Secondary Caries Detection and Treatment Decision according to Two Criteria and the Impact of a Three-Dimensional Intraoral Scanner on Gap Evaluation.

This study aimed to evaluate the in vitro performance in detecting caries around composite restorations in permanent posterior teeth and the impact of treatment decisions of two visual criteria: International Dental Federation (FDI) criteria and the Caries Associated with Restorations and Sealants (CARS) system. The correlation among secondary caries and the presence of gap measured with a three-dimensional (3D) intraoral scanner was also aimed. One hundred sixteen teeth were assessed by a trained and calibrated examiner according to the FDI criteria or CARS system. A second examiner measured the gap on the 3D models using specific software. The reference standard was the histological examination performed by a third examiner blind to the other evaluations. Other 30 extracted permanent teeth were used only to assess the reproducibility of the methods. The same random sample was selected for re-examination by all three methods, and there were 7 days between the examinations. Unweighted and weighted kappa tests were conducted to assess intra-examiner reproducibility. Spearman's correlation coefficient (Rho) and 95% confidence intervals (95% CI) were calculated between the histological examination and scores obtained with FDI criteria, CARS system, and treatment decisions. Spearman's correlation between the visual and scanner evaluation with the reference standard was performed. Spearman's rank correlation analyses were conducted independently between the gap evaluated and measured by the visual inspection with the gap assessed using the scanner. The reproducibility of the visual score systems reached high values. Spearman's correlation coefficients (Rho; 95% CI) between the following variables versus histology were the FDI presence of caries (0.65; 0.53-0.74); CARS scores (0.65; 0.52-0.74); FDI treatment decision (0.46; 0.31-0.59); and CARS treatment decision (0.62; 0.49-0.72). Rho (95% CI) between histology and the gap assessment by the visual inspection was 0.59 (0.45-0.70), the gap measurement by the visual inspection was 0.49 (0.33-0.62), and the gap measured by the scanner was 0.37 (0.18-0.53). Both visual criteria present similar performance in detecting caries. The correlation among treatment decisions is moderate for the FDI and CARS criteria, and both are moderately correlated with lesion depth, with a slight CARS superiority. However, visual examination presents better performance than the 3D intraoral scanner on gap size assessment.

Clinical Accuracy of Two Different Criteria for the Detection of Caries Lesions around Restorations in Primary Teeth.

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 the 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 (3-10 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: (1) the presence of carious tissue after restoration removal and (2) the presence of caries lesions after 6 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.

ICCMS™ root caries lesions stages and their underlying depth towards the pulp: an in vitro study with histologic evaluation.

OBJECTIVE: To examine the relationship between the ICCMS™ (International Caries Classification and Managing System) features of root caries lesions and the underlying depth of the lesion towards the pulp. In order to control for bias, the study followed the tailored document for risk of bias assessment (RoB-tool) recently published. A pilot study showed that the outline of the pulp was much clearer on horizontal compared to vertical sections through the lesions (p = 0.03) and that the histological stereomicroscopical (SM) assessed lesion depth towards the pulp was not influenced by the cutting direction (p = 0.155). MATERIAL AND METHODS: A sample of extracted permanent molar teeth (n = 100) were classified independently by two of the authors according to ICCMS™ as no sign of root caries lesion 0 = sound; 1 = initial lesion (non-cavitated); 2 = moderate lesion (cavity depth ≤ 2 mm) and 3 = extensive lesion (cavity depth > 2 mm). After horizontal sectioning (HS) through the lesion, the depth of the underlying lesion was SM assessed independently by two of the authors as 0 = no lesion; 1 = lesion in outer 1/3; 2 = middle 1/3; and 3 = inner 1/3 of the dentine towards the pulp. RESULTS: Intra- and inter-reproducibility (weighted kappa values ≥ 0.83); the accuracy (Spearman's rho-values) = 0.94 and 0.95; and specificity/sensitivities/AUC values (three different thresholds) were ≥ 0.91, ≥ 0.93, and ≥ 0.96, respectively. CONCLUSION: Under the umbrella of the RoB-tool, the validity in terms of the reproducibility and accuracy of the ICCMS™ root caries scoring system was high. CLINICAL RELEVANCE: By means of the ICCMS™ root caries scoring system, the underlying lesion depth can be estimated, which must be considered when managing the lesion.

