Tissue Interactions in Dense Tissues of the Orofacial Region in Patients with Connective Tissue Dysplasia.

AIMS: This study aimed to investigate the rate and quality of maturation of the mineral component of impacted teeth 38 and 48 and a fragment of the human lower jaw with connective tissue dysplasia (CTD) in different periods of postnatal ontogenesis. METHODS AND MATERIAL: The study involved 102 males (76 with CTD and 26 without CTD), divided into age groups: 31-40, 41-50 and 51-60 years. For medical reasons, teeth 38 and 48 were removed from each patient, as well as a fragment of the alveolar part of the lower jaw in the projection of teeth 38 and 48 measuring 0.5 × 0.5 cm. The odontological parameters, the mineral density of the enamel and the lower jaw, the length and width of the enamel prisms, the spatial organisation of collagen fibrils and the dimensions of the bone plates of the lower jaw were determined. RESULTS: A decrease in optical density was observed at the age of 41-50 and 51-60 years with dysplasia, which indicated a decrease in mineral density and the presence of total areas of hypomineralisation relative to the age of 31-40 years. In the age groups of 41-50 and 51-60 years, pronounced sclerosis and deformation of the delimiting elements were observed at the border of the connective tissue structures and the periosteum. At the age of 31-40 years, the level of stratification of the bone plates was local; after 40 years, it was generalised. CONCLUSIONS: Progressive osteoporosis of the lower jaw and incomplete amelogenesis are obstacles to the correct and harmonious eruption of the lower 'wisdom' teeth after 30 years.

Onset and progression of dental erosion in a mouse model.

OBJECTIVE: Purpose of this research was to examine the onset, progression and wear rates of dental erosion in an established mouse model. MATERIAL AND METHODS: Dental erosion in mice was experimentally induced, and the acidic effects of cola drink on their teeth after 2, 4 and 6-weeks were closely analysed by scanning electron microscopy. The tooth height and enamel or dentin loss were established.  Results: The dental erosion on the molars showed clear progression from 2 to 6 weeks. By the 2-week mark, a significant portion of enamel was already eroded, revealing the dentin on the lingual cusps. When adjusted for attritional wear, molars exposed to cola for 2 weeks showed a 35% drop in lingual tooth height compared to controls (533 µm vs. 818 µm). At 4 and 6 weeks, the cola-exposed group continued to display decreased lingual tooth heights by 40% (476 µm vs. 799 µm) and 43% (440 µm vs. 767 µm), respectively. CONCLUSION: This study revealed significant acidic effects of cola drink on mouse molars as early as 2 weeks. These findings highlight the challenge of monitoring dental erosion clinically and underscore the importance of early preventive and intervention measures.

Developmental Defects of Enamel.

Amelogenesis, the intricate process governing enamel formation, is susceptible to a range of genetic, systemic, and environmental influences, resulting in distinct developmental defects of enamel (DDE), such as molar incisor hypomineralisation (MIH), enamel hypoplasia, dental fluorosis, and amelogenesis imperfecta (AI). This chapter aims to provide a comprehensive overview of amelogenesis and DDE, establishing correlations between histopathological findings and clinical manifestations. MIH, a qualitative enamel defect, occurs during the mineralisation and maturation phases, affecting first permanent molars and eventually incisors. Diagnostic challenges in MIH arise from the disorder's unique features, including variable tooth involvement and severity, influenced by a complex interplay of genetic, systemic, and environmental factors. Enamel hypoplasia, a quantitative defect, manifests in any tooth during enamel matrix secretion. Etiological factors include local, systemic, environmental, and genetic influences, with variable enamel matrix abnormalities depending on the stage of amelogenesis when aggression occurred. Dental fluorosis, a toxicological concern from chronic and excessive fluoride exposure, affects ameloblasts and compromises crystal growth of the homologous teeth during enamel development. Lastly, AI, an inherited condition, encompasses diverse phenotypes in enamel development. AI phenotypes, whether hypoplastic or hypomineralised, entail mutations in genes, such as AMELX, ENAM, MMP20, KLK4, WDR72, FAM83H, C4ORF26, amelotin, GPR68, and ACPT. Diagnosing AI involves considering family history and clinical observation. In conclusion, navigating the intricacies of amelogenesis, from MIH to AI, underscores the critical importance of accurate diagnosis for proper clinical management of DDE.

