a more-advanced stage were significantly more likely to recommend repair instead of replacement. Agreement among dentists on a threshold stage for the treatment of primary caries ranged from 40 to 68%, while that for repair or replacement of existing restorations was 36 to 43%.

CONCLUSIONS

Dentists who recommended repair rather than replacement of existing restorations were significantly more likely to recommend later treatment of primary caries. Conversely, dentists who recommended treatment of primary caries at an earlier stage were significantly more likely to recommend replacement of the entire restoration. Between-dentist agreement for primary caries treatment was better than between-dentist agreement for repair or replacement of existing restorations.

CLINICAL IMPLICATIONS

These findings suggest consistency in how individual dentists approach the treatment of primary caries and existing restorations. However, substantial variation was found between dentists in their treatment decisions about the same teeth.

Influence of materials radiopacity in the radiographic diagnosis of secondary caries: evaluation in film and two digital systems

OBJECTIVES

The aim of this study was to evaluate the influence of restorative materials on false-positive diagnoses of secondary caries using three imaging systems.

METHODS

Class II preparations were made on the occlusal and mesial or distal faces of extracted healthy third molar teeth. The teeth were divided into five groups and, with the exception of Group 5, they received a flow resin base. Groups 1, 2, 3 and 4 received a layer of Natural Flow (DFL, Rio de Janeiro, Brazil), Filtek Flow (3M-ESPE, St. Paul, MN), Tetric Flow (Ivoclar/Vivadent, Liechtenstein, Germany) and Protect Liner F (Kuraray, Okayama, Japan) resins, respectively, and were restored with Filtek Supreme resin (3M-ESPE). Group 5 was restored with Filtek Supreme resin. The images on film and on the Digora Optime® (Helsinki, Finland) and charge coupled device (CCD) IOX (IOX, Monninkylä, Finland) digital systems were evaluated by five examiners and the data were analysed using the Fisher's exact and Friedman tests at a 5% level of significance.

RESULTS

Group 3 showed the highest rate of correct answers (restored tooth) and the lowest proportion of secondary caries diagnosis (P ≤ 0.05). Group 4 showed the highest rate of secondary caries diagnosis and the lowest proportion of correct answers (P ≤ 0.05). The systems for obtaining images presented were similar for each material.

CONCLUSIONS

The restorative material was found to have an influence on the diagnosis of secondary caries lesions by imaging. The imaging system had no influence. Materials with greater radiopacity, higher than that of enamel, were favourable for a true-negative diagnosis.