Comparison of near-infrared imaging with cone-beam computed tomography for proximal caries detection in permanent dentition: An in vivo study

OBJECTIVES

This study aimed to evaluate the diagnostic performance of near-infrared imaging (NIRI) and unaided visual examination (UVE) in detecting proximal caries in permanent dentition in comparison with cone-beam computed tomography (CBCT).

METHODS

Patients who underwent NIRI, UVE, and CBCT imaging within 1 week were enrolled. Using CBCT as the reference test, the positive percent agreement (PPA), negative percent agreement (NPA), and overall percent agreement (OPA) of NIRI, UVE, and a combination of the two for detecting proximal caries at different depths and in different tooth locations were assessed. Additionally, the consistency of these diagnostic methods with CBCT was evaluated.

RESULTS

We evaluated 6,084 proximal surfaces and identified 177 CBCT-positive sites. NIRI had a PPA, NPA, and OPA of 68.93 %, 99.09 %, and 98.21 %, respectively, with a substantial agreement with CBCT. When combined with UVE, the PPA increased by approximately 50 % compared with that of UVE alone. Regarding caries at different depths, NIRI outperformed UVE in detecting initial caries (ICDAS 1-2) over moderate-to-advanced caries (ICDAS 3-6). However, the combined use of NIRI and UVE improved the detection of moderate-to-advanced caries. In the anterior teeth region, NIRI exhibited excellent agreement with CBCT, surpassing its performance in the posterior region.

CONCLUSIONS

Although NIRI cannot fully replace radiographic methods, the substantial agreement of NIRI with CBCT in detecting proximal caries highlights its potential as a complementary tool in routine caries screening, especially when combined with UVE.

CLINICAL SIGNIFICANCE

This study highlights the potential of NIRI as a radiation-free method for detecting proximal caries in permanent teeth. Early detection through regular NIRI scanning can lead to timely intervention, improved patient outcomes, and reduced overall disease burden.

Progression of proximal caries in primary molars using the radiographic ICDAS: a retrospective cohort study

PURPOSE

To evaluate the proximal caries progression in primary molars using the radiographic International Caries Detection and Assessment System (ICDAS).

METHODS

A study was conducted on 196 children aged 3-9 years old who underwent the clinical examination and bitewing radiography during baseline and 6-month (and over) follow-up visits. The primary molars bitewing radiographs with initial enamel caries (RA1 and RA2) or outer dentine caries (RA3) of proximal surfaces were included. Caries advancement was scored using ICDAS criteria and statistical analyses with the chi-square test. Median survival time was evaluated using Kaplan-Meier survival curves and log-rank tests.

RESULTS

A total of 439 surfaces of primary molars were included in this study and an averaged follow-up period of enamel and dentine caries group were 18.3 ± 9.6 months and 16.5 ± 9.5 months respectively. The progression of proximal enamel lesions significantly differed between primary maxillary and mandibular molars (p = 0.002) and among each patient's primary mandibular second molar and the others (p = 0.002). On the contrary, the outer dentine caries of each group of primary molars was not different. The median survival time of the initial enamel proximal caries (23.30 months) was non-significantly longer than that of the dentine (20.80 months).

CONCLUSIONS

Progressions of the initial enamel proximal caries were significantly different among primary molars at the average 18.3-month follow-up. The median survival period of the enamel proximal caries was more extended than that of dentine but without statistical difference. These results provide essential information for dentists regarding an appropriate appointment for bitewing examinations.

Evaluation of proximal slicing in primary maxillary incisors with proximal caries- a retrospective cohort study

BACKGROUND

Modern management of dental caries should be more conservative and include early detection of lesions and active surveillance, in order to apply preventive measures and carefully monitor for signs of arrest or progression. Proximal slicing was suggested for nonrestorative caries treatment for primary incisors. The aim of the study was to examine the success of proximal slicing in primary maxillary incisors in arresting caries progression.

