Treatment outcome for dentin hypersensitivity with laser therapy: Systematic review and meta-analysis.

BACKGROUND: Laser protocols for the treatment of dentin hypersensitivity (DH) have not yet been studied systematically. OBJECTIVES: The present study aimed to review clinical trials on the treatment of DH with laser therapy through a systematic review and meta-analysis. MATERIAL AND METHODS: The search of electronic databases resulted in 562 publications up to April 2020. The inclusion criteria were studies carried out on humans and reporting on the treatment of DH with laser therapy. Case reports, literature reviews and systematic reviews were excluded. Selected by abstract, potentially eligible papers were read in full (n = 160). Independent examiners performed data extraction and the assessment of the risk of bias. RESULTS: A total of 34 studies were included in the analysis, and 11 in the quantitative analysis. It was observed that most studies followed up patients for a maximum of 6 months (55%). Through the meta-analysis, we observed statistically significant differences between the average pain before and after 3 months of treatment with highand low-power lasers. However, through indirect comparisons, it was observed that the high-power laser showed a greater tendency to reduce the pain levels after 3 months of treatment as compared to the low-power laser, but without a statistically significant difference. CONCLUSIONS: It was possible to conclude that regardless of the type of laser used in the treatment of DH, this treatment is an effective option for the control of pain symptoms. However, it was not possible to establish a defined treatment protocol, since the evaluation methods are very different from each other. Text for Rewiew and clinical cases.

Evaluation of photobiomodulation therapy to accelerate bone formation in the mid palatal suture after rapid palatal expansion: a randomized clinical trial.

To evaluate the efficiency of photobiomodulation therapy (PBMT) in the midpalatal suture (MPS) and pain sensation in patients undergoing rapid palatal expansion (RPE). Thirty-four individuals with the diagnosis of skeletal maxillary hypoplasia were divided in two groups: laser (n = 18) and control (n = 16). Treatment plan consisted of the use of the Hyrax expander in all patients. Subjects in the laser group were irradiated with diode laser (980 nm, 0.3 W) in six spots bilaterally distributed along the MPS for 10 s during the active phase of treatment and after overcorrection (passive phase of RPE). Control group received sham irradiations with the laser in standby mode to characterize the placebo effect. Digital occlusal radiographs were performed at different time-points for bone formation evaluation in both groups. The effects of laser irradiation on pain were assessed by the visual analog scale (Wong-Baker Faces Pain Scale). Bone formation between groups was not significantly different (p = 0.2273). At 3 months, bone formation was not yet complete in both groups. Pain sensation was similar between groups (p = 0.3940). However, pain was significantly higher for the first 7 days of treatment compared with the 14th day. PBMT did not accelerate bone regeneration in the MPS and pain sensation was similar.

The combined use of Er,Cr:YSGG laser and fluoride to prevent root dentin demineralization.

UNLABELLED: The use of erbium lasers to prevent caries in enamel has shown positive results. However, it is not known if Er,Cr:YSGG laser can also be used to increase acid resistance of root dentine, which is another dental tissue susceptible to the action of cariogenic bacteria. OBJECTIVE: To analyze the effects of the Er,Cr:YSGG laser (λ=2.78 µm, 20 Hz) irradiation associated with 2% neutral sodium fluoride (NaF) to prevent root dentin demineralization. MATERIAL AND METHODS: One hundred human root dentin samples were divided into 10 groups (G) and treated as follows: G1: no treatment; G2: NaF; G3: laser (4.64 J/cm2) with water cooling (WC=5.4 mL/min); G4: laser (4.64 J/cm2) without WC; G5: laser (8.92 J/cm2) with WC; G6: laser (8.92 J/cm2) without WC; G7: laser (4.64 J/cm2) with WC and NaF; G8: laser (4.64 J/cm2) without WC and NaF; G9: laser (8.92 J/cm2) with WC and NaF; G10: laser (8.92 J/cm2) without WC and NaF. The NaF gel was applied alone or after 4 min of irradiation. After 14 days of acid challenge, the samples were sectioned and the Knoop microhardness (KHN) test was done at different depths (30, 60, 90 and 120 µm) from the outer dentin surface. Data were analyzed by one-way ANOVA and Fisher's test (α=5%). RESULTS: The results showed that G8 and G10 presented higher KHN than the G1 for the depths of 30 and 60 µm, indicating an increase of the acid resistance of the dentin in up to 35% (p<0.05). CONCLUSIONS: The use of Er,Cr:YSGG laser irradiation at 4.64 J/ cm2 and 8.92 J/cm2 without water cooling and associated with 2% NaF can increase the acid resistance of human root dentin.

