Criteria for a Diagnosis of Caries through the DIAGNOdent

Self-assembling peptide and nano-silver fluoride in remineralizing early enamel carious lesions: randomized controlled clinical trial

BACKGROUND

Nanoparticles and regenerative biomineralization are new caries prevention technologies. This study assessed the remineralizing effect of self-assembling peptide (P11-4), Nanosilver Fluoride (NSF) and sodium fluoride (NaF) on white spot lesions (WSLs) in permanent teeth.

METHODS

Sixty six young adults with WSLs on buccal surfaces in permanent teeth and ICDAS code 1 or 2, were randomly assigned to one of three groups; P11-4, NSF or NaF. Assessment of ICDAS scores, lesion activity (Nyvad scores) and diagnodent readings of lesions were done at baseline and after 1, 3, 6 and 12 months of agents' application. Comparisons between groups were made using chi squared test and comparison within groups were made using McNemar test. Multilevel binary logistic regression was used to assess the effect of agents on change of ICDAS scores after 3, 6 and 12 months (reduction versus no reduction).

RESULTS

There were 147 teeth in 66 patients; mean ± SD age = 13.46 ± 4.31 years. There were significant differences in the change of ICDAS scores among the three groups after 3 and 6 months (p = 0.005). The reduction in ICDAS score increased steadily in all groups across time with the greatest increase in the P11-4 group: 54.5% after 12 months. Lesion activity (Nyvad scores) showed significant differences among the three groups with the greatest percentage of inactive cases in the P11-4 group. Multilevel binary logistic regression showed non-significant reduction of ICDAS in P11-4 and NSF varnishes compared to NaF varnish (AOR = 2.56, 95% CI: 0.58, 8.77 and AOR = 2.12, 95% CI: 0.59, 7.64 respectively).

CONCLUSION

P11-4 and NSF varnish reduced the ICDAS scores, caries activity and diagnodent readings of WSLs in permanent teeth. However, the change in ICDAS scores was not significantly different from NaF.

TRIAL REGISTRATION

This trial was prospectively registered on the clinicaltrials.gov registry with ID: NCT04929509 on 18/6/2021.

Detection ability and direction effect of photothermal-radiometry and modulated-luminescence for non-cavitated approximal caries

OBJECTIVE

The objective was to evaluate the ability of photothermal-radiometry and modulated-luminescence (PTR/LUM) to detect non-cavitated approximal caries lesions, including the effect of scanning direction.

METHODS

Thirty human extracted premolars were selected based on micro-computed tomography [μ-CT: μ-CT = 0: sound (n = 12), μ-CT = 1: lesions into outer-half of enamel (n = 6), μ-CT = 2: lesions into inner-half of enamel (n = 6), and μ-CT = 3: lesions into outer one-third of dentine (n = 6)]. Teeth were mounted in a custom-made device to simulate approximal contact. Each tooth was scanned from three directions: buccal, lingual, and occlusal, then repeated 48 h later. Statistical analyses were performed by bootstrap analyses using average and maximum values across all directions. Sensitivity, specificity, area under ROC-curve (AUC), intraclass correlation coefficient (ICC) and correlation with μ-CT were calculated. Sensitivity was further evaluated based on lesion extension.

RESULTS

Using the manufacturer-suggested lesion cut-off, overall sensitivity ranged from 3%-61%, where the maximum value of all measurements (All-max) showed higher sensitivity (61 %) than other measurements except the buccal direction, which was also higher than the lingual and occlusal directions. As μ-CT score increased from μ-CT = 1-3, the sensitivity of All-max also increased from 50 % to 74 %. Specificity was 100 % regardless of direction, and AUC ranged from 0.65 to 0.88. All-max had the highest ICC (0.74). PTR/LUM values showed weak to moderate correlations with μ-CT.

CONCLUSION

Within the limitations of this in vitro study, PTR/LUM non-cavitated approximal caries lesion detection achieved best individual results from the buccal direction, while using the maximum value from all directions might improve performance.

CLINICAL SIGNIFICANCE

Non-cavitated approximal caries detection is a challenging procedure. PTR/LUM is a nondestructive, no ionized-radiation caries detection method that can scan from buccal, lingual, and occlusal directions of an approximal surface. PTR/LUM seems suitable to detect deeper non-cavitated approximal caries. The maximum PTR/LUM value from three directions may be optimal.