STAndard Reporting of CAries Detection and Diagnostic Studies (STARCARDDS).

AIM: The aim of this paper is to present recommendations from an international workshop which evaluated the methodology and reporting of caries diagnostic studies. As a unique feature, this type of studies is focused on caries lesion detection and assessment, and many of them are carried out in vitro, because of the possibility of histological validation of the whole caries spectrum. This feature is not well covered in the existing reporting STARD guideline within the EQUATOR Network. PARTICIPANTS AND METHODS: An international working group of 13 cariology researchers was formed. The STARD checklist was reviewed and modified for caries detection and diagnosis purposes, in a three-step process of evaluation, consensual modification, and delivery during three 2-day workshops over 18 months. Special attention was paid to reporting requirements of caries studies that solely focus on reliability. RESULTS: The STARD checklist was modified in 14/30 items, with an emphasis on issues of sample selection (tooth selection in in vitro studies), blinding, and detailed reporting of results. CONCLUSION: Following STARCARDDS (STAndard Reporting of CAries Detection and Diagnostic Studies) is expected to result in complete reporting of study design and methodology in future caries diagnosis and detection experiments both in vivo and in vitro, thus allowing for better comparability of studies and higher quality of systematic reviews. CLINICAL RELEVANCE: Standardization of caries diagnostic studies leads to a better comparability among future studies, both in vivo and in vitro.

Additional information of bitewings to first time clinical examination of caries and restoration status in permanent dentition.

OBJECTIVES: Identifying additional information obtained by X-rays combined with clinical examination concerning primary caries, caries adjacent to restorations and quality of restorations. MATERIAL AND METHODS: A total of 240 adult patients, equally distributed in gender and six age-groups, were randomly selected from an original study population of 4,402 subjects (DANHES). Clinical and radiographical registrations on occlusal and approximal surfaces in posterior teeth were categorized into unrestored surfaces (sound/primary caries) and restored surfaces (without/with caries adjacent to restorations). Material and quality of restorations were also recorded. Chi-square and Fisher-exact tests were used for statistical analyses. RESULTS: Of potentially 11,520 surfaces, 3,015 occlusal and 5,112 approximal surfaces were analysed. Occlusal: Of 907 unrestored surfaces, 110 had primary caries and 53% were detected radiographically. A total of 183 of 2,108 restored surfaces had caries adjacent to restorations, and 99% were found radiographically. A total of 190 restorations were over/under-extended, and 89% were registered radiographically. Approximal: Of 2,649 unrestored surfaces 648 had primary caries, and 92% were registered radiographically. A total of 565 of 2,463 restored surfaces had caries adjacent to restorations, and 99% were found radiographically. A total of 638 restorations were over/under-extended, and 98% were found radiographically. For all restorations, material and depth influenced quality of restorations and incidence of caries adjacent to restorations. At least one independent variable (gender/age group/tooth-type/jaw/side/mesial-distal surface) influenced frequencies of primary caries, caries adjacent to restorations and quality of restorations. CONCLUSIONS: First-time clinical examination must be supplemented with X-rays to obtain a complete impression of caries status in posterior regions regarding diagnostics of caries, assessment of lesion depth and quality of restorations.

Systematic review and meta-analysis of diagnostic methods for occlusal surface caries.