METHODS

A retrospective cohort study. Data were collected from medical records of patients who had undergone proximal slicing in primary maxillary incisors with a follow-up period of at least 6 months. Treatment was considered a success when no further invasive clinical intervention was required within the follow-up period of at least 6 months. Treatment was considered a failure when further invasive clinical intervention was needed during the follow-up period (restoration, crown, or extraction). Additional variables included were the patient's gender, treated tooth, treated surface, age during their first visit to the clinic, age during slicing treatment, follow-up period, number of follow-up visits, and number of fluoride applications and additional slicing during follow-up.

RESULTS

Seventy-one patients were included in the study. Proximal slicing was successful in 76% of participants with a follow-up of at least 6 months. Success was associated with older age at the first dental visit (3.5yo vs. 2.5yo, p = 0.0011) and age when proximal slicing was performed (4yo vs. 3yo, p < 0.001).

CONCLUSION

Proximal slicing may successfully arrest proximal caries in primary maxillary incisors.

Clinical validation of near-infrared imaging for early detection of proximal caries in primary molars

OBJECTIVES

The aim of this study was to validate the near-infrared imaging (NIRI) in comparison with visual inspection (VI) for early detection of proximal caries in primary molars.

METHODS

VI and intraoral scans were performed on 126 patients aged 3-12 years with at least one non-cavitied and non-restored proximal tooth surface, who were scheduled for bite wing radiography (BWR) as part of their standard care. Teeth with signs of proximal cavities, restorations or residual caries were excluded in this study. BWR, a gold standard to diagnose proximal caries in primary molars, was used to validate the findings of NIRI and VI. The accuracy, sensitivity, specificity and the area under the curve (AUC) of NIRI and VI were calculated.

RESULTS

The accuracy, sensitivity and specificity of NIRI were 82.89%, 74.10% and 90.97%, while those of VI were 71.64%, 43.88% and 97.14%, respectively. NIRI showed higher accuracy and sensitivity, and lower specificity (P < 0.001). The AUC of NIRI was higher than that of VI (0.826 vs 0.706; P < 0.05).

CONCLUSIONS

NIRI showed higher sensitivity and lower specificity compared with VI when detecting proximal caries in primary molars. Therefore, it is recommended to use NIRI in combination with BWR to improve the detection rate of proximal caries in primary molars.

CLINICAL SIGNIFICANCE

In children, there is a high incidence of proximal caries in primary molars, which require high technical sensitivity for detection. NIRI shows high sensitivity in detecting proximal caries, which may improve their detection rate in primary molars.

THE CLINICAL TRIAL REGISTRATION NUMBER

ChiCTR2300070916.

Accuracy of different approaches for detecting proximal root caries lesions in vitro

OBJECTIVES

The objective was to evaluate the diagnostic accuracy of radiographic evaluation (XR), visual-tactile assessment (VT), laser-fluorescence (LF) (DIAGNOdent Pen/KaVo), and near-infrared-light transillumination (NILT) (DIAGNOcam/KaVo) on proximal root caries lesions in vitro.

METHODS

Two-hundred extracted permanent premolars and molars with and without proximal root caries lesions were allocated to 50 diagnostic models simulating the proximal contacts between teeth and mounted in a phantom dummy head. Two independent examiners used the diagnostic approaches to detect any or advanced root caries lesions, with histologic evaluation of the lesions serving as reference. Receiver operating characteristic (ROC) curves were employed, and sensitivity, specificity, and the area under the ROC curve (AUC) are calculated. Significant differences in mean AUCs between approaches were assumed if p < 0.05 (two-sample t-test).

RESULTS

NILT was not applicable for proximal root caries detection. The sensitivity/specificity to detect any lesions was 0.81/0.63 for XR, 0.76/0.88 for VT and 0.81/0.95 for LF, and the sensitivity/specificity to detect advanced lesions was 0.43/0.94 for XR, 0.66/0.99 for VT, and 0.83/0.78 for LF, respectively. For both, any and advanced root caries lesions, mean AUCs for LF and VT were significantly higher compared to XR (p < 0.05). For any root caries lesions, LF was significantly more accurate than VT (p = 0.01), but not for advanced root caries lesions (p = 0.59).

