Association and comparison between visual inspection and bitewing radiography for the detection of recurrent dental caries under restorations

Assessing the Use of Radiographs Alone to Determine Air Force Dental Readiness Classification

INTRODUCTION

The Air Force Dental Service is responsible for ensuring that airmen are dentally ready to support military operations worldwide by delivering top-tier dental care. As the military healthcare landscape undergoes significant changes, the Air Force Dental Service has explored innovative approaches to dental care delivery. One consideration involves the potential use of radiographs as the primary tool for assessing service members' dental conditions, specifically focusing on identifying nondeployable conditions and periodontal health.

MATERIALS AND METHODS

Providers who previously participated as examiners in the 2018 Air Force Recruit Oral Health Study were recruited to re-evaluate randomly selected de-identified records, this time making assessments exclusively based on radiographs. Their evaluations included Dental Readiness Classification (DRC) determinations, total caries counts, and Periodontal Screening and Recording (PSR) index scores, providers also rated their confidence in these conclusions using a 5-point Likert scale. The study then computed sensitivity and specificity to assess the diagnostic performance of providers using radiographs only compared to the original study results that use the gold standard of radiographs with a clinical examination.

RESULTS

Providers exceled at ruling out most DRC 3 conditions, with specificities surpassing 70%. Positively identifying those with DRC 3, particularly radiographically identifying periodontal conditions posed challenges with computed sensitivity rates as low as 8%. Discrepancies in PSR scores also accentuated limitations in relying solely on radiographs, where provider's radiographically determined PSR scores that matched less than one third of the time. In general, providers had low to very low confidence in their assessments.

CONCLUSIONS

The study strongly cautions against relying solely on radiographs for determining the dental health of U.S. Air Force personnel. While providers effectively ruled out the absence of certain conditions, the challenge of positively identifying DRC 3 conditions poses significant risks to oral health if such a workflow was utilized. Particularly, the high probability of false negatives would be detrimental to the operational readiness of military personnel. Therefore, results support the continued use of radiographic and clinical examinations for comprehensive dental exams.

Visibility of Recurrent Caries Through Universal Shade Resin Composite Restorations

This in vitro study aimed to investigate whether color differences in the stained cavity floor simulating recurrent caries can be detected using various restored resin composites. Artificial teeth were made with conventional resin composite (Estellite Sigma Quick A3; ET), and class V cavities were prepared. To simulate the color of caries, a dot was marked in the center of the cavity floor using four different magic pens. The cavities were filled with ET and two universal shade resin composites (UC, Omnichroma; OMI, Essentia Universal; ESS). For photographic analysis, a standard correction color chart was used. The color difference (ΔE00) between (i) the lab value at the center of the cavity and (ii) the average lab value at 1 mm mesial and distal to the center of the cavity was calculated. The data were statistically746o-way ANOVA (p < 0.05). For visual analysis, 25 dentists were asked to complete a questionnaire to determine whether the color differences were noticeable. In the photographic analysis, UC showed larger ΔE00 values than ET in all colors. Visual analysis revealed higher detection rates for UC than ET. Universal shade resin composite tends to reflect the color of the cavity more effectively than conventional resin composite.

Determining the Ability of Senior Dental Students to Detect Interproximal Caries Using Different Radiographic Techniques

Objective: To evaluate the diagnostic capability of 5th-year students using digital imaging, conventional bitewing (BW) radiographs, and printed film on paper to detect interproximal caries lesions. Methods: A cross-sectional study was conducted with senior dental students. Three different radiographs: digital, BW, and printed films on paper were used; thus, nine radiographs, each with a 2-min viewing time, were considered by students along with a questionnaire. A control group of specialists from Prosthodontics and Radiology had finalized the answers prior to conducting the study. The appropriate responses were divided into five categories: R0: Intact surface, R1: Radiolucency in the outer half of enamel, R2: Radiolucency in the inner half of enamel, R3: Radiolucency in the outer half of dentin, and R4: Radiolucency in the inner half of dentin. Students' responses were analyzed using a one-way analysis of variance (ANOVA) test and a t-test. Results: Ethics for the study was obtained from the institutional committee (Reg No: BM19/9/8). When compared with the control group using ANOVA testing, the results showed good detection accuracy with a success rate of ~64 accuracy. There was a significant difference in the outcomes when detecting the presence of the caries lesion between the three diagnostic techniques (p  > 0.001). In detecting the size of the carious lesion, the students' ability was recorded as poor. The highest average for detecting the presence of the carious lesion was correspondent to the printed film on paper method. Conclusions: Senior dental students have shown good accuracy in detecting the presence but not the size of interproximal caries on all radiographs viewed. Clinical Significance: Teachings and availability of diverse radiological diagnostic techniques ensured a reasonable level of understanding and use of the diagnostic caries risk assessment methodologies as required in restorative treatment planning.