MIH-Affected Substrate: An Overview of Adhesive Challenges to the Dental Structures.

Based on the current state of the art regarding molar incisor hypomineralisation (MIH)-affected enamel, bonding systems are expected to play a relevant role on the restorative procedures when required. MIH-affected enamel is often subjected to posteruptive breakdown combined or not with carious lesions, predominantly on molars, and may also affect the aesthetics of anterior teeth. As unbalanced mineral and protein contents occur, understanding these alterations is essential before selecting the most appropriate adhesive systems, while bearing in mind their limitations. In particular, when dentin is involved due to enamel breakdown, the use of functional monomer-based bonding systems present in self-etching and universal systems produce a chemical interaction that enhance the bonding. So far, the overall recommendation relies on placing the margin of the restoration on clinically sound enamel, regardless of the category of the adhesive system.

Molar Incisor Hypomineralisation as a Dental Caries Risk Factor - Is It True?

The development of the human dentition is susceptible to disruption owing to its intricate and delicate nature, encompassing variations in tooth number, anatomical configuration, and the characteristics of enamel, dentine, and cementum. This chapter will specifically address the prevalent defect of molar incisor hypomineralisation (MIH), which can impose a significant treatment burden on individuals. MIH is linked to deleterious alterations in the properties of affected enamel, which can lead to rapid enamel breakdown and carious lesion formation in those at a heightened caries risk. In addition, MIH is associated with tooth sensitivity, dental anxiety, difficulty eating, aesthetic concerns, and negative influence during the child's psychological growth, especially when the MIH is severe. Regarding dental caries, it is essential to note that MIH does not directly increase the risk of caries. However, MIH can alter the way the caries process manifests by creating niches where biofilm can accumulate, complicating oral cleaning efforts. Additionally, MIH adversely modifies the physicochemical properties of enamel, influencing how this "hardest of tissues" responds to cariogenic challenges.

Implications of Histological and Ultrastructural Characteristics on the Chemical and Mechanical Properties of Hypomineralised Enamel and Clinical Consequences.

Molar incisor hypomineralisation (MIH) is a qualitative type of enamel defect, which occurs due to a failure in the biomineralisation process of the enamel organic matrix during amelogenesis. The tooth enamel affected by MIH shows changes in its chemical, structural, and mechanical properties, leading to different clinical repercussions. The color of MIH opacities varies from opaque white to yellow/brown, and elemental analyses of these lesions show a lower calcium and phosphate content, minerals that are more abundant in sound enamel. Furthermore, the incorporation of other molecules occurs, such as carbonate, a component that provides a greater degree of solubility, thus making hypomineralised enamel more susceptible to posteruptive fractures. At a structural level, the layer of hydroxyapatite crystals appears to be disorganized, with morphological changes, implying a greater degree of porosity in the structure. The increase in porosity of the structure may be associated with dental hypersensitivity, a common clinical repercussion among patients with MIH. Among the mechanical properties, a decrease in hardness and modulus of elasticity occurs, and this also makes the enamel more fragile. Deficiency in biomineralisation can be caused by changes in the function of ameloblasts or by failures at the intercellular junction that result in lower activity of proteases such as MMP-20 and KLK4. The increase in proteins in the organic matrix of enamel impairs the growth and incorporation of minerals into the hydroxyapatite crystals, so that the enamel becomes hypomineralised and has larger organic content, thus having an impact on its properties. These changes present in the enamel with MIH help to explain the clinical repercussions caused by this condition.

