Caries treatment decisions among undergraduate and postgraduate students supported by visual detection systems.

BACKGROUND: The difficulties of caries diagnosis and the level of examiner's experience may influence the treatment decision, resulting excessive and inefficient intervention. AIM: This randomized experimental study evaluated caries treatment decisions made by undergraduate (UG) and postgraduate (PG) students when examination was performed through conventional visual clinical examination (CVCE) and when supported by ICDAS (IC) or Nyvad's (NY) criteria. DESIGN: Four UG and four PG initially analyzed, by CVCE, 300 primary incisors and molars surfaces of 25 children aged 5-12 years, and choose between no treatment, non-operative, and operative treatment. Students were randomized between IC (2UG; 2PG) and NY (2UG; 2PG) and, after one week of receiving training, repeated evaluations and treatment suggestions. Reference standard was established by two researchers' consensus. Sensitivity, specificity, ROC analysis, and kappa were calculated. Treatment decisions were analyzed by means of contingency tables. RESULTS: Only sensitivity showed statistical difference (P < 0.05). Operative treatment had high percentage for initial lesions at first evaluation for both criteria; second evaluation showed higher percentage of non-operative treatments for the same lesions. CONCLUSIONS: IC and NY present satisfactory performance in primary teeth by UG and PG, and their use may assistance UG to adopt a less interventionist approach for initial enamel lesions.

Desempenho de métodos baseados em indução de fluorescência na avaliação da remoção de dentina cariada / Performance of fluorescence-based methods in evaluating dentin caries removal

Introdução: Critérios clínicos vêm sendo utilizados para determinação da presença de tecido cariado remanescente, mas geram dúvidas, tornando-se relevante a utilização de métodos que auxiliem na determinação da presença de cárie dentária remanescente. Objetivo: Avaliar in vitro a eficácia de métodos de indução de fluorescência no diagnóstico da remoção de tecido cariado artificial dentinário. Material e método: O esmalte oclusal de 94 terceiros molares humanos hígidos foi removido, expondo a dentina subjacente, para indução microbiológica de lesão de cárie artificial. Após a remoção do tecido cariado induzido, o remanescente dentinário foi avaliado por dois examinadores com DIAGNOdent, DIAGNOdent pen e Quantitative Light-Induced Fluorescence (QLF). Após todas as avaliações, secções dos dentes foram observadas e fotografadas em lupa estereoscópica com 30× de aumento por um examinador independente. As imagens foram analisadas no software Image J, permitindo a quantificação de tecido remanescente em milímetros quadrados. Foi calculada a reprodutibilidade interexaminador através de coeficiente intraclasse, sensibilidade, especificidade e área sob a curva ROC, e o teste de McNemar (p< 0,05) foi aplicado para comparação dos diferentes métodos. Resultado: Dos 94 dentes, 51 (54,2%) apresentaram remanescente de tecido cariado. Os valores de sensibilidade, especificidade e área sobre a curva ROC foram semelhantes para os três grupos (p> 0,05). Os valores de reprodutibilidade variaram entre 0,952 e 0,978. Conclusão: Dentre os métodos utilizados, o DIAGNOdent e o DIAGNOdent pen apresentaram melhor desempenho na avaliação da presença de cárie artificial remanescente quando comparados ao QLF.

Introduction: Clinical criteria have been used for the determination of the presence of residual caries, however in a subjective manner. Then the use of auxiliary methods that assist in determination of the remaining presence of caries can be considered for this purpose. Objective: Evaluate the in in vitro efficacy fluorescence induction methods in the diagnosis of removing artificial dentinal caries. Material and method: Ninety-four thirds sound human molars without occlusal enamel were used for microbiological artificial caries lesion induction. The decayed tissue was removed and the remaining dentin evaluated by two examiners with DIAGNOdent, DIAGNOdent pen and Quantitative Light-Induced Fluorescence - QLF. After all assessments, sections of the specimens were observed and photographed in stereoscopic lens with 30× increase by an independent examiner. These images were analyzed with Image J software, allowing quantitation of remaining caries tissue in mm2. The inter-examiner reliability, sensitivity, specificity, and area under the ROC curve was calculated and the McNemar test (p< 0.05) was used to compare the different among methods. Result: Of the 94 teeth, 51 (54.2%) had residual caries. The sensitivity, specificity, and area under the ROC curve were similar for the three methods (p> 0.05). The inter-examiner agreement ranged between 0.952 and 0.978. Conclusion: Among the methods used, the DIAGNOdent, DIAGNOdent pen showed better performance in residual caries detection after dentin caries removal when compared to QLF.

Influence of professional experience on detection and treatment decision of occlusal caries lesions in primary teeth.

AIM: To evaluate the influence of examiner's clinical experience on detection and treatment decision of caries lesions in primary molars. DESIGN: Three experienced dentists (Group A) and three undergraduate students (Group B) used the International Caries Detection and Assessment System (ICDAS) criteria and bitewing radiographs (BW) to perform examinations twice in 77 primary molars that presented a sound or carious occlusal surface. For the treatment decision (TD), the examiners attributed scores, analyzing the teeth in conjunction with the radiographs. The presence and the depth of lesion were validated histologically, and reproducibility was evaluated. The sensitivity, specificity, accuracy, and area under the ROC curve values were calculated for ICDAS and BW. The associations between ICDAS, BW, and TD were analyzed by means of contingency tables. RESULTS: Interexaminer agreement for ICDAS, BW, and TD were excellent for Group B and moderate for Group A. The two groups presented similar and satisfactory performance for caries lesion detection using ICDAS and BW. In the treatment decision, Group A was shown to have a less invasive approach than Group B. CONCLUSION: The examiner's experience was not determinant for the clinical and radiographic detection of occlusal lesions in primary teeth but influenced the treatment decision of initial lesions.

