Comparative Assessment of Marginal Micro Leakage of Different Esthetic Restorative Materials Used on Primary Teeth: An In-vitro Study.

AIM: The aim of the current investigation was to evaluate the marginal microleakage of various esthetic restorative materials applied to primary teeth. MATERIALS AND METHODS: A total of 75 noncarious primary molars that were removed for orthodontic intervention and teeth nearing exfoliation were chosen. One millimeter (mm) above the cementoenamel junction, on the buccal surface of the teeth, Class V cavities were prepared. William's graded periodontal probe was used to standardize cavity preparation on all teeth. 3 mm was the cavity's length, 2 mm in width, and 2 mm in depth. The teeth were then divided into three groups (25 samples in each group) according to the type of esthetic restorative material used. Group I: Resin-modified glass ionomer cement, Group II: Ormocer, Group III: Giomer. The samples underwent 500 cycles of thermocycling, with an immersion time of 60 seconds and a well time of 15 seconds, between 5 and 55°C. The samples were submerged in methylene blue dye for 24 hours at room temperature and dried. The samples were then divided into sections and examined with a stereomicroscope. Data was recorded and statistically analyzed. RESULTS: The least marginal microleakage was found in the ormocer group (1.22 ± 0.01) followed by resin-modified glass ionomer cement group (1.31 ± 0.07) and the giomer group (1.78 ± 0.03). There was a highly statistically significant difference found between resin-modified glass ionomer cement group and the ormocer group, resin-modified glass ionomer cement group and giomer group. And no significant difference was found between the ormocer group and the giomer group. CONCLUSION: The present study concluded that there was some amount of microleakage in primary teeth in all restorative materials examined in this in-vitro investigation. However, the marginal sealing ability of ormocer was found highest compared to resin-modified glass ionomer cement and Giomer materials. CLINICAL SIGNIFICANCE: The primary reason dental restorations fail, particularly in Class V cavities, is microleakage since the margins of these restorations are typically found in the dentin or cementum. Assessing microleakage is a crucial step in determining the marginal integrity of restorative materials. Developing methods and resources that reduce the adverse effects caused by the restorative marginal seal failing would benefit from this. How to cite this article: Al Ghwainem A, Alqarni AS. Comparative Assessment of Marginal Micro Leakage of Different Esthetic Restorative Materials Used on Primary Teeth: An In-vitro Study. J Contemp Dent Pract 2024;25(1):58-61.

Radiographic assessment of the relationship between root canal treatment quality, coronal restoration quality, and periapical status.

OBJECTIVE: The aim of this cross-sectional study was to assess the prevalence of apical periodontitis in root canal treated teeth in Turkish subpopulation and to evaluate the effects of both coronal restoration quality and root canal treatment (RCT) quality on apical periodontitis. MATERIALS AND METHODS: Panoramic images of individuals who applied to our department for different diagnostic reasons were randomly and retrospectively scanned. Total RCT number, RCT quality, type of coronal restoration, restoration quality, periapical status, and total number of teeth were recorded. The criteria used for coronal restorations quality and RCT quality were defined by De Moor et al. and slightly modified by Gunduz et al. Periapical status was assessed by the periapical index developed by Orstavik et al. Pearson's Chi-square test was used for statistical analysis, and the intraobserver agreements were assessed by Kappa coefficients. Values of P < 0.05 were accepted to be meaningful. RESULTS: The total examined teeth number was 6064, of which had 541 (8.9%) RCT. The prevelance of apical periodontitis was 40.5%. The number of adequate RCT was 178 (32.9%), and 138 (77.5%) of them were healthy. The number of adequate coronal restoration was 334, and 62.3% of them were healthy. For the cases that have adequate coronal restorations, there was statistically significant relationship between adequate RCT and periapical status (P < 0.001). CONCLUSION: The prevelance of apical periodontitis was 40.5% and there was statistically significant relationship between adequate RCT and periapical status.

Assessment of enamel cracks at adhesive cavosurface margin using three-dimensional swept-source optical coherence tomography.