CONCLUSIONS

Under the in vitro conditions chosen, LF and VT were more accurate than XR to detect proximal root caries lesions, with LF being particularly useful for initial lesion stages.

CLINICAL RELEVANCE

LF might be a useful diagnostic aid for proximal root caries diagnosis. Clinical studies are necessary to corroborate the findings.

Detection of Proximal Caries Lesions on Bitewing Radiographs Using Deep Learning Method

This study aimed to evaluate the validity of a deep learning-based convolutional neural network (CNN) for detecting proximal caries lesions on bitewing radiographs. A total of 978 bitewing radiographs, 10,899 proximal surfaces, were evaluated by two endodontists and a radiologist, of which 2,719 surfaces were diagnosed and annotated with proximal caries and 8,180 surfaces were sound. The data were randomly divided into two datasets, with 818 bitewings in the training and validation dataset and 160 bitewings in the test dataset. Each annotation in the test set was then classified into 5 stages according to the extent of the lesion (E1, E2, D1, D2, D3). Faster R-CNN, a deep learning-based object detection method, was trained to detect proximal caries in the training and validation dataset and then was assessed on the test dataset. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic curve were calculated. The performance of the network in the overall and different stages of lesions was compared with that of postgraduate students on the test dataset. A total of 388 carious lesions and 1,435 sound surfaces were correctly identified by the neural network; hence, the accuracy was 0.87. Furthermore, 27.6% of lesions went undetected, and 7% of sound surfaces were misdiagnosed by the neural network. The sensitivity, specificity, PPV, and NPV of the neural network were 0.72, 0.93, 0.77, and 0.91, respectively. In contrast with the network, 52.8% of lesions went undetected by the students, yielding a sensitivity of only 0.47. The F1-score of the students was 0.57, while the F1-score of the network was 0.74 despite the accuracy of 0.82. A significant difference in the sensitivity was found between the model and the postgraduate students when detecting different stages of lesions (p < 0.05). For early lesions which limited in enamel and the outer third of dentin, the neural network had sensitivities all above or at 0.65, while students showed sensitivities below 0.40. From our results, we conclude that the CNN may be an assistant in detecting proximal caries on bitewings.

Clinical Extension of Proximal Carious Lesions Compared to Bitewing Radiographs using Photostimulable Phosphor Plates (PSP): Clinical vs. Radiographic Interproximal Carious Extension

OBJECTIVES

The aim of this study was to evaluate the use of digital bitewing radiographs using photostimulable phosphor (PSP) plates in the estimation of the true extension of proximal carious lesions.

METHODS

The sample size was calculated to be 70 teeth. Adult patients with a minimum of one posterior tooth with primary proximal caries lesions were included. A preoperative bitewing radiograph was taken and the extension of the carious lesion was measured from the most prominent point on the adjacent sound tooth to the deepest axial point of the lesion. An experienced general dentist provided the restorative treatment and made a polyvinyl siloxane impression of the cavity preparation. Clinical caries extension was measured from the most prominent point of the adjacent tooth until the deepest boundary of the axial wall of the preparation on the impression. Postoperative radiographs were taken at the completion of restorative care. The bitewing radiographs were done using PSP plates and caries extension measurements were performed using measuring tools of the digital radiography software. Pairwise comparisons were made between preoperative and postoperative radiographs, and the true clinical depth measurements using paired t-tests.

RESULTS

A significant difference of 0.82 mm was found between preoperative radiographs and clinical measurements (p<0.001). Similarly, comparisons between preoperative and postoperative radiographic measurements showed significant differences of 0.99 mm (p<0.001).

CONCLUSIONS

The study found that the true clinical extension of proximal caries after non-selective caries removal was significantly deeper than the preoperative radiographic extension assessment. This was not influenced by the tooth type, the location of the tooth, or the affected tooth surfaces.