Detection of pit and fissure sealant microleakage using quantitative light-induced fluorescence technology: an in vitro study

This in vitro study aimed to evaluate the feasibility of quantitative light-induced fluorescence (QLF) technology for detecting the presence and severity of microleakage of pit and fissure sealants. The areas of interest (AOIs) were 160 pits and fissures of 40 extracted permanent teeth. Fluorescent images were acquired using a QLF device, and the maximum fluorescence loss ΔFmax of each AOI was analyzed. After staining and cross-sectioning of the teeth, histological dye penetration was scored on a scale of 0 to 3. The relationship between ΔFmax and microleakage depth was analyzed, and the areas under the curve (AUCs) were calculated. The │ΔFmax│ increased as microleakage depth increased. The ΔFmax values of microleakage areas showed a strong significant correlation with the histological scores of dye penetration (r = - 0.72, P = 0.001). AUC analysis showed a high diagnostic accuracy for microleakage depth (AUC = 0.83-0.91). The highest AUC of 0.91 was found when differentiating the outer half microleakage of the sealant (histological score 0 vs. 1-3). QLF technology is effective in assessing the presence and severity of microleakage, suggesting its potential for noninvasive detection and monitoring of sealant microleakage in clinical settings.

Evaluation of the efficiency, trueness, and clinical application of novel artificial intelligence design for dental crown prostheses

OBJECTIVE

The unique structure of human teeth limits dental repair to custom-made solutions. The production process requires a lot of time and manpower. At present, artificial intelligence (AI) has begun to be used in the medical field and improve efficiency. This study attempted to design a variety of dental restorations using AI and evaluate their clinical applicability.

METHODS

Using inlay and crown restoration types commonly used in dental standard models, we compared differences in artificial wax-up carving (wax-up), artificial digital designs (digital) and AI designs (AI). The AI system was designed using computer calculations, and the other two methods were designed by humans. Restorations were made by 3D printing resin material. Image evaluations were compared with cone beam computed tomography (CBCT) by calculating the root mean squared error.

RESULTS

Surface truth results showed that AI (68.4 µm) and digital-designed crowns (51.0 µm) had better reproducibility. Using AI for the crown reduced the time spent by 400% (compared to digital) and 900% (compared to wax-up). Optical microscopic and CBCT images showed that AI and digital designs had close margin gaps (p < 0.05). The margin gap of the crown showed that the wax-up group was 4.1 and 4.3 times greater than those of the AI and digital crowns, respectively. Therefore, the utilization of artificial intelligence can assist in the production of dental restorations, thereby enhancing both production efficiency and accuracy.

SIGNIFICANCE

It is expected that the development of AI can contribute to the reproducibility, efficiency, and goodness of fit of dental restorations.

Fluorescence and Near-Infrared Light for Detection of Secondary Caries: A Systematic Review

BACKGROUND

Early detection of secondary caries near dental restorations is essential to prevent further complications. This systematic review seeks to evaluate the sensitivity of fluorescence and near-infrared (NIR) imaging techniques for detecting secondary caries and to provide insight into their clinical utility.

METHODS

A comprehensive search strategy was used to select studies from seven databases, emphasizing diagnostic accuracy studies of secondary caries detection using fluorescence and NIR imaging techniques. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) instrument assessed bias risk and practicality. Two evaluators performed data extraction, screening, and quality assessment independently.

RESULTS

From 3110 initial recordings, nine studies were selected for full-text analysis. Wide variations in sensitivity (SE) and specificity (SP) values were reported across the studies. These studies exhibited variable SE and SP values, and the findings highlighted the importance of method selection based on clinical context. This systematic review underlines the potential for fluorescence and NIR imaging to detect secondary caries. However, results from different studies vary, indicating the need to consider additional variables such as restoration materials.

CONCLUSIONS

Although these technologies exhibit potential for detecting caries, our research underscores the complex procedure of identifying secondary caries lesions. It is a continuous necessity for progress in dental diagnostics to promptly identify secondary caries lesions, particularly those in proximity to tooth-colored ones.

Frequency of caries in triangular-shaped radiolucencies on periapical radiographs of maxillary deciduous second molars

Background

Dentists might face various artifacts (such as triangular-shaped radiolucencies [TSRs]) during the assessment of radiographs and should be able to differentiate them from caries to avoid unnecessary treatments.