AIM: This systematic review and meta-analysis aimed to assess the diagnostic performance of commonly used methods for occlusal caries diagnostics, such as visual examination (VE), bitewing radiography (BW) and laser fluorescence (LF), in relation to their ability to detect (dentin) caries under clinical and laboratory conditions. MATERIALS AND METHODS: A systematic search of the literature was performed to identify studies meeting the inclusion criteria using the PIRDS concept (N = 1090). A risk of bias (RoB) assessment tool was used for quality evaluation. Reports with low/moderate RoB, well-matching thresholds for index and reference tests and appropriate reporting were included in the meta-analysis (N = 37; 29 in vivo/8 in vitro). The pooled sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR) and areas under ROC curves (AUCs) were computed. RESULTS: SP ranged from 0.50 (fibre-optic transillumination/caries detection level) to 0.97 (conventional BW/dentine detection level) in vitro. AUCs were typically higher for BW or LF than for VE. The highest AUC of 0.89 was observed for VE at the 1/3 dentin caries detection level; SE (0.70) was registered to be higher than SP (0.47) for VE at the caries detection level in vivo. CONCLUSION: The number of included studies was found to be low. This underlines the need for high-quality caries diagnostic studies that further provide data in relation to multiple caries thresholds. CLINICAL RELEVANCE: VE, BW and LF provide acceptable measures for their diagnostic performance on occlusal surfaces, but the results should be interpreted with caution due to the limited data in many categories.

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.

How combining different caries lesions characteristics may be helpful in short-term caries progression prediction: model development on occlusal surfaces of primary teeth.

BACKGROUND: Few studies have addressed the clinical parameters' predictive power related to caries lesion associated with their progression. This study assessed the predictive validity and proposed simplified models to predict short-term caries progression using clinical parameters related to caries lesion activity status. METHODS: The occlusal surfaces of primary molars, presenting no frank cavitation, were examined according to the following clinical predictors: colour, luster, cavitation, texture, and clinical depth. After one year, children were re-evaluated using the International Caries Detection and Assessment System to assess caries lesion progression. Progression was set as the outcome to be predicted. Univariate multilevel Poisson models were fitted to test each of the independent variables (clinical features) as predictors of short-term caries progression. The multimodel inference was made based on the Akaike Information Criteria and C statistic. Afterwards, plausible interactions among some of the variables were tested in the models to evaluate the benefit of combining these variables when assessing caries lesions. RESULTS: 205 children (750 surfaces) presented no frank cavitations at the baseline. After one year, 147 children were reassessed (70%). Finally, 128 children (733 surfaces) presented complete baseline data and had included primary teeth to be reassessed. Approximately 9% of the reassessed surfaces showed caries progression. Among the univariate models created with each one of these variables, the model containing the surface integrity as a predictor had the lowest AIC (364.5). Univariate predictive models tended to present better goodness-of-fit (AICs < 388) and discrimination (C:0.959-0.966) than those combining parameters (AIC:365-393, C:0.958-0.961). When only non-cavitated surfaces were considered, roughness compounded the model that better predicted the lesions' progression (AIC = 217.7, C:0.91). CONCLUSIONS: Univariate model fitted considering the presence of cavitation show the best predictive goodness-of-fit and discrimination. For non-cavitated lesions, the simplest way to predict those lesions that tend to progress is by assessing enamel roughness. In general, the evaluation of other conjoint parameters seems unnecessary for all non-frankly cavitated lesions.

Cariology consensus for undergraduates at dental schools in the Caribbean region.

AIM: To obtain a consensus on the domains of cariology for undergraduates in dental schools in the Caribbean. MATERIALS AND METHODS: Dental school deans from the Dominican Republic (DR) and Puerto Rico (PR) were invited to participate. Afterwards, 24 cariology faculty members from the dental schools in the DR received a 40-h workshop on the current understanding of dental caries. Then, representatives from participating dental schools in the DR and PR were divided into six groups and tasked with exploring the cariology domains described in the European and Colombian consensus. For each domain, the competencies in what the dental student, upon graduation, would have to (1) be proficient in, (2) have knowledge of, (3) and be familiar with were described. Two cariology consensus meetings to work on the domains and suggest changes for the Caribbean region were done, and representatives from the DR and PR agreed on a cariology consensus. For the second stage, Caribbean English-speaking countries were invited to participate in the consensus. Meetings were held with representatives from dental schools in Trinidad and Tobago (TT) and Jamaica (J) to include their suggestions on each consensus domain. RESULTS: A total of 15 dental schools (DR = 12; PR = 1; TT = 1; and J = 1) participated; they agreed on a new consensus considering the realities of the Caribbean participating countries. CONCLUSION: A cariology consensus for undergraduates was achieved for 15 dental schools in the Caribbean region. This accomplishment will promote a shift for the Caribbean dental schools' graduates towards a current understanding of dental caries.