CLINICAL SIGNIFICANCE

When a non-selective caries removal strategy is adopted, clinicians should be aware that PSP bitewing radiographs underestimate the true clinical extension of proximal caries lesions. This will have an impact on clinicians' practice and restorative treatment decisions.

Systematic review and meta-analysis of diagnostic studies of proximal surface caries

AIM

This systematic review and meta-analysis aimed to assess the diagnostic accuracy and reliability of commonly used caries detection methods for proximal caries diagnostics. Visual examination (VE), bitewing radiography (BWR), laser fluorescence (LF), and fibre-optic transillumination (FOTI) were considered in detail.

MATERIAL AND METHODS

PRISMA guidelines for the reporting of systematic reviews and meta-analyses were applied. The mnemonic PIRDS (problem, index test, reference test, diagnostic and study type) concept was used to guide the literature search. Next, studies that met the inclusion criteria were stepwise selected and evaluated for their quality with a risk of bias (RoB) assessment tool. Studies with low/moderate bias and sufficient reporting were considered for meta-analysis. The pooled sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR), and area under the ROC curve (AUC) were calculated.

RESULTS

From 129 studies meeting the selection criteria, 31 in vitro studies and five clinical studies were finally included in the meta-analysis. The AUC values for in vitro VE amounted to 0.84 (caries detection) and 0.85 (dentin caries detection). BWR ranged in vitro from 0.55 to 0.82 (caries detection) and 0.81-0.92 (dentin caries detection). LF showed higher AUC values for overall caries detection (0.91) and dentin caries detection (0.83) than did other methods. Clinical data are limited.

CONCLUSION

The number of diagnostic studies with low/moderate RoB was found to be low and indicates a need for high-quality, well-designed caries diagnostic studies.

CLINICAL RELEVANCE

BWR and LF showed good diagnostic performance on proximal surfaces. However, because of the low number of includable clinical studies, these data should be interpreted with caution.

Reflected near-infrared light versus bite-wing radiography for the detection of proximal caries: A multicenter prospective clinical study conducted in private practices

OBJECTIVES

The aim of the present prospective multicenter clinical study was to compare the detection of proximal caries with near-infrared light reflection (NILR) versus bitewing radiography (BWR).

MATERIALS AND METHODS

Intraoral scans were performed on 100 patients in five dental clinics using an intraoral scanner (iTero Element 5D, Align Technology, Tempe, AZ, USA) that includes a near-infrared light source (850 nm) and sensor. Reflected near-infrared light images of posterior teeth were used by the individual dentists to detect proximal caries and the results were compared to the BWRs. In a total of 3499 proximal surfaces of molars and premolars which were examined, 223 carious lesions were detected by BWR, while NILR detected 549 carious lesions. Caries detection using both methods was also done by an expert team of five dentists, highly experienced in NILR image interpretation, who used the same sets of clinically-obtained data. Sensitivity, specificity, and accuracy were calculated for caries detection by both the dentists and the expert team. Fifty-nine of the detected carious lesions were clinically treated and the observations during caries excavation were compared with those done with NILR and BWR. Statistical analysis to compare between NILR and BWR diagnosis was performed using non-parametric two-sided McNemar's Chi-Square test with the significance level set at p < 0.05. Kappa coefficients were calculated to assess the level of agreement between the two caries detection methods.

RESULTS

Accuracy of NILR detection of early enamel lesions was 88% and that of carious lesions involving the dentino-enamel junction (DEJ) was 97%. Accuracy was found to be higher at 96% and 99%, respectively, when the same data were examined by the expert team. Direct observation during caries-excavation treatment suggested that NILR detected early enamel lesions that were not detectable with BWR alone.

CONCLUSIONS

Within the limitations of the present study, NILR was more sensitive than BWR in detecting early enamel lesions and comparable to BWR in detecting lesions that involved the DEJ.