The combined use of Er, Cr: YSGG laser and fluoride to prevent root dentin demineralization

The use of erbium lasers to prevent caries in enamel has shown positive results. However, it is not known if Er,Cr:YSGG laser can also be used to increase acid resistance of root dentine, which is another dental tissue susceptible to the action of cariogenic bacteria. Objective: To analyze the effects of the Er,Cr:YSGG laser (λ=2.78 μm, 20 Hz) irradiation associated with 2% neutral sodium fluoride (NaF) to prevent root dentin demineralization. Material and Methods: One hundred human root dentin samples were divided into 10 groups (G) and treated as follows: G1: no treatment; G2: NaF; G3: laser (4.64 J/cm2) with water cooling (WC=5.4 mL/min); G4: laser (4.64 J/cm2) without WC; G5: laser (8.92 J/cm2) with WC; G6: laser (8.92 J/cm2) without WC; G7: laser (4.64 J/cm2) with WC and NaF; G8: laser (4.64 J/cm2) without WC and NaF; G9: laser (8.92 J/cm2) with WC and NaF; G10: laser (8.92 J/cm2) without WC and NaF. The NaF gel was applied alone or after 4 min of irradiation. After 14 days of acid challenge, the samples were sectioned and the Knoop microhardness (KHN) test was done at different depths (30, 60, 90 and 120 μm) from the outer dentin surface. Data were analyzed by one-way ANOVA and Fisher’s test (α=5%). Results: The results showed that G8 and G10 presented higher KHN than the G1 for the depths of 30 and 60 μm, indicating an increase of the acid resistance of the dentin in up to 35% (p<0.05). Conclusions: The use of Er,Cr:YSGG laser irradiation at 4.64 J/ cm2 and 8.92 J/cm2 without water cooling and associated with 2% NaF can increase the acid resistance of human root dentin. .

Microleakage in conservative cavities varying the preparation method and surface treatment.

OBJECTIVE: To assess microleakage in conservative class V cavities prepared with aluminum-oxide air abrasion or turbine and restored with self-etching or etch-and-rinse adhesive systems. MATERIALS AND METHODS: Forty premolars were randomly assigned to 4 groups (I and II: air abrasion; III and IV: turbine) and class V cavities were prepared on the buccal surfaces. Conditioning approaches were: groups I/III - 37% phosphoric acid; groups II/IV - self-priming etchant (Tyrian-SPE). Cavities were restored with One Step Plus/Filtek Z250. After finishing, specimens were thermocycled, immersed in 50% silver nitrate, and serially sectioned. Microleakage at the occlusal and cervical interfaces was measured in mm and calculated by a software. Data were subjected to ANOVA and Tukey's test (α=0.05). RESULTS: Marginal seal provided by air abrasion was similar to high-speed handpiece, except for group I. There was SIGNIFICANT difference between enamel and dentin/cementum margins for to group I and II: air abrasion. The etch-and-rinse adhesive system promoted a better marginal seal. At enamel and dentin/cementum margins, the highest microleakage values were found in cavities treated with the self-etching adhesive system. At dentin/cementum margins, high-speed handpiece preparations associated with etch-and-rinse system provided the least dye penetration. CONCLUSION: Marginal seal of cavities prepared with aluminum-oxide air abrasion was different from that of conventionally prepared cavities, and the etch-and-rinse system promoted higher marginal seal at both enamel and dentin margins.

Microleakage in conservative cavities varying the preparation method and surface treatment

OBJECTIVE: To assess microleakage in conservative class V cavities prepared with aluminum-oxide air abrasion or turbine and restored with self-etching or etch-and-rinse adhesive systems. Materials and Methods: Forty premolars were randomly assigned to 4 groups (I and II: air abrasion; III and IV: turbine) and class V cavities were prepared on the buccal surfaces. Conditioning approaches were: groups I/III - 37 percent phosphoric acid; groups II/IV - self-priming etchant (Tyrian-SPE). Cavities were restored with One Step Plus/Filtek Z250. After finishing, specimens were thermocycled, immersed in 50 percent silver nitrate, and serially sectioned. Microleakage at the occlusal and cervical interfaces was measured in mm and calculated by a software. Data were subjected to ANOVA and Tukey's test (α=0.05). RESULTS: Marginal seal provided by air abrasion was similar to high-speed handpiece, except for group I. There was SIGNIFICANT difference between enamel and dentin/cementum margins for to group I and II: air abrasion. The etch-and-rinse adhesive system promoted a better marginal seal. At enamel and dentin/cementum margins, the highest microleakage values were found in cavities treated with the self-etching adhesive system. At dentin/cementum margins, high-speed handpiece preparations associated with etch-and-rinse system provided the least dye penetration. CONCLUSION: Marginal seal of cavities prepared with aluminum-oxide air abrasion was different from that of conventionally prepared cavities, and the etch-and-rinse system promoted higher marginal seal at both enamel and dentin margins.