Morphological changes produced by acid dissolution in Er:YAG laser irradiated dental enamel

Several scientific reports have shown the effects of Er:YAG laser irradiation on enamel morphology. However, there is lack of information regarding the morphological alterations produced by the acid attack on the irradiated surfaces. The aim of this study was to evaluate the morphological changes produced by acid dissolution in Er:YAG laser irradiated dental enamel. Forty-eight enamel samples were divided into four groups (n = 12). GI (control); Groups II, III, and IV were irradiated with Er:YAG at 100 mJ (12.7 J/cm(2) ), 200 mJ (25.5 J/cm(2) ), and 300 mJ (38.2 J/cm(2) ), respectively, at 10 Hz without water irrigation. Enamel morphology was evaluated before-irradiation, after-irradiation, and after-acid dissolution, by scanning electron microscopy (SEM). Sample coating was avoided and SEM analysis was performed in a low-vacuum mode. To facilitate the location of the assessment area, a reference point was marked. Morphological changes produced by acid dissolution of irradiated enamel were observed, specifically on laser-induced undesired effects. These morphological changes were from mild to severe, depending on the presence of after-irradiation undesired effects.

Chemical changes associated with increased acid resistance of Er:YAG laser irradiated enamel

BACKGROUND

An increase in the acid resistance of dental enamel, as well as morphological and structural changes produced by Er:YAG laser irradiation, has been reported.

PURPOSE

To evaluate the chemical changes associated with acid resistance of enamel treated with Er:YAG laser. Methods. Forty-eight enamel samples were divided into 4 groups (n = 12). Group I (control); Groups II, III, and IV were irradiated with Er:YAG at 100 mJ (12.7 J/cm(2)), 200 mJ (25.5 J/cm(2)), and 300 mJ (38.2 J/cm(2)), respectively.

RESULTS

There were significant differences in composition of irradiated groups (with the exception of chlorine) and in the amount of calcium released.

CONCLUSIONS

Chemical changes associated with an increase in acid resistance of enamel treated with Er:YAG laser showed a clear postirradiation pattern characterized by a decrease in C at.% and an increase in O, P, and Ca at.% and no changes in Cl at.%. An increased Ca/P ratio after Er:YAG laser irradiation was associated with the use of higher laser energy densities. Chemical changes produced by acid dissolution showed a similar trend among experimental groups. Stable or increased Ca/P ratio after acid dissolution was observed in the irradiated groups, with reduction of Ca released into the acid solution.

A comparison between three different pit and fissure sealants with regard to marginal integrity

AIM

THE AIM OF THIS STUDY IS TO COMPARE THE OCCURRENCE OF ENAMEL FRACTURES, SEALANT FRACTURES AND MARGINAL FISSURES AFTER PLACEMENT OF THREE SEALANTS: Helioseal F, Conseal F and Clinpro.

MATERIALS AND METHODS

Thirty individuals between 13 and 15 years of age, diagnosed with pit and fissure caries by visual and DIAGNOdent examination, were chosen for sealant placement on their mandibular molars. The sealants were placed at random, after which, impressions were made with polyvinyl siloxane and casts were fabricated. Dies were prepared, each of which were sputter coated with gold in order to be examined under a scanning electron microscope. The following morphologies were analyzed from dies from each of the sealant groups: Continuous margins, sealant fractures, marginal fissures and enamel fractures. After six months, they were recalled for impression making. Dies were prepared and microscopically analyzed as mentioned. Based on the time of evaluation, there were two groups: Initial group (soon after placement) and final group (after six months). Statistical analysis was done using the paired 't' test and One-way analysis of variance (ANOVA).

RESULTS AND CONCLUSIONS

Clinpro had the greatest fracture resistance, followed by Conseal F and Helioseal F. The occurrence of marginal fissure was found to be least with Clinpro.