OBJECTIVES: Swept-source optical coherence tomography (SS-OCT) can construct cross-sectional images of internal biological structures. The aim of this study was to evaluate enamel cracks at the cavosurface margin of composite restorations using SS-OCT. METHODS: Bowl-shaped cavities were prepared at two locations (mid-coronal and cervical regions) on the enamel surface of 60 bovine teeth. Half of the cavities (30) were treated with phosphoric acid gel. A two-step self-etch adhesive (Clearfil SE Bond) was applied to all cavities and a flowable composite was placed in bulk. After 7days in water at 37°C, three-dimensional (3D) images of the specimens were obtained using SS-OCT, and cross-sectional views of the cavosurface margin were examined. Presence and extent of enamel cracks along the cavosurface margin circumference were evaluated using a 5-point scale. The results were statistically compared with Wilcoxon rank sum test with Bonferroni correction. RESULTS: 3D SS-OCT could detect enamel cracks at the cavosurface margin of composite restorations. Cervical regions caused more enamel cracking than mid-coronal regions. Phosphoric acid etching increased the incidence of enamel cracks compared with the preparations without etching. CONCLUSION: SS-OCT can be used to detect enamel cracks at the margins of composite restorations noninvasively. Presence and extent of enamel cracks depended on the enamel region and bonding protocol. CLINICAL SIGNIFICANCE: SS-OCT can be used to detect enamel cracks at the margins of composite restorations noninvasively. Selective phosphoric acid etching of the enamel significantly increased the incidence of marginal cracks, especially in cervical preparation.

In vitro assessment of retention and resistance failure loads of two preparation designs for maxillary anterior teeth.

STATEMENT OF PROBLEM: Parallel labiolingual walls and the preservation of the cingulum in anterior tooth preparations have been advocated. However, their contribution to retention and resistance form has not been evaluated. PURPOSE: The purpose of this in vitro study was to evaluate the retention and resistance failure loads of 2 preparation designs for maxillary anterior teeth. MATERIAL AND METHODS: Forty metal restorations were fabricated and paired with 40 cobalt-chromium prepared tooth analogs. Twenty of the specimens had parallel buccolingual walls at the cervical part (group PBLW; the control group), whereas the remaining 20 had converging buccolingual walls (group CBLW; the experimental group). The restorations were cemented to the tooth analogs with a resin-modified glass ionomer luting agent. Ten specimens from each group were subjected to tensile loading with a universal testing machine; the rest were subjected to compression loading until failure. Descriptive statistics and the independent t test (α=.05) were used to determine the effect of failure loads in the tested groups. RESULTS: The independent t test revealed statistically significant differences between the tested groups in tensile loading (P<.001) and in compressive loading (P<.001). The PBLW group presented a higher tensile failure load than the CBLW. On the contrary, the PBLW group presented a smaller compression failure load than the CBLW. CONCLUSIONS: Parallelism of the buccolingual axial walls in anterior maxillary teeth increased the retention form but decreased the resistance form.

Atraumatic Restorative Treatment compared to the Hall Technique for occluso-proximal cavities in primary molars: study protocol for a randomized controlled trial.

BACKGROUND: In many parts of the world, school-age children have high dental treatment needs; however, there is often low, or no, dental care provision. Although Atraumatic Restorative Treatment (ART) was developed to address this, its survival rate in occluso-proximal lesions is low. An alternative, the Hall Technique (HT) has shown better relative outcomes for occluso-proximal lesions, but has not been directly compared to ART or tested in field settings. This trial will compare ART and the HT for the most clinically- and cost-effective strategy for managing occluso-proximal lesions in primary molars, in a school setting, using low-technology and child-friendly dental techniques. METHODS/DESIGN: This two-arm, parallel group, patient-randomized controlled, superiority trial will have treatment provided in schools. Schoolchildren (n = 124, age 6-8) with at least one occluso-proximal carious primary molar lesion will have random allocation to treatment with ART or HT. Baseline measures and outcome data will be assessed through participant report, clinical examination and parent report/questionnaires. The primary outcome is survival rate, a composite measure of absence of Minor Failures (a defect in the restoration/crown, but not interfering with tooth health) and Major Failures (signs or symptoms of irreversible pulp damage, such as dental fistula/abscess, tooth fracture or failures that cannot be repaired). Secondary outcomes are: (1) child-reported discomfort, (2) childrens' and (3) parents' concerns around dental appearance and (4) acceptability of treatments, (5) occlusal-vertical dimensions (OVD) changes, (6) plaque index, (7) gingival health, (8) decayed, missing, filled teeth in permanent teeth (DMFT)/decayed, missing, filled teeth in primary teeth (dmft), (9) oral health-related-quality of life, reported by children and parents/caregivers, (10) the incremental cost-effectiveness, and (11) operator effect. A trained and calibrated examiner will evaluate the treated teeth after 1 week, then 1, 6, 12, 24 and 36 months post treatment. Kaplan-Meier and Cox regression tests will be used to investigate the primary outcome. The Mann-Whitney or t test, Friedman test, paired t test or Wilcoxon test and Ordinal Logistic Regression Analysis will be used to analyze the secondary outcomes. DISCUSSION: The results of this trial will support decision-making by clinicians and policy-makers for managing occluso-proximal lesions in settings with constrained resources and limited dental access. TRIAL REGISTRATION: www.clinicaltrials.gov, NCT02569047 , registered 5 October 2015.