Chemical and morphological features of dental composite resin: influence of light curing units and immersion media.

AIMS: The study evaluated the influence of light curing units and immersion media on superficial morphology and chemistry of the nanofilled composite resin Supreme XT (3M) through the EDX analysis and SEM evaluation. Light curing units with different power densities and mode of application used were XL 3000 (480 mW/cm(2)), Jet Lite 4000 Plus (1230mW/cm(2)), and Ultralume Led 5 (790 mW/cm(2)) and immersion media were artificial saliva, Coke((R)), tea and coffee, totaling 12 experimental groups. Specimens (10 mm x 2 mm) were immersed in each respective solution for 5 min, three times a day, during 60 days and stored in artificial saliva at 37 degrees C +/- 1 degrees C between immersion periods. Topography and chemical analysis was qualitative. FINDINGS: Groups immersed in artificial saliva, showed homogeneous degradation of matrix and deposition of calcium at the material surface. Regarding coffee, there was a reasonable chemical degradation with loss of load particles and deposition of ions. For tea, superficial degradation occurred in specific areas with deposition of calcium, carbon, potassium and phosphorus. For Coke((R)), excessive matrix degradation and loss of load particles with deposition of calcium, sodium, and potassium. CONCLUSION: Light curing units did not influence the superficial morphology of composite resin tested, but the immersion beverages did. Coke((R)) affected material's surface more than did the other tested drinks.

Effect of Er:YAG laser parameters on ablation capacity and morphology of primary enamel.

OBJECTIVE: The purpose of this study was to evaluate the ablation capacity of different energies and pulse repetition rates of Er:YAG laser energy on primary molar enamel, by assessing mass loss and by analyzing the surface morphology with scanning electron microscopy. BACKGROUND DATA: Previous studies have demonstrated the capacity of the Er:YAG laser to ablate enamel substrate. METHODS: Forty-two sound primary molars were bisected in a mesiodistal direction. The enamel surfaces were flattened and their initial mass (in milligrams) was obtained. An area of 4 mm(2) was delimited. The specimens were randomly assigned to 12 groups according to the combination of energy (160, 200, 250, and 300 mJ) and pulse repetition rate (2, 3, and 4 Hz). Er:YAG laser irradiation was performed on each specimen for 20 sec. After irradiation, the final mass was obtained and specimens were prepared for examination with scanning electron microscopy. The data obtained by subtracting the final mass from the initial mass were statistically analyzed using ANOVA and the Tukey test (p < 0.05). RESULTS: The pulse repetition rate of 4 Hz provided greater mass loss, different from that seen with 2 Hz, and similar to that seen with 3 Hz. The energy level of 300 mJ resulted in greater mass loss, similar to that seen with 200 and 250 mJ. Scanning electron photomicrographs showed that there was non-selective enamel removal, with fused and cracked areas in all specimens. CONCLUSION: The parameters of 200 mJ and 2 Hz produced a good ablation rate with fewer surface alterations in primary molar enamel.

Water flow on erbium:yttrium-aluminum-garnet laser irradiation: effects on dental tissues.

Since lasers were introduced in dentistry, there has been considerable advancement in technology. Several wavelengths have been investigated as substitutes for high-speed air turbine. Owing to its high absorbability in water and hydroxyapatite, the erbium:yttrium-aluminum-garnet (Er:YAG) laser has been of great interest among dental practitioners and scientists. In spite of its great potential for hard tissue ablation, Er:YAG laser effectiveness and safety is directly related to an adequate setting of the working patterns. It is assumed that the ablation rate is influenced by certain conditions, such as water content of the target tissue, and laser parameters. It has been shown that Er:YAG irradiation with water coolant attenuates temperature rise and, hence, minimizes the risk of thermally induced pulp injury. It also increases ablation efficiency and enhances adhesion to the lased dental tissue. The aim of this review was to obtain insights into the ablation process and to discuss the effects of water flow on dental tissue ablation using Er:YAG laser.