Development of a Fluorescence-Based Caries Scoring System for an Intraoral Scanner: An in vitro Study.

OBJECTIVES: To develop an automated fluorescence-based caries scoring system for an intraoral scanner and totest the performance of the system compared to state-of-the-art methods. METHODS: Seventy-three permanent posterior teeth were scanned with a three-dimensional (3D) intraoral scanner prototype which emitted light at 415 nm. An overlay representing the fluorescence signal from the tissue was mapped onto 3D models of the teeth. Multiple examination sites (n = 139) on the occlusal surfaces were chosen, and their red and green fluorescence signal components were extracted. These components were used to calculate 4 mathematical functions upon which a caries scoring system for the scanner prototype could be based. Visual-tactile (International Caries Detection and Assessment System, ICDAS), radiographic (ICDAS), and histological assessments were conducted on the same examination sites. RESULTS: Most index tests showed significant correlation with histology. The strongest correlation was observed for the visual-tactile examination (rs = 0.80) followed by the scanner supported by the caries classification function that quantifies the overall fluorescence compared to sound surfaces (rs = 0.78). Additionally, this function resulted in the highest intra-examiner reliability (κ = 0.964), and the highest sum of sensitivity (SE) and specificity (SP) (sum SE-SP: 1.60-1.84) at the 2 histological levels where the comparison with visual-tactile assessment was possible (κ = 0.886, sum SE-SP = 1.57-1.81) and at the 3 out of 4 histological levels where the comparison with radiographic assessment was possible (κ = 0.911, sum SE-SP = 1.37-1.78); the only exception was for the lesions in the outer third of dentin, where the radiographic assessment showed the highest sum SE-SP (1.78). CONCLUSION: A fluorescence-based caries scoring system was developed for the intraoral scanner showing promising performance compared to state-of-the-art caries detection methods. The intraoral scanner accompanied by an automated caries scoring system may improve objective caries detection and increase the efficiency and effectiveness of oral examinations. Furthermore, this device has the potential to support reliable monitoring of early caries lesions.

Terminology of Dental Caries and Dental Caries Management: Consensus Report of a Workshop Organized by ORCA and Cariology Research Group of IADR.

A 2-day workshop of ORCA and the IADR Cariology Research Group was organized to discuss and reach consensus on definitions of the most commonly used terms in cariology. The aims were to identify and to select the most commonly used terms of dental caries and dental caries management and to define them based on current concepts. Terms related to definition, diagnosis, risk assessment, and monitoring of dental caries were included. The Delphi process was used to establish terms to be considered using the nominal group method favored by consensus. Of 222 terms originally suggested by six cariologists from different countries, a total of 59 terms were reviewed after removing duplicates and unnecessary words. Sixteen experts in cariology took part in the process of reaching consensus about the definitions of the selected caries terms. Decisions were made following thorough "round table" discussions of each term and confirmed by secret electronic voting. Full agreement (100%) was reached on 17 terms, while the definitions of 6 terms were below the agreed 80% threshold of consensus. The suggested terminology is recommended for use in research, in public health, as well as in clinical practice.

How to Intervene in the Caries Process in Children: A Joint ORCA and EFCD Expert Delphi Consensus Statement.

This paper provides recommendations for dentists for the treatment of dental caries in children, with an emphasis on early childhood caries (ECC), primary teeth, and occlusal surfaces in permanent teeth. A consensus workshop followed by an e-Delphi consensus process was conducted with an expert panel nominated by the European Organization for Caries Research (ORCA) and European Federation of Conservative Dentistry (EFCD)/German Association of Conservative Dentistry (DGZ) boards. Based on 3 systematic reviews and a nonsystematic literature search, recommendations were developed. The caries decline has led to a more polarized disease distribution in children and adolescents along social gradients which should be taken into account when managing the caries process at all levels, such as the individual, the group, or a population. The control or reduction of caries activity is the basis for successful caries management. In children, caries management requires adequate daily oral hygiene and fluoride application via toothpaste, ensured by caregivers, and especially for ECC prevention an emphasis on sugar intake reduction is needed. These noninvasive interventions are also suitable to arrest or control initial or even cavitated dentine caries lesions in the absence of irreversible pulpitis. Fluoride varnish or silver diammine fluoride can be added as supplementary agents. In pits and fissures, composite resin materials can be used as preventive sealants and for defect-oriented minimally invasive restorations. In primary molars, preformed metal crowns are more successful than multisurface fillings, especially in caries-active patients. With persisting high caries activity, multiple lesions, and limited cooperation, caries control should consist of robust measures with high success rates, even including extraction in selected cases. This applies especially to treatments performed under general anesthesia.