Can dual-energy CT improve the assessment of tumor margins in oral cancer?

OBJECTIVES: The aim was to investigate the image quality of dual-energy computed-tomography (DECT) compared to single-energy images at 80 kV and 140 kV in oral tumors. MATERIALS AND METHODS: Forty patients underwent a contrast-enhanced DECT scan on a definition flash-CT. Four reconstructions (80 kV, 140 kV, mixed (M), and optimum-contrast (OC)) were assessed by four blinded readers for subjective image quality (10-point scale/10=best). For objective quality assessment, linear attenuation measurements (line density profiles (LDP)) were positioned at the tumor margin, and the difference between minimum and maximum was calculated. Signal-to-noise ratios (SNR) were measured in the tongue. RESULTS: The mean image quality for all readers was 5.1±0.3, 8.4±0.3, 8.1±0.2, and 8.3±0.2 for the 140 kV, 80 kV, M, and OC, respectively (P<001 between 140 kV and all others). The mean difference between the minimum and maximum within the LDP was 139.4±59.0, 65.7±29.5, 105.1±46.5, and 118.7±59.4 for the 80 kV, 140 kV, M, and OC, respectively (P<001). The SNR for the tongue was 3.8±2.1, 3.8±2.1, 4.2±2.4, and 4.1±2.3 for the 80 kV, 140 kV, M, and OC, respectively. DISCUSSION: DECT of oral tumors offers high image quality, with subjectively rated image quality and attenuation contrast at the tumor margin similar to that of 80 kV; DECT, however, provides a significantly higher SNR compared to 80 kV.

Use of Oral Chroma™ in the assessment of volatile sulfur compounds in patients with fixed protheses.

Prosthetic rehabilitation improves the patient's quality of life and oral health. The purpose of the present study was to assess the production of volatile sulfur compounds (VSCs) using Oral Chroma™ in patients wearing provisional and permanent fixed prosthesis, who were treated or not, with supportive non-surgical periodontal therapy. A total of 10 healthy patients not affected by periodontal disease and who needed the restoration of at least two edentulous single sites were included in the present study. Registrations of VSCs were carried out with a Gas Chromatograph OralChroma™ (Oral Chroma™, Abimedical, Abilit Corp., Osaka, Japan) one month after placement of the provisional restoration (group 1) and one month after placement of the final restoration (group 3). After each measurement, professional oral hygiene was carried out both on patients with provisional (group 2) and permanent prostheses (group 4) and VSC values were registered. The results showed that there were no statistical significant differences in the VSC quantity between groups with temporary or permanent prostheses. Meanwhile, statistically significant differences were found in VCS values between groups before and after the professional health care session (p less than 0.05). Also it was observed that dimethyl sulphide (CH3)2S was present in all the study groups. The present preliminary study suggests that OralChroma™ produce a comprehensive assessment of VSC in the clinical diagnosis of halitosis and that professional oral hygiene seems to influence VSC production. However, further clinical long-term studies with a larger sample size are necessary for a better understanding of halitosis manifestation in patients wearing provisional and permanent fixed prosthesis.

Dental fracture and chocolate candies: case report.

A complaint by a customer to a food company claimed that the consumption of a chocolate candy fractured his anterior teeth, due to its hard consistency. Fragments of the fractured teeth and the chocolate candy that supposedly caused it were collected, examined and photographed. Fragments presented caries, large restorations, and suggested previous endodontic treatment. To evaluate causation, the food company requested a laboratory analysis, which simulated the human bite on chocolate candies of the same brand. Human teeth were assembled in a simulating device of masticatory functions of apprehension and incision. Teeth used were either sound or with non-restored endodontic accesses, to simulate previous conditions of the collected fragments. Twenty chocolate candies, cooled in a freezer to 0 °C for 2 h were used as test foods, and were positioned between the teeth of the device at the moment of the test. The set was put in a dynamometer, programmed to apply increasing forces (rate of advance of 5 mm/min), until rupture (either of the specimen or of the teeth). The applied force, in N, at the time of fracture was recorded and analyzed. The average force to fracture the test food was 233.23 N. No tooth was fractured in the experiment. Forces ranging from 191.3 to 275.2 N, applied to chocolate candies were not sufficient to neither fracture human teeth nor cause any structural damage. It was concluded that the dental fracture occurred because of previous oral health conditions of the customer.