Understanding the Enamel Disintegration and Posteruptive Breakdown of Demarcated Opacities on Molar Incisor Hypomineralisation.

This review aims to present scientific knowledge regarding the demarcated opacities of molar incisor hypomineralisation (MIH) and factors that clarify the occurrence of posteruptive enamel breakdown. The demarcated opacities have distinct boundaries with the adjacent nonaffected enamel and may vary in color among white, creamy, yellow, and brownish. The hypomineralised enamel is more porous and less organized than the nonaffected enamel. As a result of the reduced mineral content and higher protein content, the hypomineralised enamel shows a progressive reduction in its mechanical properties according to the opacity feature. Chemically, the protein content of MIH opacities is abnormally high, mainly composed by albumin, which is a serum protein usually not found in mature enamel. The highest protein content is seen in brown opacities, followed by yellow and white opacities, both with higher protein content than nonaffected enamel. The fact that the hypomineralised enamel is more fragile than the nonaffected enamel is supported not only by laboratorial findings but also by clinical prospective studies that observed an aggravation of MIH over time, as well as the correlation between the color of the demarcated opacities and the risk of posteruptive enamel breakdown. A better understanding about the microstructure of the hypomineralised enamel has relevant implications for the clinical approach of the condition. In the clinic, besides a comprehensive assessment of anamnesis and clinical data, it is advisable to record the color and the location of the opacities by tooth surface in order to support the treatment decisions and estimate a prognosis for MIH patients.

Is It Possible to Remineralise Hypomineralised Enamel Lesions in Patients with Molar Incisor Hypomineralisation?

Molar incisor hypomineralisation (MIH) is characterized with reduced enamel mineral quantity, especially in the calcium and phosphate content, with increases in the carbonate and protein contents. Albumin is the main protein that accumulates pre-eruptively, leading to defective initiation of mineralisation. Other oral-fluid proteins are found in cases of posteruptive enamel surface breakdown. Most of the lesions extend through the full thickness of enamel. Due to the lower mineral quantity and increased carbon and protein content, MIH teeth are more prone to fractures once exposed to mastication. In addition, susceptibility to dental caries is increased and hypersensitivity is common in MIH patients. For these reasons, MIH-affected teeth might benefit from exposure to remineralising agents that will decrease caries susceptibility and reduce sensitivity. Several in vitro, in situ, and in vivo studies have shown that improving the mineralisation of MIH teeth after eruption is possible, especially at the surface. However, complete resolution is difficult due to the depth/thickness of these lesions. In fact, the process is similar to posteruptive maturation. Thus, this nomenclature should be used instead of remineralisation. The evidence available so far indicates that among the several available remineralising agents, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) cream and fluoride (F) varnish show the best results and are equally effective in remineralising MIH-affected teeth. Fluoride varnish demands no patient adherence, while CPP-ACP cream can be applied at home. However, it is important to consider that fluoride varnish is generally more economical than CPP-ACP cream. Consequently, the choice between these agents can be tailored to the patient's specific requirements.

The use of silver diamine fluoride to prevent/treat enamel carious lesions: a narrative review.

This comprehensive literature review examines the use of silver diamine fluoride (SDF) for the prevention and treatment of enamel carious lesions. SDF has been approved by different international drug associations as a caries-preventing agent to be used on deep carious lesions (dentin). However, SDF can cause staining of exposed tooth structures. Furthermore, the effect of SDF on the bond of adhesives to the tooth structure is still being determined. This review explores various studies on the use of SDF to treat enamel carious lesions, highlighting its effectiveness and preventive action. The literature suggests that SDF inhibits bacterial growth, promotes remineralization, and does not negatively affect adhesive retentions. Potassium iodide (KI) or glutathione (GSH) can reduce staining and discoloration. However, the reviewed studies have limitations. Further research, including well-designed clinical trials, is necessary to validate the findings and evaluate the long-term implications of SDF treatment. Conclusion: Despite the above-mentioned limitations, SDF shows potential as a therapy for enamel caries prevention, remineralization, and use as an adjuvant to other dental treatments, warranting further investigation and the refinement of application methods.