Histórico de saúde: atenção a condições sistêmicas e suas implicações, sobretudo nos fatores de risco de cárie: [revisão] / History taking: attention to systemic conditions and their implications with emphasis on caries risk: [review]

Diversas doenças sistêmicas, bem como medicações utilizadas para o seu tratamento, podem influenciar a saúde bucal de um indivíduo. Assim, dentro da filosofia de promoção de saúde, alicerçada em uma abordagem holística e interdisciplinar, o objetivo do presente artigo é divulgar as principais desordens sistêmicas e medicamentos que apresentam repercussões de interesse para o cirurgião-dentista. Dentro desse contexto, esta revisão de literatura visa ressaltar a importância do histórico de saúde geral como ferramenta de detecção dessas condições, sobretudo porque podem implicar em maior risco da doença cárie. Para tanto, foram descritas e discutidas as repercussões da paralisia cerebral, das doenças de Parkinson e de Alzheimer, da síndrome de Sjögren, da artrite reumatóide, do diabetes mellitus, da síndrome de Down, dos distúrbios alimentares, da radioterapia/quimioterapia aplicada em cabeça e pescoço, da síndrome da imunodeficiência humana e dos transtornos depressivos. A partir do entendimento da importância do histórico de saúde do indivíduo e do valor das informações com ele coletadas, o cirurgião-dentista se articulará melhor com equipes multidisciplinares e obterá elementos que o direcionará a formulações diagnósticas e estratégias terapêuticas no âmbito odontológico, já que algumas condições sistêmicas e medicamentos podem resultar em maior risco de cárie.

Several systemic diseases and medications used to treat these conditions may influence oral health status. Thus, within a philosophy of health promotion based on a holistic and interdisciplinary approach, the purpose of this paper is to review the main systemic disorders and medicines with clinical impact on dental practice. Within this context, this review aims to emphasize the importance of medical history taking for detection of these conditions, especially because they may lead to high caries risk. Specific topics described and discussed were manifestations of cerebral palsy, Parkinson disease, Alzheimer disease, Sjögren syndrome, rheumatoid arthritis, diabetes mellitus, Down syndrome, eating disorders, head and neck radiotherapy/chemotherapy, acquired immunodeficiency syndrome, and depressive disorders. Understanding the importance of medical history taking and information recorded in this process allows dental practitioners to articulate actions in a multidisciplinary team. In addition, dental practitioner will have elements to formulate diagnosis and therapeutic strategies for dental treatment plan, since some systemic conditions and medicines may increase caries risk.

Microleakage on Class V glass ionomer restorations after cavity preparation with aluminum oxide air abrasion.

This in vitro study assessed the marginal microleakage on class V cavities prepared with aluminum oxide air abrasion and restored with different glass ionomer cements. The cavities were prepared on the buccal and lingual surfaces of 15 sound third molars with an air- abrasion device (Kreativ Mach 4.1; New Image) using a 27.5-microm aluminum oxide particle stream, and were assigned to 3 groups of 10 cavities each. The restorative materials were: group I, a conventional glass ionomer cement (Ketac-Fil); groups II and III, resin-modified glass ionomer cements (Vitremer R and Fuji II LC, respectively). After placement of the restorations, the teeth were stored in distilled water at 37 degrees C for 24 h, polished and then submitted to a thermocycling regimen of 500 cycles, isolated, immersed in 0.2% Rhodamine B solution for 24 h, included and serially sectioned. Microleakage was assessed by viewing the specimens under an optical microscope connected to a color video camera and a computer. The images obtained were digitized and analyzed for microleakage using software that allows for a standard quantitative assessment of dye penetration in millimeters. Statistical analysis was done using the Kruskall-Wallis and Wilcoxon tests. Means of dye penetration (%) were: occlusal - I: 25.76 +/- 34.35, II: 20.00 +/- 42.16, III: 28.25 +/- 41.67; cervical - I: 23.72 +/- 41.84; II: 44.22 +/- 49.69, III: 39.27 +/- 50.74. No statistically significant differences (p>0.05) were observed among either the glass ionomer cements or the margins. In conclusion, class V cavities restored with either conventional or resin-modified glass ionomer cements after preparation with aluminum oxide air abrasion did not show complete sealing at the enamel and dentin/cementum margins.

Influence of different beverages on the microhardness and surface roughness of resin composites.