Reliance on social security benefits by Swedish patients with ill-health attributed to dental fillings: a register-based cohort study.

BACKGROUND: Some people attribute their ill health to dental filling materials, experiencing a variety of symptoms. Yet, it is not known if they continue to financially support themselves by work or become reliant on different types of social security benefits. The aim of this study was to analyse reliance on different forms of social security benefits by patients who attribute their poor health to dental filling materials. METHODS: A longitudinal cohort study with a 13-year follow up. The subjects included were 505 patients attributing their ill health to dental restorative materials, who applied for subsidised filling replacement. They were compared to a cohort of matched controls representing the general population (three controls per patient). Annual individual data on disability pension, sick leave, unemployment benefits, and socio-demographic factors was obtained from Statistics Sweden. Generalized estimating equations were used to test for differences between cohorts in number of days on different types of social security benefits. RESULTS: The cohort of dental filling patients had a significantly higher number of days on sick leave and disability pension than the general population. The test of an overall interaction effect between time and cohort showed a significant difference between the two cohorts regarding both sick leave and disability pension. In the replacement cohort, the highest number of sick-leave days was recorded in the year they applied for subsidised replacement of fillings. While sick leave decreased following the year of application, the number of days on disability pension increased and peaked at the end of follow-up. CONCLUSIONS: Ill health related to dental materials is likely to be associated with dependence on social security benefits. Dental filling replacement does not seem to improve workforce participation.

Risk management in clinical practice. Part 8. Temporomandibular disorders.

Temporomandibular disorders can arise apparently idiopathically, as a result of macro-trauma or micro-trauma such as parafunction, as a result of a separate disease process or as a consequence of dental treatment. The objectives of this chapter are to make the practitioner aware of his/her responsibilities in any of these situations. Precise record keeping and careful risk management are essential. Guidelines are given to protect not only the practitioner but also the patient.

Survey of accidental ingestion and aspiration at Tokyo Dental College Chiba Hospital.

The occurrence of accidental ingestion/aspiration and preventive measures were investigated at Tokyo Dental College Chiba Hospital. In addition, the characteristics of accidents at our hospital were analyzed by surveying the awareness of accidental ingestion/aspiration to utilize the data for prevention. Accidental ingestion accounted for about 30% of accidents that occurred at our hospital in fiscal 2008, but all ingested items were naturally excreted, and no accidental aspiration occurred. Accidental ingestion most frequently occurred when dental restorations were removed. Inlays and crowns were most frequently ingested, and dentists with 5 to less than 10 years of clinical experience tended to be involved in these accidents. According to the results of the questionnaire, removal of restorations was perceived as the treatment least likely to cause accidental ingestion/aspiration. Moreover, dentists who always took preventive measures against accidental ingestion/aspiration accounted for only 40% or less on average. To avoid accidental ingestion/aspiration, repeated courses and individual instruction for repeaters and the establishment of a surveillance system along with manuals to manage the violation should be emphasized.

Risk management in endodontics.

INTRODUCTION: Endodontic claims are the most frequently filed malpractice claims in dentistry. The aim of this study was to categorize and review errors and complications related to endodontic procedures that resulted in legal actions against the treating practitioner. METHODS: All dental malpractice complaints reported to the Medical Consultants International Company (MCI) in Israel between the years 1992-2008 were retrospectively analyzed according to a structured form. All complaints were categorized as either financial risk bearing (eg, justified) or financial non-risk bearing (eg, nonjustified). The treatment errors that were found in the files were categorized according to phases of treatment: preoperative, intraoperative, and postoperative errors. RESULTS: A total of 720 complaints were analyzed including 520 complaints (72.2%) that were found to be justified and 200 complaints (27.8%) that were judged as not justified. Most of the treatment errors occurred during the intraoperative phase. In lower anterior teeth and in cases involving more than 1 tooth, significantly more errors were found during instrumentation and root canal filling (P < .05). There was a similar distribution of operator errors and of negative outcomes for teeth with elective endodontic treatment and teeth with endodontic treatment as a result of a pathologic process. CONCLUSIONS: The technical skills of the dental practitioners performing root canal treatments require improvement. All possible risks and complications should be considered and explained to the patient before treatment.