Masking efficacy of bleaching and/ or resin infiltration of fluorotic spots on anterior teeth - a systematic review and meta-analysis.

OBJECTIVES: The aim of this systematic review and meta-analysis was to evaluate the masking success of bleaching and/or resin infiltration treatment of fluorotic lesions in anterior teeth of adults and adolescents. DATA SOURCES: PubMed, Cochrane Library, and Embase were systematically searched from the beginning of documentation to December 31, 2023. PRIMARY OUTCOME WAS THE NUMBER OF MASKED TEETH: A tooth was considered masked when the color difference (ΔE CIE76) between fluorotic areas and the surrounding sound enamel was ≤3.7 and unmasked if ΔE > 3.7. Secondary outcomes were mean ΔE values between fluorotic and sound enamel reported for a treatment group at baseline and after any intervention as well as patient satisfaction. STUDY SELECTION: Of 1575 search results 4 publications met the inclusion criteria, comprising 230 treated anterior teeth with fluorosis in 47 patients. Meta-analyses were performed comparing the result after treatment (bleaching, resin infiltration, or bleaching followed by resin infiltration) to baseline. RESULTS: Bleaching and resin infiltration were suitable intervention strategies to improve the esthetics of fluorosis affected anterior teeth, with a combination of both treatment approaches being particularly effective in reducing the color difference between fluorotic defects and the surrounding sound enamel below the acceptability thresholds of 3.7 (success rate [95 %CI]: 0.75 [0.44, 1.06]). Patient satisfaction increased after treatments, indicating a beneficial impact on their mental health. The overall bias of the included studies was 2.5 (ROBINS-I analysis tool). CONCLUSION: There is evidence that resin infiltration with preceding bleaching therapy is more effective in masking fluorotic lesions in anterior teeth than bleaching alone. The combination therapy also showed a tendency towards higher success rates compared to infiltration alone. However, this difference was statistically not significant, and more studies are needed to further assess the efficacy of specific treatments and their combinations as well as the certainty in the evidence. The methodologic heterogeneity of study designs regarding estimation of color difference before and after treatment and bleaching protocols calls for unification in future studies. CLINICAL SIGNIFICANCE: Results of this systematic review and meta-analysis revealed the combination of bleaching followed by resin infiltration as efficacious approach for masking fluorotic lesions in young adults. While resin infiltration alone improves the aesthetic appearance of fluorotic lesions, dentists should consider a combined bleaching-infiltration regimen to achieve more favorable clinical outcome for their patients.

Clinical SWIR and CP-OCT imaging of interproximal lesions.

BACKGROUND: Enamel is highly transparent at short wavelength infrared imaging (SWIR) wavelengths allowing the detection of dental decay without the need for ionizing radiation. The purpose of this study was to use SWIR imaging methods including cross polarization optical coherence tomography (CP-OCT), occlusal transillumination (SWIR-OT), proximal transillumination (SWIR-PT), and occlusal reflectance (SWIR-R) to image interproximal lesions in vivo and compare the sensitivity with radiography. METHODS: Participants (n = 30) aged 18-80 each with a radiopositive interproximal lesion scheduled for restoration were enrolled in the study. Studies have shown that the opposing proximal surfaces across the contact will likely also have lesions. SWIR images were acquired of the adjoining teeth at each contact with an interproximal lesion scheduled for restoration. Lesion presence and depth were assessed on each side of the contact for radiography and each SWIR imaging method. Lesions on radiographs and in CP-OCT images were identified by a single examiner while lesions in SWIR images were identified by a contrast threshold via semi-automatic image segmentation. RESULTS: All SWIR imaging methods had significantly higher sensitivity (P < 0.05) than radiographs for the detection of interproximal lesions on the teeth opposite those restored. CP-OCT and SWIR-R imaging methods had significantly higher sensitivity than the other methods. SWIR imaging methods showed significantly higher lesion contrast than radiography. CONCLUSIONS: SWIR imaging methods can be used to detect interproximal lesions on posterior teeth with higher diagnostic performance than radiographs. CP-OCT appears well suited as a potential gold standard for the detection of interproximal lesions and assessment of their severity in vivo.