CLINICAL RELEVANCE

Reflected near-infrared light images that are generated simultaneously with 3D intra-oral scanning may be used reliably for detection, screening, and monitoring of proximal caries, thus potentially minimizing the traditional use of ionizing radiation.

In vivo performance of near-infrared light transillumination for dentine proximal caries detection in permanent teeth

Objective

The purpose of this in vivo study was to confirm the detection of proximal caries using near-infrared light transillumination (NILTI) (DIAGNOcam) device, and to compare the diagnostic performance of the device with other caries detection methods, including visual examination using the International Caries Detection and Assessment System (ICDAS), bitewing radiography (BW), an LED-based device (Midwest Caries I.D.), and a laser fluorescence device (LFpen).

Methods

A total of 974 proximal surface of permanent posterior teeth from 34 patients (19 females and 15 males between the ages of 22–55) were evaluated in the present study. After clinical examination of each proximal surface by an experienced examiner, they were coded according to the ICDAS criteria and subsequently with BW, the NILTI, LED, and LFpen. The proximal dentin caries of 106 were opened based on the combination of visual, NILTI and radiographic assessment and validated; and were treated with restorative materials. The data were analyzed with descriptive statistics and calculation of the sensitivity, specificity, and area under curve (AUC).

Results

The highest sensitivity values were recorded from NILTI readings (99.1%), followed by BW scores (86.8%). The highest specificity values were recorded from ICDAS (100%). The best AUC values were found from the NILTI readings (0.97), followed by BW (0.93) and ICDAS (0.87).

Conclusion

The NILTI device exhibited the best performance in terms of detecting proximal dentin caries.

Clinical performance of clinical-visual examination, digital bitewing radiography, laser fluorescence, and near-infrared light transillumination for detection of non-cavitated proximal enamel and dentin caries

The aim of this study was to compare the clinical performance of clinical-visual examination using the International Caries Detection and Assessment System (ICDAS) II, digital bitewing radiography, near-infrared light transillumination (NIR-LT), and laser fluorescence (LF) for the detection of non-cavitated proximal enamel and dentin caries. The study included 335 patients, aged 12-18 years, with no cavities in the posterior teeth. Clinical-visual inspections of 335 non-cavitated proximal caries were performed by two examiners. For enamel caries, clinical validation included a combination of clinical-visual and digital bitewing radiography assessments. For dentin caries, the clinical validation was opening the cavity. The accuracy rate, sensitivity, specificity, predictive values, and areas under receiver operating characteristic curves were determined. The agreement between the examiners' measurements was calculated using the kappa coefficient. The sensitivity, specificity, and accuracy of the methods were compared using the McNemar test. The significance level was set at p < 0.05. Digital bitewing radiography had the highest sensitivity (0.96) and accuracy (0.96), and LF had the lowest sensitivity (0.38) and accuracy (0.39). After separation of the lesions into enamel and dentin caries, clinical-visual examination had the highest sensitivity (0.98) and accuracy (0.98) for enamel caries, while digital bitewing radiography had the highest sensitivity (0.97) and accuracy (0.97) for dentin caries. The NIR-LT method had a higher sensitivity for enamel caries (0.86). Each method also differed significantly from the others (p < 0.001). Digital bitewing radiography gave the best prediction of proximal enamel and dentin caries. NIR-LT showed good potential for detection of proximal caries.

The Effect of Resin Infiltration on the Progression of Proximal Caries Lesions: A Randomized Clinical Trial

OBJECTIVE

The aim of this clinical trial was to assess the effect of resin infiltration on the progression of proximal caries lesions.

SUBJECTS AND METHODS

Forty-one patients, aged between 15 and 33 years, with 2 or more non-cavitated proximal caries lesions were included. In 41 of the adolescent and young adults, 45 pairs of proximal lesions with radiological extension into the inner and outer half of the enamel, or into the outer third of the dentin, were randomly allocated to the test groups (resin infiltration application + fluoridated toothpaste and flossing use) or to the control group (fluoridated toothpaste and flossing use). Standardized geometrically aligned digital bitewing radiographs were obtained using individual biting holders. The radiographic progression of the lesions was assessed after 1 year by digital-subtraction radiography. The McNemar test was used for statistical analysis.