How to Intervene in the Caries Process in Older Adults: A Joint ORCA and EFCD Expert Delphi Consensus Statement.

AIM: To provide recommendations for dental clinicians for the management of dental caries in older adults with special emphasis on root caries lesions. METHODS: A consensus workshop followed by a Delphi consensus process were conducted with an expert panel nominated by ORCA, EFCD, and DGZ boards. Based on a systematic review of the literature, as well as non-systematic literature search, recommendations for clinicians were developed and consented in a two-stage Delphi process. RESULTS: Demographic and epidemiologic changes will significantly increase the need of management of older adults and root caries in the future. Ageing is associated with a decline of intrinsic capacities and an increased risk of general diseases. As oral and systemic health are linked, bidirectional consequences of diseases and interventions need to be considered. Caries prevention and treatment in older adults must respond to the patient's individual abilities for self-care and cooperation and often involves the support of caregivers. Systemic interventions may involve dietary counselling, oral hygiene instruction, the use of fluoridated toothpastes, and the stimulation of salivary flow. Local interventions to manage root lesions may comprise local biofilm control, application of highly fluoridated toothpastes or varnishes as well as antimicrobial agents. Restorative treatment is often compromised by the accessibility of such root caries lesions as well as the ability of the senior patient to cooperate. If optimum restorative treatment is impossible or inappropriate, long-term stabilization, e.g., by using glass-ionomer cements, and palliative treatments that aim to maintain oral function as long and as well as possible may be the treatment of choice for the individual.

How to intervene in the caries process in adults: proximal and secondary caries? An EFCD-ORCA-DGZ expert Delphi consensus statement.

OBJECTIVES: To provide consensus recommendations on how to intervene in the caries process in adults, specifically proximal and secondary carious lesions. METHODS: Based on two systematic reviews, a consensus conference and followed by an e-Delphi consensus process were held with EFCD/ORCA/DGZ delegates. RESULTS: Managing an individual's caries risk using non-invasive means (oral hygiene measures including flossing/interdental brushes, fluoride application) is recommended, as both proximal and secondary carious lesions may be prevented or their activity reduced. For proximal lesions, only cavitated lesions (confirmed by visual-tactile, or radiographically extending into the middle/inner dentine third) should be treated invasively/restoratively. Non-cavitated lesions may be successfully arrested using non-invasive measures in low-risk individuals or if radiographically confined to the enamel. In high-risk individuals or if radiographically extended into dentine, for these lesions, additional micro-invasive (lesion sealing and infiltration) treatment should be considered. For restoring proximal lesions, adhesive direct restorations allow minimally invasive, tooth-preserving preparations. Amalgams come with a lower risk of secondary lesions and may be preferable in more clinically complex scenarios, dependent on specific national guidelines. In structurally compromised (especially endodontically treated) teeth, indirect cuspal coverage restorations may be indicated. Detection methods for secondary lesions should be tailored according to the individual's caries risk. Avoiding false positive detection and over-treatment is a priority. Bitewing radiographs should be combined with visual-tactile assessment to confirm secondary caries detections. Review/refurbishing/resealing/repairing instead of replacing partially defective restorations should be considered for managing secondary caries, if possible. CONCLUSIONS: An individualized and lesion-specific approach is recommended for intervening in the caries process in adults. CLINICAL SIGNIFICANCE: Dental clinicians have an increasing number of interventions available for the management of dental caries. Many of them are grounded in the growing understanding of the disease. The best evidence, patients' expectations, clinicians' expertise, and the individual clinical scenario all need to be considered during the decision-making process.