External validation of an artificial intelligence-based method for the detection and classification of molar incisor hypomineralisation in dental photographs.

OBJECTIVES: This ex vivo diagnostic study aimed to externally validate an open-access artificial intelligence (AI)-based model for the detection, classification, localisation and segmentation of enamel/molar incisor hypomineralisation (EH/MIH). METHODS: An independent sample of web images showing teeth with (n = 277) and without (n = 178) EH/MIH was evaluated by a workgroup of dentists whose consensus served as the reference standard. Then, an AI-based model was used for the detection of EH/MIH, followed by automated classification and segmentation of the findings (test method). The accuracy (ACC), sensitivity (SE), specificity (SP) and area under the curve (AUC) were determined. Furthermore, the correctness of EH/MIH lesion localisation and segmentation was evaluated. RESULTS: An overall ACC of 94.3 % was achieved for image-based detection of EH/MIH. Cross-classification of the AI-based class prediction and the reference standard resulted in an agreement of 89.2 % for all diagnostic decisions (n = 594), with an ACC between 91.4 % and 97.8 %. The corresponding SE and SP values ranged from 81.7 % to 92.8 % and 91.9 % to 98.7 %, respectively. The AUC varied between 0.894 and 0.945. Image size had only a limited impact on diagnostic performance. The AI-based model correctly predicted EH/MIH localisation in 97.3 % of cases. For the detected lesions, segmentation was fully correct in 63.4 % of all cases and partially correct in 33.9 %. CONCLUSIONS: This study documented the promising diagnostic performance of an open-access AI tool in the detection and classification of EH/MIH in external images. CLINICAL SIGNIFICANCE: Externally validated AI-based diagnostic methods could facilitate the detection of EH/MIH lesions in dental photographs.

Reliability of impedance spectroscopy versus digital radiograph and ICDAS-II in occlusal caries detection: a prospective clinical trial.

The traditional methods in early caries detection had many limitations. So, this study aimed to evaluate the clinical performance of alternating current impedance spectroscopy ACIST in comparison with digital radiograph and ICDAS-II in detection of occlusal carious lesions. Occlusal surfaces of molar and premolar teeth from 40 adult participants were examined by two observers using three diagnostic methods: (1) international caries detection and assessment system (ICDAS-II) (2) digital radiograph (DR) and (3) Cariescan Pro device (ACIST). Agreement analysis and the difference in sensitivities and specificities were evaluated. The results showed an excellent agreement in the different groups. The difference from the visual tactile against ACIST scoring for enamel caries detection, was statistically significant (p = 0.012) and the agreement was moderate (k = 0.509). For dentinal caries the difference was not statistically significant (p > 0.05) and the agreement was similarly moderate (k < 0.6). The difference from the digital radiograph against ACIST scoring, for enamel caries, digital radiography had significantly higher sensitivity and specificity than ACIST (p < 0.001) while for dentinal caries detection and overall, ACIST had higher sensitivity and digital radiography had higher specificity and the difference was statistically significant (p < 0.001). Visual-tactile examination is a considered as feasible and valid technique for occlusal caries detection, digital radiography is superior to ACIST in diagnosing enamel caries, but it could underestimate the caries depth, ACIST is a reliable tool for detecting occlusal caries in dentin.

Dual-species biofilm of Streptococcus mutans and Candida albicans produces subsurface caries lesions on bovine enamel.