RESULTS

In the test group 1/45 of the lesions (2.2%) and in the control group 9/45 of the lesions (20%) showed progression. The caries progression rate of the control group was significantly higher than that of the test group (p < 0.05).

CONCLUSIONS

Resin infiltration of proximal caries lesions is effective in reducing progression of the lesion.

Enhancing the detection of proximal cavities on near infrared transillumination images with Indocyanine Green (ICG) as a contrast medium: In vitro proof of concept studies

OBJECTIVES

The use of near infrared transillumination for caries detection is gaining recognition in daily practice. Differentiation between cavitated and non cavitated proximal lesions is recognized as a threshold for restorative treatment. This investigation focused on the use of a near infrared absorbent dye which may enhance the detection of cavitation on near infrared transillumination images.

MATERIALS AND METHODS

1: Natural teeth with artificial proximal cavitation were images with 3 different dyes to establish that near infrared absorbent dye can act like a contrast medium. 2: Natural teeth with natural cavitated lesions were used to investigate the contrast enhancing effect of indocyanine green (ICG) on near infrared transillumination images. 3: Artificial teeth with artificial cavitations were used to determine the best consistency of ICG as a contrast medium. 4: natural teeth with proximal lesions were used to confirm that ICG can differentiate between cavitated and non cavitated proximal lesions.

RESULTS

1: ICG enhanced the contrast of cavitations compared to other dyes (ANOVA; p < 0.05). 2: ICG enhanced the contrast of the cavitated area on natural lesions but not significantly (t-test; p > 0.05). 3: ICG in a gel form enhanced the detection of cavitated lesions when compared to liquid ICG (t-test; p < 0.05). 4: ICG gel was able to differentiate between cavitated and non cavitated proximal lesions (ANOVA; p < 0.05).

CONCLUSION

ICG can potentially be used as a contrast medium to enhance the detection of cavitated proximal lesions in vitro on near infrared transillumination images. A clinical study is required to validate these results in vivo.

In Vitro Comparison of Diagnostic Accuracy of DIAGNOdent and Digital Radiography for Detection of Secondary Proximal Caries Adjacent to Composite Restorations

Introduction: Early detection of secondary proximal caries is critical for the preservation of tooth vitality. This study sought to assess and compare the diagnostic accuracy of DIAGNOdent and digital radiography for detection of secondary proximal caries adjacent to composite restorations. Methods: Sixty extracted molars including 30 teeth with carious lesions and 30 sound teeth were randomly selected. Class II cavities were prepared in all teeth and carious dentin was intentionally left in the gingival floor of cavities in 30 carious teeth. All cavities were restored with composite resin. The teeth were mounted in wax blocks (three teeth per block) and examined for caries using (DIAGNOdent kaVo Dental, Biberach, Germany). Digital radiographs using DIGORA photostimulable phosphor (PSP) plates (Soredex Corporation, Helsinki, Finland) were obtained from all teeth using the parallel technique and were evaluated by 4 observers. Repeated measure analysis of variance (ANOVA) was applied to calculate sensitivity and specificity values of the two diagnostic techniques. Receiver operating characteristic (ROC) curve was plotted for DIAGNOdent results and based on that, the cutoff points were determined. Results: The sensitivity and specificity values at the cut-off point of 10.5 were 0.622±0.038 and 0.822±0.077 for DIAGNOdent and 0.591±0.093 and 0.891±0.083 for digital radiography, respectively. The area under the ROC curve was 0.7 for DIAGNOdent. Weighted kappa revealed moderate to almost perfect intra-observer agreement (0.46-0.99). Intraclass correlation coefficient (ICC) for DIAGNOdent was calculated to be 0.88. Conclusion: No statistically significant difference was noted in diagnostic accuracy of DIAGNOdent and digital radiography for detection of secondary proximal caries adjacent to composite restorations. Thus, DIAGNOdent may be used as an adjunct diagnostic tool for detection of secondary proximal caries beneath composite restorations.