Dental caries and pulpal disease

This article reviews the diagnostic process, from the first clinically evident stages of the caries process to development of pulpal pathosis. The caries diagnostic process includes 4 interconnected components-staging caries lesion severity, assessing caries lesion activity, and risk assessments at the patient and tooth surface level - which modify treatment decisions for the patient. Pulpal pathosis is diagnosed as reversible pulpitis, irreversible pulpitis (asymptomatic), irreversible pulpitis (symptomatic), and pulp necrosis. Periapical disease is diagnosed as symptomatic apical periodontitis, asymptomatic apical periodontitis, acute apical abscess, and chronic apical abscess. Ultimately, the goal of any diagnosis should be to achieve better treatment decisions and health outcomes for the patient.

In Vivo Evaluation of DIAGNOdent for the Quantification of Occlusal Dental Caries

There is a weak correlation between DIAGNOdent readings and carious lesion depth and volume. Based on the current study, the appropriate DIAGNOdent cut-off point to detect carious lesions reaching the DEJ or beyond is between 35 and 40.

Xenon light has effectiveness on the detection of incipient carious lesions on bovine enamel in vitro

OBJECTIVE

Filtered 325-nm xenon light was used to test its effectiveness in the detection of incipient carious lesions on bovine enamel by measuring the fluorescence spectrum.

BACKGROUND DATA

The combination of early detection with new interventional methodology and caries management will be the preferred dental practice in the future.

METHODS

Specimens of bovine tooth enamel were embedded in resin, polished, exposed to a lactate carbopol buffer system for 71 hours, and randomly divided into one control and three test groups of 10 specimens each, with Vickers hardness number (VHN) stratification. The surface changes were characterized by atomic force microscopy. All specimens were irradiated with xenon light, and a fluorescence spectrum was produced. Characteristics of fluorescence among the demineralized tooth groups were measured using an optical multichannel analyzer and a confocal laser scanning microscope.

RESULTS

The VHNs were significantly different among the four groups (p < 0.05). The fluorescence had a peak intensity of approximately 425 nm, and the slope value between 450 and 550 nm was significantly decreased in all test groups (groups II-IV) compared to the control group (group I), as the VHN decreased (p < 0.05). Demineralized lesion depth gradually increased to 30-40 microm in groups II-IV.

CONCLUSIONS

The 325-nm xenon light resulted in high efficacy for detecting incipient carious lesions. By evaluating the highest peak and slope value, the incipient carious lesion may be detected.

Light Intensity Evaluation of Laser-induced Fluorescence after Caries Removal Using an Experimental Caries Staining Agent

OBJECTIVE

The purpose of this study was to evaluate the intensity of fluorescent light reflected from cavity wall dentin, after dentin stained by an experimental caries detecting liquid was removed.

BACKGROUND DATA

The conventional caries detecting liquid tends to penetrate dentin too deeply. On the other hand, DIAGNOdent has gradually gained recognition and established itself as a caries detection device using a laser beam.

METHOD

An experimental caries staining liquid or the conventional caries staining liquid was applied in the same cavity to observe for differences in dye penetration. Intensity of fluorescence reflected from treated dentin was measured by DIAGNOdent.

RESULTS

The mean DIAGNOdent value after removing the tooth substance stained by the experimental liquid was 17.9+/-4.1, compared with 7.7+/-2.7 by conventional one.

CONCLUSION

Light intensity evaluation of laser-induced fluorescence suggested that the experimental caries detecting liquid did not penetrate the dentin which should be preserved, hence avoiding overtreatment.

Dental caries paradigms in diagnosis and diagnostic research

In this article, the fundamentals of caries diagnosis are reviewed from the three component perspectives, namely the strategy, the logics, and the tactics. Strategy concerns the objectives of the diagnostic process (i.e. why we diagnose caries). The logics describe how we assemble and evaluate the information collected and how this leads to an assessment of diagnostic value. Finally, tactics are about how we collect the information necessary to arrive at a correct diagnosis. We argue that the hitherto-dominant essentialistic caries paradigm should be replaced by a nominalistic caries concept. This allows us to circumvent the problem of a lack of a caries gold standard and to proceed in caries-diagnostic research to find the diagnostic methods that result in the best health outcomes for our patients. We also demonstrate the limitations of the medical model when attempting to understand caries diagnosis, and adhere to the Bader & Shugars caries script model. It is concluded that the current caries profile, characterized by lower prevalence and extent, and slower progression, has increased the need for an academic strengthening of the dental curriculum with respect to diagnostic reasoning and clinical decision-making processes.