Materials and Methods

In this cross-sectional study, 109 maxillary second primary molars were evaluated in cooperative children aged 4-9 years, who had distal caries in their maxillary first primary molars. First, TSRs were recorded on periapical radiographs of each maxillary second primary molar's proximal surface. Then, after excavating distal caries in the adjacent teeth "D," a pedodontist examined the mesial surfaces of teeth "E." Chi-square test was used to compare the distribution of caries in different variables, and the kappa coefficient was applied to evaluate clinical and radiographic agreements. A P < 0.05 was considered statistically significant.

Results

Forty-four cases were found to be carious both clinically and radiographically, and 54 cases were noncarious by both methods, while for 11 cases, the diagnosis was controversial. No statistically significant difference was found between radiographic and clinical caries detection methods in children whose periapical radiographs contained TSRs, and most of the subjects had similar diagnoses. Value of caries detection sensitivity, specificity, positive predictive value, and negative predictive value in TSRs was 88%, 92%, 90%, and 90%, respectively.

Conclusion

Considering high radiographic sensitivity for caries detection in TSRs, clinicians should be more cautious about them being carious or not, and both radiographic and clinical examinations are necessary. Further, to avoid misinterpretation in radiographs, additional education is necessary for young dentists.

Detection Methods for Early Caries Diagnosis: A Systematic Review and Meta-Analysis

The aim was to appraise the evidence on the performance of various means for the detection of incipient caries in vivo. Five databases of published and unpublished research were searched for studies from January 2000 to October 2019. Search terms included "early caries" and "caries detection." Inclusion criteria involved diagnostic test accuracy studies for early caries detection in permanent and primary teeth. A risk-of-bias assessment was performed using the QUADAS-2 tool. We performed the study selection, data extraction, and risk-of-bias assessment in duplicate. The review protocol was a priori registered in the Open Science Framework. Of the initially 22,964 search results, 51 articles were included. For permanent teeth, when histologic examination was considered as the reference for occlusal surfaces, the sensitivity (Se) range appeared high for the DIAGNOdent Pen (DD Pen) at 0.81-0.89, followed by ICDAS-II at 0.62-1, DIAGNOdent (DD) at 0.48-1, and bitewing radiography (BW) at 0-0.29. The corresponding specificity (Sp) range was: DD Pen 0.71-0.8, ICDAS-II 0.5-0.84, DD 0.54-1, and BW 0.96-1. When operative intervention served as the reference for occlusal surfaces, again, the DD means valued the most promising results on Se: DD 0.7-0.96 and DD Pen 0.55-0.90, followed by ICDAS-II 0.25-0.93, and BW 0-0.83. The Sp range was: DD 0.54-1, DD Pen 0.71-1, ICDAS-II 0.44-1, and BW 0.6-1. For approximal surfaces, the Se was: BW 0.75-0.83, DD Pen 0.6, and ICDAS-II 0.54; the Sp was: BW 0.6-0.9, DD Pen 0.2, and ICDAS-II 1. For primary teeth, under the reference of histologic assessment, the Se range for occlusal surfaces was: DD 0.55-1, DD Pen 0.63-1, ICDAS-II 0.42-1, and BW 0.31-0.96; the respective Sp was: DD 0.5-1, DD Pen 0.44-1, ICDAS-II 0.61-1, and BW 0.79-0.98. For approximal surfaces, the Se range was: DD Pen 0.58-0.63, ICDAS-II 0.42-0.55, and BW 0.14-0.71. The corresponding Sp range was: DD Pen 0.85-0.87, ICDAS-II 0.73-0.93, and BW 0.79-0.98. Se and Sp values varied, due to the heterogeneity regarding the setting of individual studies. Evidently, robust conclusions cannot be drawn, and different diagnostic means should be used as adjuncts to clinical examination. In permanent teeth, visual examination may be enhanced by DD on occlusal surfaces and BW on approximal surfaces. In primary teeth, DD Pen may serve as a supplementary tool across all surfaces.

Detection of Caries Around Resin-Modified Glass Ionomer and Compomer Restorations Using Four Different Modalities In Vitro

The aim of this study was to evaluate the ability of visual examination (International Caries Detection and Assessment System—ICDAS II), light-emitting diodes (LED) fluorescence (SPECTRA), laser fluorescence (DIAGNODent, DD), photothermal radiometry and modulated luminescence (PTR-LUM, The Canary System, CS) to detect natural decay beneath resin-modified glass ionomer (RMGIC) and compomer restorations in vitro. Twenty-seven extracted human molars and premolars, consisting of 2 control teeth, 10 visually healthy/sound and 15 teeth with natural cavitated lesions, were selected. For the carious teeth, caries was removed leaving some carious tissue on one wall of the preparation. For the sound teeth, 3 mm deep cavity preparations were made. All cavities were restored with RMGIC or compomer restorative materials. Sixty-eight sites (4 sites on sound unrestored teeth, 21 sound sites and 43 carious sites with restorations) were selected. CS and DD triplicate measurements were done at 2, 1.5, 0.5, and 0 mm away from the margin of the restoration (MOR). SPECTRA images were taken, and two dentists provided ICDAS II scoring for the restored surfaces. The SPECTRA data and images were inconclusive due to signal interference from the restorations. Visual examinations of the restored tooth surfaces were able to identify 5 of the 15 teeth with caries. In these situations, the teeth were ranked as having ICDAS II 1 or 2 rankings, but they could not identify the location of the caries or depth of the lesion. CS and DD were able to differentiate between sound and carious tissue at the MOR, but larger variation in measurement, and poorer accuracy, was observed for DD. It was concluded that the CS has the potential to detect secondary caries around RMGIC and compomer restorations more accurately than the other modalities used in this study.