Radiographic diagnosis of proximal caries-influence of experience and gender of the dental staff

OBJECTIVES

The aim of this study was to examine the influence of experience and gender on the radiographic detection of proximal caries lesions and on therapeutic decisions.

MATERIALS AND METHODS

A survey of 220 examiners (students and employees at three universities and dentists in the field) was taken using a standardized written questionnaire concerning radiographic diagnosis and therapy planning. An expert opinion of four dentists was determined as radiographic reference. A mixed effect logistic regression model was used for statistical evaluation and the odds ratio and p values were calculated (α = 0.05).

RESULTS

Examiners with experience had an almost four times greater chance of a correct assessment, if proximal caries lesion was present or not, than examiners with low experience (OR 3.7 (95% CI 2.4-5.8)). No gender-specific differences were discovered (OR women vs. men 0.9 (95% CI 0.6-1.4)). There was a relationship between the severity of the burnout effect on the x-ray and false positive caries diagnosis. Overall, 43% of respondents would plan invasive treatment in the enamel on a patient at low risk of caries and 78% on a high-risk patient. The results showed that the more experienced practitioners would be more likely to postpone restorative therapy on proximal caries until the lesion reached a later stage.

CONCLUSIONS

The results of this study suggest that examiner's experience influences the radiographic diagnosis of proximal lesions. No gender-specific differences could be found.

CLINICAL RELEVANCE

Examiner's professional experience is an important factor when radiography is included for detection and treatment planning of proximal lesions.

Comparison of Diagnostic Ability of Storage Phosphor Plate in Detecting Proximal Caries with Direct Measurement by Stereomicroscope: A Pilot Study

Radiography plays an important role in detection of interproximal caries. The aim of study is to compare diagnostic ability of photo stimulable phosphor (PSP) with direct measurement using stereomicroscope in detecting proximal caries. Hundred proximal surfaces of 50 extracted human posterior teeth were radiographed with dental X-ray unit. The image receptors used was storage phosphor plate Vista scan (size 2), (time of exposure 0.4 s). Radiographs were interpreted and caries lesions were classified on a 4-point scale suggested by Abesi et al. The teeth were sectioned with diamond disc and were examined under a stereomicroscope with 20x magnification. Diagnostic accuracy of digital image is similar to that observed with stereomicroscope. The PSP plate digital X ray system can effectively be employed for detecting proximal caries as compared to direct observation by stereomicro-scope. Further study with more number of observer/evaluator and large sample size is recommended.

The evaluation of effect of developer age in the detection of approximal caries using three speed dental x-ray films: an in-vitro study

BACKGROUND AND OBJECTIVES

Ever since the first radiograph was taken in 1895, radiographs have become an essential part of dental practice. Since radiation exposure for the patients is a major concern, it is important for us to reduce the radiation exposure to the patient and surrounding environment, without compromising the quality of image. Since improper film processing is one of the major causes of poor image quality, it is very important to test dental films under a variety of processing conditions. So this study was conducted to compare the diagnostic accuracy between Kodak Ultraspeed, Ektaspeed and Agfa Dentus M2 Comfort films for the detection of approximal caries in fresh as well as in aged processing solution.

METHODS

Hundred extracted unrestored maxillary and mandibular teeth were aligned in a group of five teeth in each plaster model. Total of 20 plaster models were constructed and only 3 teeth in the middle were utilized for the study. The final sample consisted of 60 teeth in the study. The exposure time for Ultraspeed film was standardized at 0.5 seconds and for Ektaspeed and Agfa Dentus M2 films, the exposure time was 0.32 seconds. For each radiograph two blocks were used simulating bitewing radiograph. All 20 plaster blocks were exposed using three film types at standardized exposure timings with 30 radiographs each week. The procedure was repeated every week until 6 weeks. Radiographs were evaluated by an observer and assessed by following four point scale 0- sound tooth, 1- lesion in enamel, 2- lesion in amelodentinal junction, 3- dentinal lesion. Only distal surfaces were assessed. Thereafter all the teeth were subjected for histological study and actual depth of the lesion was recorded which acted as gold standard and this reading was subtracted in observer readings after radiographic examination. All data collected were analyzed statistically using ANOVA, paired and unpaired t-tests.