Exposure to dental amalgam restorations in pregnant women.

OBJECTIVES: The Norwegian Mother and Child Cohort Study (MoBa) started in 1999 to identify environmental factors that could be involved in mechanisms leading to disease. Questions have been raised about potential risks to the fetus from prenatal exposure to mercury from amalgam fillings in pregnant women. The aim of the present study was to identify factors potentially associated with amalgam fillings in pregnant women participating in the Norwegian Mother and Child Cohort Study (MoBa). An additional aim was to obtain information about dental treatment in the cohort. METHODS: Total of 67,355 pregnancies from the MoBa study were included in the present study. Information regarding age, education, smoking habits, alcohol consumption, weight, and height for the women was obtained from a questionnaire that was filled in at the 17th week of pregnancy. In another questionnaire, which was sent to all participants in the 30th week of pregnancy, the women reported types of dental treatment during pregnancy, total number of teeth, and number of teeth with amalgam fillings. The self-assessed number of teeth and number of teeth with amalgam fillings were validated in an external sample of 97 women of childbearing age. RESULTS: Odds ratio for having more than 12 teeth with amalgam fillings increased considerably with age. Other significant risk factors for having high exposure to amalgam were low education, high body mass index (BMI), and smoking during pregnancy. Women with the lowest levels of education had a twofold increased odds ratio of having more than 12 teeth filled with amalgam compared with women who had more than 4 years of university studies. According to the results from the validation of self-assessed number of teeth with amalgam fillings, the information obtained was reliable. CONCLUSION: Age, education, smoking habits, and BMI were associated with amalgam exposure.

Treatment of health complaints attributed to amalgam.

The aim of the present study was to compare the reduction of subjective complaints by 3 treatment strategies in 90 "amalgam patients" whose complaints could not be explained by a medical or psychological disorder. The individuals were randomly assigned either to removal of dental amalgam only (removal group), or removal in combination with a "biological detoxification" therapy with high doses of vitamins and trace elements (removal-plus group), or participation in a health promotion program without removal of dental amalgam (no-removal group). Between baseline and month 12, the sum score of main complaints decreased by 3.5 (SD=2.2) points on average in the removal group as well as in the removal-plus group, and by 2.5 (SD=2.4) points in the no-removal group (p=0.152). Both removal groups showed a significant decrease in steady-state levels of inorganic mercury compared with the no-removal group. Thus, all 3 interventions were associated with clinically relevant improvements.

Clinical assessment of postoperative sensitivity in posterior composite restorations.

This incidence of postoperative sensitivity was evaluated in resin-based posterior restorations. Two hundred and ninety-two direct restorations were evaluated in premolars and molars. A total of 143 Class I and 149 Class II restorations (MO/OD and MOD) were placed in patients ranging in age from 30 to 50 years. After the cavity preparations were completed, a rubber dam was placed, and the preparations were restored using a total-etch system (Prime & Bond NT) and a resin-based restorative material (TPH Spectrum). The patients were contacted after 24 hours and 7, 30 and 90 days postoperatively and questioned regarding the presence of sensitivity and the stimuli that triggered that sensitivity. The Chi-square and Fisher's Exact Test were used for statistical analysis. Evaluation at 24 hours after restorative treatment revealed statistically significant differences among the types of cavity preparations restored and the occurrence of postoperative sensitivity (p = 0.0003), with a higher frequency of sensitivity in Class II MOD restorations (26%), followed by Class II MO/DO (15%) and Class I restorations (5%). At 7, 30 and 90 days after restorative treatment, there was a decrease in the occurrence of sensitivity for all groups. The percentage of sensitivity among the groups was not significantly different. This study shows that the occurrence of sensitivity is correlated with the complexity of the restoration.

Benefícios de um trinamento participativo no julgamento de restaurações de amálgama / Benefits of a participative training for amalgam restoration assessment

A variação no julgamento clínico das restaurações é um problema que afeta a maioria dos profissionais, resultando em prejuízos biológico e financeiro. Este trabalho teve como objetivo avaliar um programa de treinamento participativo para padronização de critérios na avaliação de restaurações de amálgama. Um grupo de cinco professores de Clínica Integrada de um Curso de Odontologia avaliou 28 dentes permanentes extraídos contendo restaurações de amálgama, antes e após a participação num programa de treinamento. Foram utilizados os exames visual e radiográfico e a avaliação final foi agrupada em quatro categorias de julgamento: satisfatória, necessita de substituição total, necessita de substituição parcial ou necessita de acabamento e polimento, com justificativa da opção feita. O programa de treinamento foi constituído de quatro sessões quinzenais: fundamentação teórica, calibração com slides, calibração com dentes extraídos e elaboração da tabela de critérios. Os resultados mostraram um aumento após o treinamento tanto no nível de concordância inter-examinadores (índice kappa) como no nível de acurária em relação ao padrão ouro (validade), e estes se mantiveram, mesmo decorridos cinco meses após o término do programa de trinamento. Estes resultados sinalizam a possibilidade da utilização desta metodologia para outras calibrações e outros grupos

In vitro embryotoxicity assessment with dental restorative materials.