This study assessed the influence of different beverages on the microhardness and surface roughness of microfilled (A110, 3M/ESPE), hybrid (Z250 3M/ESPE) and flowable (Flow, 3M/ESPE) resin composites, over time. Twenty-four disc-shaped specimens (10 mm; 2-mm thick) of each resin composite were fabricated, thereby forming three groups (n=24). Knoop microhardness and surface roughness (Ra) were analyzed at predetermined evaluation periods: 24 hours, and 7, 30 and 60 days after specimens fabrication. The 24-hour measurements were recorded after storage in artificial saliva. Next, each group (n=24) was divided into four subgroups (n=6) according to the test beverages: Coca-Cola, sugar cane spirit, coffee and artificial saliva (control). Control specimens were kept in saliva throughout the experiment (60 days). For experimental specimens, a 60-day testing cycle was carried out: specimens were initially stored in saliva for four hours, then submitted to a five-minute immersion in the beverages (Coca-Cola, sugar cane spirit, coffee) intercalated by immersions in saliva three times daily. Microhardness/roughness measurements were done at 7-, 30- and 60-day intervals. Data were submitted to three-way ANOVA and Scheffée test (p<0.05). It was observed that the tested beverages somewhat altered (p<0.05) the composites' microhardness and/or surface roughness. Knoop microhardness-for all resin composites, microhardness remained stable up to the 30-day record, decreasing significantly at the 60-day evaluation. During the interaction beverage X evaluation period, it was observed that the microhardness of materials immersed in coffee and Coca-Cola remained stable up to the seven-day measurement, showing a decrease at the 30-day record and a more accentuated drop at the 60-day evaluation (p<0.05). Specimens immersed in sugar cane spirit exhibited no significant change in microhardness up to the seven-day measurement, increasing significantly at the 30-day record and later decreasing at the 60-day evaluation. Surface Roughness--For all resin composites, surface roughness increased at the seven-day measurement, while decreasing at the 30-day record and even more at the 60-day record. In the interaction beverage X evaluation period, the surface roughness of specimens immersed in test beverages increased at the seven-day measurement, showing a gradual decrease at the following records (30- and 60-day evaluations). The findings of the reported research disclosed that all beverages altered, to some degree, the microhardness and/or surface roughness of the tested resin composites. The alterations' effects ranged from slightly adverse to a markedly negative impact on the composites' microhardness and surface roughness, depending on the characteristics of the materials, type of beverage and the evaluated period. Generally, the greater number of immersions in beverages resulted in a more accentuated impact on the resins' properties.

Microleakage on class V glass ionomer restorations after cavity preparation with aluminum oxide air abrasion

Este estudo in vitro avaliou a microinfiltração marginal em cavidades classe V preparadas com jato de óxido de alumínio e restauradas com diferentes sistemas ionôméricos. As cavidades foram preparadas nas superfícies vestibular e lingual de 15 terceiros molares hígidos e foram divididas em três grupos com 10 cavidades cada um. Os seguintes materiais foram utilizados: no grupo I, cimento de ionômero de vidro convencional (Ketac Fil) e nos grupo II e III, cimentos de ionômero de vidro modificado por monômeros resinosos (Vitremer e Fuji II LC, respectivamente). O preparo cavitário foi realizado por meio da aplicação do jato de óxido de alumínio (Kreativ Mach 4.1; New Image), com partículas de 27,5 µm. Após a restauração das cavidades, os dentes foram armazenados durante 24 h em água destilada a 37ºC, polidos e então submetido a termociclagem (500 ciclos), imersos em Rodamina B a 0,2% por 24 h, incluídos e seccionados. A análise da microinfiltração marginal foi realizada por meio de um microscópio óptico acoplado a uma câmera e a um computador. As imagens obtidas foram digitalizadas e analisadas utilizando um software que permite uma análise quantitativa padronizada da microinfiltração, em milímetros. As médias (%) obtidas foram: oclusal - I: 25,76 mais ou menos 34,35; II: 20,00 mais ou menos 42,16; III: 28,25 mais ou menos 41,67; cervical I: 23,72 mais ou menos 41,84; II: 44,22 mais ou menos 49,69; III: 39,27 mais ou menos 50,74. Os dados foram submetidos à análise estatística, utilizando os testes de Kruskall-Wallis e Wilcoxon. Não houve diferença estatisticamente significante (p>0.05) entre os materiais testados nem entre as margens oclusal e cervical. Conclui-se que em cavidades classe V preparadas com ar abrasão e restauradas com cimentos de ionômero de vidro convencional e modificados por monômeros resinosos não houve completo vedamento marginal.