OBJECTIVES: To develop a protocol for forming subsurface caries lesions on bovine enamel by dual-species biofilms of Streptococcus mutans and Candida albicans in vitro. DESIGN: Biofilms were grown on bovine enamel specimens in artificial saliva (AS) for seven days. After 24 h of formation, the AS was supplemented or not with fluoride (F) using sodium fluoride (0.005 or 0.008 ppm F), and the biofilms were exposed or not to a 20 % sucrose solution (reproducing a cariogenic challenge) once/day. On the seventh day, the biofilms were harvested and had their extracellular polysaccharides (EPS) and inorganic components analyzed. The specimens were subjected to computed X-ray microtomography analysis to determine their mineral concentration. Data were compared using two-way analyses of variance, followed by Fisher's LSD or Student-Newman-Keuls tests (p < 0.05). RESULTS: Biofilms exposed to the cariogenic challenge had significantly higher EPS concentrations than those not exposed, regardless of the presence of F. For biofilms grown with 0.008 ppm F, those exposed to the cariogenic challenge had lower F levels than those not exposed. For biofilms exposed to the cariogenic challenge, those grown with 0.008 ppm F had lower lesion depths and integrated mineral loss, and higher outer layers than those grown without F. CONCLUSIONS: The dual biofilm model assessed was able to create subsurface caries lesions in bovine enamel in vitro, which was influenced by the presence of F in the culture medium and exposure to sucrose.

The effect of silver diammine fluoride on In Vitro Enamel caries lesion remineralization and staining as a function of lesion baseline mineral distribution.

OBJECTIVES: to investigate whether baseline mineral distribution modulates the ability of silver diammine fluoride (SDF) to remineralize and stain enamel caries lesions. METHODS: This laboratory study followed a 3 [treatment: SDF/fluoride varnish (FV)/deionized water (DIW)] ×3 [lesion protocol: methylcellulose (MeC)/hydroxyethylcellulose (HEC)/Carbopol 907 (C907)] factorial design. Lesions were created in bovine enamel specimens (n = 20). Treatments were applied and lesions remineralized in artificial saliva. Digital transverse microradiography (TMR-D) was used to analyze lesions. Lesion color was monitored spectrophotometrically. The effects of lesion protocol and treatment on changes in lesion depth (ΔLD), mineral loss (ΔΔZ), maximum mineral density at the surface zone (ΔSZmax), and color changes related to remineralization (ΔL*remin) were analyzed using two-way ANOVA. RESULTS: The treatment×lesion protocol interaction was significant for ΔΔZ (p < 0.01) and ΔL*remin (p < 0.01), however not for ΔLD (p = 0.23) or ΔSZmax (p = 0.91). There were no differences in ΔΔZ between treatments in HEC and C907 lesions. However, DIW resulted in more remineralization than both SDF (p < 0.01) and FV (p = 0.01) in MeC lesions. Considering changes from lesion baseline after remineralization in MeC lesions, SDF treatment resulted in the highest mineral gain in the surface zone. However, DIW revealed the highest mineral gain after remineralization in the lesion body. SDF stained lesions with the intensity increasing after remineralization in C907 lesions, whereas staining decreased in MeC and HEC lesions. CONCLUSION: High fluoride treatments can interfere with continuous remineralization of caries lesions due to partial arrest. Baseline lesion mineral distribution affects SDF's ability to enhance remineralization and the staining caused by SDF. CLINICAL SIGNIFICANCE: SDF is being used to arrest active caries lesions extending into dentin and to treat dentin hypersensitivity. This study shed light on SDF's effect on an isolated process in dental caries only, remineralization. It achieved this by examining enamel caries lesions with differing mineral distributions and assessing their staining properties.

Proteomic profiling of human dental enamel affected by molar incisor hypomineralisation of different clinical severity grades: an in vitro study.