European Organization for Caries Research Workshop: Methodology for Determination of Potentially Available Fluoride in Toothpastes.

Toothpastes are the most universally accepted form of fluoride delivery for caries prevention. To provide anti-caries benefits, they must be able to release fluoride during the time of tooth brushing or post brushing into the oral cavity. However, there is no standard accepted procedure to measure how much fluoride in a toothpaste may be (bio) available for release. The European Organization for Caries Research proposed and supported a workshop with experts in fluoride analysis in toothpastes and representatives from industry. The objective of the workshop was to discuss issues surrounding fluoride analysis in toothpaste and reach consensus on terminology and best practices, wherever the available evidence allowed it. Participants received a background paper and heard presentations followed by structured discussion to define the problem. The group also reviewed evidence on the validity, reliability and feasibility of each technique (namely chromatography and fluoride electroanalysis) and discussed their strengths and limitations. Participants were able to reach a consensus on terminology and were also able to identify and summarize the advantages and disadvantages of each technique. However, they agreed that most currently available methods were developed for regulatory agencies several decades ago, utilizing the best available data from clinical trials then, but require to be updated. They also agreed that although significant advances to our understanding of the mechanism of action of fluoride in toothpaste have been achieved over the past 4 decades, this clearly is an extraordinarily complex subject and more work remains to be done.

The International Caries Detection and Assessment System - ICDAS: A Systematic Review.

The aims of this study were: (1) to evaluate the overall reproducibility and accuracy of the International Caries Detection and Assessment System (ICDAS) for assessing coronal caries lesions, and (2) to investigate the use of systems associated with the ICDAS for activity assessment of coronal caries lesions. Specific search strategies were adopted to identify studies published up to 2016. For the first objective, we selected studies that assessed primary coronal caries lesions using the ICDAS as a reference standard. A total of 54 studies were included. Meta-analyses summarized the results concerning reproducibility and accuracy (correlation with histology, summary ROC curves [SROC], and diagnostic odds ratio [DOR]). The latter 2 were expressed at D1/D3 levels. The heterogeneity of the studies was also assessed. Reproducibility values (pooled) were > 0.65. The ICDAS mostly presented a good overall performance as most areas under SROC were > 0.75 at D1 and > 0.90 at D3; DOR ≥6. For the second objective, we selected studies investigating activity assessment associated with the ICDAS. The meta-analyses pooled results based on the same methodology and parameters as above. Longitudinal findings regarding caries progression were described to estimate the validity of these systems. On average, the systems for activity assessment of caries lesions showed moderate values concerning reproducibility and overall performance. Active caries lesions were more prone to progress than inactive ones after 2 years. In conclusion, the ICDAS presented a substantial level of reproducibility and accuracy for assessing primary coronal caries lesions. Additional systems associated with the ICDAS that classify caries lesion activity can be useful as they are moderately reproducible and accurate.

Approximal morphology as predictor of approximal caries in primary molar teeth.

OBJECTIVE: To evaluate the predictive power of the morphology of the distal surface on 1st and mesial surface on 2nd primary molar teeth on caries development in young children. SAMPLE AND METHODS: Out of 101 3-to 4-year-old children from an on-going study, 62 children, for whom parents' informed consent was given, participated. Upper and lower molar teeth of one randomly selected side received a 2-day temporarily separation. Bitewing radiographs and silicone impressions of interproximal area (IPA) were obtained. One-year procedures were repeated in 52 children (84%). The morphology of the distal surfaces of the first molar teeth and the mesial surfaces on the second molar teeth (n=208) was scored from the occlusal aspect on images from the baseline resin models resulting in four IPA variants: concave-concave; concave-convex; convex-concave, and convex-convex. Approximal caries on the surface in question was radiographically assessed as absent/present. RESULTS: Of the 52 children examined at follow-up, 31 children (60%) had 1-4 concave surfaces. In total 53 (25%) of the 208 surfaces were concave. A total of 22 children (43%) had 1-4 approximal lesions adding up to 59 lesions. Multiple logistic regression analyses disclosed that gender, surface morphology on one of the approximal surfaces (focus-surface), and adjacent-surface morphology were significantly related to caries development (p values ≤ 0.03). The odds ratio for developing caries in the focus-surface/adjacent-surface in the four IPA variants were convex-convex, 1.0; convex-concave, 5.5 (CI 2.0-14.7); concave-convex, 12.9 (CI 4.1-40.3); and concave-concave, 15.7 (CI 5.1-48.3). CONCLUSION: Morphology of approximal surfaces in primary molar teeth, in particular both surfaces being concave, significantly influences the risk of developing caries. CLINICAL RELEVANCE: The concave morphology of approximal surfaces can predict future caries lesions supporting specific home-care and in-office preventive strategies.