Can clusters based on caries experience and medical status explain the distribution of overhanging dental restorations and recurrent caries? A cross-sectional study in Madinah - Saudi Arabia

BACKGROUND

Overhanging dental restorations (ODRs) and secondary caries lesions (SCLs) are of high prevalence and jeopardize the fate of the restoration.

OBJECTIVES

To assess the relationship between ODRs, SCLs and certain caries contributory factors.

METHODS

A total of 502 radiographic records of dental patients with proximal fillings (mean age 38 ± 13 years, 50% females) were screened for ODRs and SCLs. Descriptive and inferential statistics were used. In addition, two-step cluster analysis was performed in an attempt to explain trends in ODR and SCL distribution. A p value of ≤ 0.05 was considered statistically significant.

RESULTS

More than 30% of the individuals had ODRs and SCLs. No differences between genders were observed (p > 0.05). Individuals with medical conditions had more ODRs than those without (49% vs. 34%, p ≤ 0.05), while those with high caries experience had more SCLs (49%, p ≤ 0.05). The cluster analysis grouped the participants in five clusters, with the cluster involving individuals with no medical conditions and low caries experience demonstrating the lowest prevalence of ODRs and SCLs.

CONCLUSIONS

Within the study limits, more than one third of the sample of dental patients had ODRs and SCLs. The medical condition was associated with ODRs, while the past caries experience was associated with SCLs.

Clinical effectiveness of fluorescence, digital images and ICDAS for detecting occlusal caries

Abstract Introduction The detection of small caries lesions is still a challenge for dental professionals who in their clinical practice have a wide variety of methods to detect caries on occlusal surfaces. Objective To clinically assess the effectiveness of the Vista Proof fluorescence camera, the Vista Cam digital intraoral micro camera and the International Caries Detection and Assessment System (ICDAS) visual criterion for detecting caries lesions on occlusal surfaces of permanent teeth. Material and method One hundred and seven posterior teeth from adult patients were examined visually and by means of digital radiographs by an examiner who rated them according to the presence or absence of occlusal caries. The teeth were then assessed by the other examiner using ICDAS, fluorescence and magnified digital images. The effectiveness of the methods was measured based on sensitivity, specificity, positive and negative likelihood ratio. For each method, the Receiver Operating Characteristic (ROC) curve and the Area Under the ROC curve (AUROC) were estimated. Result There was exceptional discrimination capacity for the intraoral images (AUROC=.93) and the ICDAS (AUROC=.91), with no significant statistical difference between them (z=.35, p=.73). The fluorescence exhibited an acceptable discrimination capacity (AUROC=0.78), although it was lower than the others. The positive likelihood ratio for the fluorescence was only 2.32, compared to 20.58 for the intraoral image and 58.11 for the ICDAS. Conclusion Both methods and the ICDAS exhibited an adequate clinical performance, although the ICDAS and intraoral image were more effective than the fluorescence.

Diagnosis of occlusal caries lesions in deciduous molars by coherent light scattering pattern speckle

BACKGROUND

This study presents the correlation between laser speckle images and detection of incipient caries lesions from changs in the microstructure of the surface of tooth enamel.

METHODS

We used 30 healthy deciduous molar teeth collected from the Biobank Human Teeth, Faculty of Dentistry, University of São Paulo who had carious lesions induced by the pH cycling method. The samples were evaluated for the diagnosis of caries by two methods ICDAS and speckle pattern of coherent light scattering after 5, 10 and 15days and the results were statistically analyzed using α=0.05 significance level.

RESULTS

A significant difference was observed between the image of the speckle scattering of healthy and injured areas within the 3 study groups, but not when comparing the three groups, showing us that it is an innovative technique that needs further study, but can be used as a diagnostic method for the detection of early caries lesions.

CONCLUSION

It can be concluded that the analysis of scattering speckle pattern is a diagnostic technique that provides information on the microstructure of the surface of tooth enamel which has sensitivity for detection of incipient caries lesions.