PURPOSE: The aim of this study was to explore the potential to profile and distinguish varying clinical severity grades of MIH, compared to normal enamel, using proteomics. METHODS: Liquid chromatography-mass spectrometry analyses were conducted on enamel samples of extracted teeth, from 11 children and adolescents, spanning an age range of 6-18 years. Enamel powder samples were collected from extracted, third molars (n = 3) and first permanent molars diagnosed with MIH (n = 8). The MIH tooth samples were categorized into subgroups based on clinical severity grade. The data were statistically analyzed using ANOVA and Welch's t test. RESULTS: Teeth affected by MIH exhibited a diverse array of proteins, each with different functions related to dental enamel, distinguishing them from their normal enamel counterparts. The application of microdissection combined with LC-MS techniques has revealed the potential to discern unique proteomic profiles among MIH-affected teeth, characterized by varying clinical severity grades. Both analyzed MIH groups displayed consistent trends in the presentation of biological processes, including underabundance of proteins primarily associated with cell organization and biogenesis. Furthermore, proteins linked to cell death were overabundant in both MIH groups. CONCLUSION: Proteomics enabled the detection and differentiation of various proteins across different clinical severity grades of MIH.

Clinical, Radiographic, and Histological Changes in Enamel and Dentin, According to Caries Care International™ Evaluation, In Permanent Posterior Teeth: An Observational Study / Cambios Clínicos, Radiográficos e Histológicos en Esmalte y Dentina, Según Evaluación de Caries Care International™, en Dientes Posteriores Permanentes: Un Estudio Observacional

SUMMARY: CariesCare International ™ practical guide is a tool for the comprehensive assessment and treatment of caries that synthesizes clinical and radiographic diagnosis and risk factors, classifying the severity, progression, and activity of lesions. The objective of this study was to analyze the validity and prediction characteristics of the proposed dental caries classification in the CariesCare International ™ practical guide as a reference through clinical and radiographic evaluation versus histological evaluation. Ninety-seven permanent posterior teeth were evaluated, and clinical and radiographic diagnoses were determined according to parameters defined in the CariesCare International™ guide as a reference. Subsequently, histological evaluation was performed to compare each stage of dental caries progression, and statistical analysis was applied. When comparing the validity and prediction values between radiographic and clinical diagnoses in relation to histological evaluation, a low sensitivity and high specificity relationship was found. The sensitivity and specificity percentages between the clinical and radiographic methods show that the clinical method has a lower number of false negatives. Histological changes in dental tissue were evident from the earliest stages of lesions, even in those not related to the caries process, indicating that the dentist should be careful when deciding on a treatment plan and take into account all variables involved in the caries process, as proposed by the CariesCare International ™ guide.

La guía práctica CariesCare International™ es una herramienta para la evaluación y tratamiento integral de la caries que sintetiza el diagnóstico clínico y radiográfico y los factores de riesgo, clasificando la gravedad, progresión y actividad de las lesiones. El objetivo de este estudio fue analizar la validez y características de predicción de la clasificación de caries dental propuesta en la guía práctica CariesCare International™ como referencia a través de la evaluación clínica y radiográfica versus la evaluación histológica. Se evaluaron noventa y siete dientes posteriores permanentes y se determinaron diagnósticos clínicos y radiográficos según parámetros definidos en la guía CariesCare International™ como referencia. Posteriormente se realizó una evaluación histológica para comparar cada etapa de progresión de la caries dental y se aplicó análisis estadístico. Al comparar los valores de validez y predicción entre los diagnósticos radiológicos y clínicos en relación con la evaluación histológica, se encontró una relación de baja sensibilidad y alta especificidad. Los porcentajes de sensibilidad y especificidad entre el método clínico y radiográfico muestran que el método clínico tiene un menor número de falsos negativos. Los cambios histológicos en el tejido dental fueron evidentes desde las primeras etapas de las lesiones, incluso en aquellas no relacionadas con el proceso de caries, lo que indica que el odontólogo debe tener cuidado al decidir un plan de tratamiento y tener en cuenta todas las variables involucradas en el proceso de caries, tal como propone la guía CariesCare International™.