Approximal sealings on lesions in neighbouring teeth requiring operative treatment: an in vitro study.

OBJECTIVES: With this in vitro study we aimed to assess the possibility of precise application of sealant on accessible artificial white spot lesions (WSL) on approximal surfaces next to a tooth surface under operative treatment. A secondary aim was to evaluate whether the use of magnifying glasses improved the application precision. MATERIAL AND METHODS: Fifty-six extracted premolars were selected, approximal WSL lesions were created with 15% HCl gel and standardized photographs were taken. The premolars were mounted in plaster-models in contact with a neighbouring molar with Class II/I-II restoration (Sample 1) or approximal, cavitated dentin lesion (Sample 2). The restorations or the lesion were removed, and Clinpro Sealant was placed over the WSL. Magnifying glasses were used when sealing half the study material. The sealed premolar was removed from the plaster-model and photographed. Adobe Photoshop was used to measure the size of WSL and sealed area. The degree of match between the areas was determined in Photoshop. RESULTS: Interclass agreement for WSL, sealed, and matched areas were found as excellent (κ = 0.98-0.99). The sealant covered 48-100% of the WSL-area (median = 93%) in Sample 1 and 68-100% of the WSL-area (median = 95%) in Sample 2. No statistical differences were observed concerning uncovered proportions of the WSL-area between groups with and without using magnifying glasses (p values ≥ .19). However, overextended sealed areas were more pronounced when magnification was used (p = .01). The precision did not differ between the samples (p = .31). CONCLUSIONS: It was possible to seal accessible approximal lesions with high precision. Use of magnifying glasses did not improve the precision.

Relationship between depth of approximal caries lesions and presence of bacteria in the dentine in primary and permanent posterior teeth: a radiographic examination with microbiological evaluation.

OBJECTIVES: We aimed to determine the relation between the radiographical depth of approximal lesions and the presence of bacteria in the dentine in posterior teeth in both dentitions. MATERIAL AND METHODS: Sample 1 consisted of 34 approximal lesions in primary molars in children aged 5-7 years old. Sample 2 consisted of 48 approximal lesions in molars and premolars in adult patients aged 18-67 years old. All lesions were in need of restorative treatment according to the dentists. During the operative interventions dentine biopsies were collected with a sterile bur just pulpally of the enamel-dentin junction. Two authors evaluated the presence/absence of bacterial colonies. The lesions depth on bitewing radiographs (RSCORING) were assessed independently by two examiners twice using the ICCMS classification system: RI=initial-; RM=moderate-; RE=extensive caries. RESULTS: In sample 1, the RSCORING was distributed as follows: RI=15; RM=12; RE = 7. In 9 cases the lesions were clinically cavitated. Bacteria were visible on the agar plates in one case (7%) of the RI lesion, 86% of the RM lesions and in all the RE lesions, (p < .001). In sample 2, RSCORING was distributed as follows RI=14; RM=23; RE=9. In 15 cases, the lesions were clinically cavitated. In 2 cases (14%), there were visible bacteria on the agar plates among the RI lesions, while this was the case in 86% of RM lesions and in 100% of RE lesions (p < .001). CONCLUSIONS: RM and RE lesions seem to harbor bacteria in the dentine and are candidates for invasive treatment. In contrast, RI lesions should in general be managed non-invasively.