OBJECTIVES: Resin (co)monomers may be released from restorative dental materials and can diffuse into the tooth pulp or the gingiva, and can reach the saliva and the circulating blood. Genotoxic potential of some dental composite components has been clearly documented. The genotoxic effects of xenobiotics can represent a possible step in tumor initiation and/or embryotoxicity/teratogenesis. A modified fluorescent mouse embryonic stem cell test (R.E.Tox) was used to test the embryotoxic potential of following dental restorative materials: Bisphenol A glycidylmethacrylate (BisGMA), urethanedimethacrylate (UDMA), hydroxyethylmethacrylate (HEMA), and triethyleneglycoldimethacrylate (TEGDMA), as well as some of their metabolic intermediates 2,3-epoxy-2-methyl-propionicacid-methylester (EMPME), methacrylic acid (MA), and 2,3-epoxy-2-methylpropionic acid (EMPA). METHODS: Mouse embryonic stem (ES) cells stably transfected with a vector containing the gene for the green fluorescent protein under control of the cardiac alpha-myosin heavy chain promoter were differentiated in the presence of various concentrations of the test compounds for 12 days. Fluorescence was measured using the TECAN Safire and values were expressed as percent of control values. To distinguish between cytotoxic and embryotoxic effects, all compounds were tested in a standard MTT assay. RESULTS: HEMA, TEGDMA and EMPME did not influence the differentiation process of ES cells towards cardiac myocytes. No cytotoxic effects were observed at any of the concentration levels tested. Exposure to BisGMA resulted in a 50% decrease in cell survival and a very strong inhibition of cell differentiation at 10(-5)M (p<0.01). Embryotoxic effects were also present at 10(-6) and 10(-7)M (p<0.05). EMPA induced a decrease in ES cell differentiation at 10(-5)M (p<0.01) without cytotoxic effects. No embryotoxic effects were induced at lower concentrations. Exposure to UDMA resulted in a slight decrease of cell differentiation at 10(-5)M (p<0.05). Exposure of cells to MA resulted in an increase of cardiac differentiation up to 150% (p<0.05) at 10(-5)M without cytotoxic effects. CONCLUSIONS: BisGMA induced a significant high embryotoxic/teratogenic effect over a large range of concentration. Therefore attention should be focused on this dental monomer, which should be investigated further by in vivo experiments.

Initial in vitro evaluation of DIAGNOdent for detecting secondary carious lesions associated with resin composite restorations.

OBJECTIVE: To assess the potential of DIAGNOdent (DD) readings for detecting secondary enamel and dentin carious lesions associated with resin composite restorations in a set of preserved extracted adult teeth. METHOD AND MATERIALS: Thirty test sites adjacent to resin composite restorations in 15 extracted teeth were evaluated visually and with DD readings for enamel and dentin caries. The results were compared to gold standard diagnosis determined by sectioning through each site and subsequent microscopic observation. Sensitivity, specificity, accuracy, and likelihood ratios at optimum threshold values for enamel and dentin caries were determined. Receiver operator characteristic (ROC) analysis was performed to compare visual and DD diagnostic methods. RESULTS: Histologic incidence of enamel caries was 20% and dentin caries was 36.67%. All composite restorations in the sample teeth fluoresced (range 5 to 22). For enamel caries detection with DD, the optimum threshold of > or = 26 produced a sensitivity of .67 and a specificity of .79. For dentin caries detection with DD, the optimum threshold of > or = 22 produced a sensitivity of .73 and a specificity of .84. ROC analysis showed that the DD readings do contain diagnostic information. DD readings for dentin caries diagnosis produced better diagnostic results compared to visual readings for the 30 test sites in the study, but these results were not significantly different. CONCLUSION: DIAGNOdent readings may have potential for resin composite secondary enamel and dentin carious lesion detection. DIAGNOdent instrument design factors and technique should be optimized to improve performance prior to clinical trial for this application.