RESULTS

Ektaspeed and Agfa films required less exposure compared to Ultraspeed film. With respect to film, all films had equal diagnostic accuracy upto three weeks. From fourth week Ultraspeed and Agfa films were considerably better than E speed film. E speed film was inferior in the depleted solution compared to other two solutions. With respect to lesion detection Agfa film was inferior to other two films.

CONCLUSION

All three films had equal diagnostic accuracy in fresh solution. Considering the significant reduction in patient radiation with Ektaspeed film, this should be the film of choice whenever possible. As far as the diagnosis of approximal caries is concerned processing solutions should not be used longer than 3 weeks.

Sodium fluoride mouthrinse used twice daily increased incipient caries lesion remineralization in an in situ model

OBJECTIVES

To investigate the remineralizing effects of fluoride mouthrinses used at different times and frequency in addition to fluoride toothpaste.

METHODS

A randomized crossover single blinded study comprised 4 experimental phases of 21 days each. Twelve orthodontic volunteers were fixed with an orthodontic bracket containing an artificial carious enamel slab, which was from the same tooth in all 4 phases, and were randomly assigned to the following groups: (1) brushing with F toothpaste 2× per day (F- brush), (2) F- brush+rinsing with 0.05% NaF (F- rinse) after lunch, (3) F- brush+F-rinse before bedtime, and (4) F- brush+F- rinse 2× per day. Mean mineral gain after each phase was determined from mineral density profiles obtained using Micro-CT.

RESULTS

The mean mineral gain in all treatments with F- brush and F-rinse were significantly greater than those in F- brush (p<0.05). Moreover F- rinse 2× per day increased lesion remineralization more than F- rinse once a day.

CONCLUSIONS

The twice-daily use of 0.05% NaF mouthrinse combined with twice-daily regular use of fluoride toothpaste resulted in the greatest remineralization of incipient caries. These data indicate that rinsing frequency is a factor affecting the effectiveness of fluoride mouthrinse.

CLINICAL SIGNIFICANCE

The rinsing frequency of NaF mouthrinse, when used with fluoride toothpaste, also affects the remineralization. This finding, if confirmed by a clinical study, would lead to a new recommendation for fluoride mouthrinse used in high caries risk patients who could benefit from using it twice a day.

Diagnostic accuracy of digitized conventional radiographs by camera and scanner in detection of proximal caries

Background and aims

Digital radiographs have some advantages over conventional ones. Application of digital recep-tors is not routine yet. Therefore, there is a need for digitizing conventional radiographs. The aim of the present study was to compare the diagnostic accuracy of digitized conventional radiographs by scanner and camera in detection of proximal car-ies.

Materials and methods

Three hundred and sixteen surfaces of 158 extracted posterior teeth were radiographed. The radiographs were digitized using a digital camera and a scanner. Five observers scored the images for the presence and depth of caries. Histopathologic sections were the gold standard. Kappa agreement coefficient was used for statistical analysis.

Results

Kappa agreement coefficients between the camera and the scanner and also between each one with the gold stan-dard in detecting the depth of caries were 0.504, 0.557 and 0.454, respectively. In detection of caries, the indexes were 0.571, 0.553 and 0.527, respectively.

Conclusion

Diagnostic accuracy of camera images in caries detection was more than that of scanned images, but there was also a moderate consistency between them. The consistency of detecting the presence of caries was more than that of detecting their depths. It seems that both digital cameras and scanners can be used interchangeably.