Enamel Caries Lesion Depth Obtained by Optical Coherence Tomography and Transverse Microradiography: A Comparative Study.

INTRODUCTION: Visual imaging of subsurface caries lesions is of vital interest in dentistry, which can be obtained by invasive radiography technique as well as by available non-destructive imaging approaches. Thus, as a first step toward the development of a new innovative approach, Spectral-domain optical coherence tomography (SD-OCT) was applied to detect the lesion depth in comparison to the established reference technique (transverse microradiography [TMR]). METHODS: Bovine enamel specimens were demineralized for 5 days, following previous studies. For OCT, the resulting artificial lesions were scanned three-dimensionally (SD-OCT) and semi-automated measured (CarLQuant). For TMR, specimens were sectioned and the lesion depth was manually determined (Inspektor Research System). RESULTS: The range of lesion depth detected with OCT was 24.0-174.0 µm (mouth rinse study), 18.0-178.0 µm (toothpastes study) and with TMR 59.2-198.0 µm (mouth rinse study), 33.2-133.4 µm (toothpastes study). We found a strong correlation between both methods in terms of lesion depth (Spearman rankwith outlierp < 0.001, Rho = 0.75, Spearman rankwithout outlierp = 0.001, Rho = 0.79). The two methods produce similar results (Passing-Bablok regression, 1.16). As deeper is the lesion, the smallest is the difference between both methods as indicated by Bland-Altman-plots. CONCLUSION: Especially in the case of deep lesions, the values obtained by both methods are in agreement, and OCT can potentially substitute TMR to detect and assess lesion depth with the benefit of being non-destructive.

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.

The effect of combined use of resin infiltration with different bioactive calcium phosphate-based approaches on enamel white spot lesions: An in vitro study.

OBJECTIVES: This in vitro study aimed to evaluate the effect of resin infiltration combined with casein phosphopeptide-amorphous calcium phosphate with fluoride (CPP-ACPF) or bioactive glass (BAG) on the stability of enamel white spot lesions (WSLs) treatment. MATERIALS AND METHODS: Eighty-four enamel blocks were prepared from the buccal surfaces of sound human premolars. All enamel blocks were placed in a demineralisation solution for 3 days to establish the artificial enamel WSLs. Enamel blocks with WSLs were randomly divided into three groups (n = 28 each group): RI/B: one-off resin infiltration followed by twice daily BAG treatment; RI/C: one-off resin infiltration followed by twice daily CPP-ACPF treatment; RI: one-off resin infiltration treatment only (as control) and subjected to pH cycling for 7 days. Surface morphology, elemental analysis, crystal characteristics, surface roughness and microhardness of enamel surfaces were investigated by scanning electron microscopy and energy-dispersive spectrometry observation, X-ray diffraction (XRD), atomic force microscope and Vickers' hardness testing, respectively. RESULTS: Mean values of the surface roughness (mean±standard deviation (nm)) were 24.52±5.07, 27.39±5.87 and 34.36±4.55 for groups RI/B, RI/C and RI respectively (p = 0.003). The calcium to phosphate ratios were 1.32±0.16, 1.22±0.26 and 0.69±0.24 for groups RI/B, RI/C and RI respectively (p < 0.001). XRD revealed apatite formation in all three groups. The mean enamel surface microhardness (kg/mm2) of the groups were 353.93±28.49, 339.00±27.32 and 330.38±22.55 for groups RI/B, RI/C and RI respectively (p = 0.216). CONCLUSIONS: Resin infiltration combined with CPP-ACPF or BAG remineralisation appears to improve the surface properties of WSLs. CLINICAL SIGNIFICANCE: The combination of resin infiltration and CPP-ACPF/BAG remineralisation may be a potential treatment for the management of the WSLs.