Shear bond strength of enamel surface treated with air-abrasive system.

The aim of this study was to evaluate the shear bond strength of a composite resin to dental enamel, using three different surface treatments. Fifteen sound third molars were randomly assigned to three groups. The mesial and distal surfaces were flattened and covered using adhesive tape with a central orifice delimiting the adhesion area (7.07 mm2). Group I, the enamel surface was conditioned with 37% phosphoric acid for 15 s; group II, the surface was treated using air abrasion with aluminum oxide; group III, the enamel surface was treated using an association of air abrasion with aluminum oxide and 37% phosphoric acid. The Single Bond (3M) adhesive system was applied and a Teflon matrix was placed and filled with composite resin Z-100 (3M) and light-cured. The shear bond strength test was performed with a universal testing machine. The acid etching technique and air abrasion with aluminum oxide associated with acid etching had the highest shear bond strength values. Data were subjected to statistical analysis using ANOVA and the Turkey test, and no statistically significant difference in shear bond strength was observed between group I (12.49 +/- 2.85 MPa) and group III (12.59 +/- 2.68 MPa). In contrast, both groups had statistically better shear bond strengths compared to group II (0.29 +/- 0.56 MPa; p < 0.05). Air abrasion with aluminum oxide does not substitute acid etching. The association of these methods to obtain adequate adhesion to the substrate is necessary.

Shear bond strength of enamel surface treated with air-abrasive system

The aim of this study was to evaluate the shear bond strength of a composite resin to dental enamel, using three different surface treatments. Fifteen sound third molars were randomly assigned to three groups. The mesial and distal surfaces were flattened and covered using adhesive tape with a central orifice delimiting the adhesion area (7.07 mm²). Group I, the enamel surface was conditioned with 37 percent phosphoric acid for 15 s; group II, the surface was treated using air abrasion with aluminum oxide; group III, the enamel surface was treated using an association of air abrasion with aluminum oxide and 37 percent phosphoric acid. The Single Bond (3M) adhesive system was applied and a Teflon matrix was placed and filled with composite resin Z-100 (3M) and light-cured. The shear bond strength test was performed with a universal testing machine. The acid etching technique and air abrasion with aluminum oxide associated with acid etching had the highest shear bond strength values. Data were subjected to statistical analysis using ANOVA and the Tukey test, and no statistically significant difference in shear bond strength was observed between group I (12.49 ± 2.85 MPa) and group III (12.59 ± 2.68 MPa). In contrast, both groups had statistically better shear bond strengths compared to group II (0.29 ± 0.56 MPa; p<0.05). Air abrasion with aluminum oxide does not substitute acid etching. The association of these methods to obtain adequate adhesion to the substrate is necessary

Comparação clínica entre diferentes métodos de diagnóstico de cárie proximal / Clinical comparison among different caries diagnosis methods for approximal surface

Comparação clínica entre diferente métodos de diagnóstico de cárie proximal. O objetivo do presente estudo foi avaliar a capacidade cinco métodos de diagnóstico de cárie proximal, que são: radiografia interproximal convencional (RC), radiografia interproximal digitalizada (RD), exame clínico (EC), inspeção visual da superfície (IV) e moldagem da superfície proximal (M) após 24 horas da colocação dos elásticos para a separação do dente e tendo como o critério de validação para todos os métodos testados a abertura da cavidade (AC). Quarenta pacientes, com idades entre 14 e 30 anos foram examinados. Os exames foram realizados por três examinadores. Duas radiografias interproximais foram feitas de cada paciente. Antes dos exames clínico e visual realizou-se a limpeza das superfícies com pedra pomes e água. A inspeção visual e a moldagem foram realizadas 24 horas após a separação temporária dos dentes. A RD foi obtida através da RC. O acordo entre dois examinadores calibrados no EC ou IV ou RC em relação a presença de cavidade foi determinante para a AC. Os valores kappa, a sensibilidade e a especificidade observadas foram respectivamente: RC: 0,78; 0,78; 0,96; RD: 0,52; 0,60; 0,92; EC: 0,43; 0,32; 1,00; IV: 0,60; 0,49; 1,00; M: 0,57; 0,39; 1,00. Permitindo as seguintes conclusões: a RC e a RD mostraram melhores resultados para os diferentes parâmetros avalizados; EC e M mostraram alta especificidade e baixa sensibilidade; a IV mostrou moderada sensibilidade e alta especificidade; se faz necessário a associação de métodos para melhor diagnóstico de lesões de cárie proximal