Influence of sterilization process on cutting effectiveness andurability of ultrasonic tips / Influência do processo de esterilização na efetividade de corte e durabilidade das pontas ultra-sônicas

Objetivo: O objetivo foi avaliar a influência de diferentes métodos de esterilização na efetividade de corte e durabilidade de pontas ultra-sônicas cilíndricas comparadas com pontas diamantadas cilíndricas convencionais. Material e Métodos:Quinze pontas diamantadas cilindricas (1092)(KG Sorensen) acopladas a um motor de de alta rotação, e quinze pontas ultrassonicas cilíndricas(8,2137) (CVDentus) acopladas a um ultra-som foram utilizadas para realizar preparos cavitários padronizados em fragmentos de dentes bovinos higidos, limpos com taça de borracha, pedra-pomes e água. Após cada um dos 10 preparos, as pontas foram9 vezes esterilizadas em autoclave (SA), estufa (SO), ou limpas com escova, sabão e água (C). Os fragmentos foram pesados e microfotografias das pontas foram tomadas no início e no final do experimento. Outras9 pontas de diamante CVD e 9 convencionais foram submetidos aos mesmos ciclos de esterilização em autoclave (SAC), forno (SOC) ou lavado com água e sabão (CC) no entanto, sem serem usadas para fazer preparos cavitários, servindo como controle. Realizou-se análise descritiva dos valores encontrados na pesagem e dos scores das microfotografias.Resultados: Diferenças estatisticamente significativas(teste t de Student pareado) foram observadas entre as pontas após a esterilização (p = 0,0001). SOe SA não influenciaram na efetividade de corte e durabilidade das pontas diamantadas ultra-sônicas e convencionais. As microfotografias mostraram diferenças morfológicas entre as pontas utilizadas para os preparos e o controle. Conclusão: As esterilizaçoes por autoclave e estufa não influenciaram a efetividade de corte e durabilidade das pontas diamantadas convencionais. Pontas diamantadas convencionais apresentaram maiores alterações estruturais após a realização de preparos cavitários e procedimentos de limpeza / esterilização, independentemente do processo utilizado.

Objectives: The aim was to evaluate influence of different sterilization methods on cutting effectiveness and durability of cylindrical ultrasonic burs compared with conventional cylindrical diamond-coatedburs. Material and Methods: Fifteen conventional cylindrical diamond-coated (1092) (KG Sorensen) coupled to a high-speed turbine, and fifteen cylindrical ultrasonic (8.2137) (CVDentus) burscoupled to an ultrasound-handpiece were used toper form standardized cavity preparations in healthy bovine tooth fragments, cleaned with rubber cup, pumice stone and water. After every 10 preparations, burs were sterilized 9 times in autoclave (SA), oven (SO), or cleaned with brush, soap and water (C). Fragments were weighed and microphotographs of burs were taken at the beginning and end of experiment. Another 9 conventional diamond-coatedand 9 CVD burs under went the same sterilizationcycles in autoclave (SAC), oven (SOC) or washedwith soap and water (CC) however, without beingused for making cavity preparations, serving ascontrol. Descriptive analyses were made of thevalues found by weighing and microphotographyscores. Results: Statistically significant differences (Paired Student’s-t test) were observed among bursafter sterilization (p = 0.0001). SO and SA didnot influence cutting effectiveness and durability of ultrasonic and conventional diamond-coatedburs. The microphotographs showed morphological differences between the burs used for preparation and the control. Conclusion: Sterilization by oven andautoclave did not influence cutting effectiveness and durability of CVD and conventional diamond-coatedburs. Conventional diamond-coated burs presented greater structural alterations after performing cavity preparations and cleaning/sterilization procedures, irrespective of the process used.

In vitro performance of a pen-type laser fluorescence device and bitewing radiographs for approximal caries detection in permanent and primary teeth.

AIM: To evaluate the performance of a pen­type laser fluorescence device (DIAGNOdent 2190; LFpen, KaVo, Germany) and bitewing radiographs (BW) for approximal caries detection in permanent and primary teeth. MATERIALS AND METHODS: A total of 246 anterior approximal surfaces (102 permanent and 144 primary) were selected. Contact points were simulated using sound teeth. Two examiners assessed all approximal surfaces using LFpen and BW. The teeth were histologically assessed for the reference standard. Optimal cut­off limits were calculated for LFpen for primary and permanent teeth. Sensitivity, specificity, accuracy and area under the receiver operating characteristic curve (Az) were calculated for D1 (enamel and dentin lesions) and D3 (dentin lesions) thresholds. The reproducibility was assessed by intraclass correlation coefficient (ICC) and Cohen's weighted kappa values. RESULTS: For permanent teeth, the LFpen cut­off were 0-27 (sound), 28-33 (enamel caries) and >33 (dentin caries). For primary teeth, the LFpen cut­off were 0-7 (sound), 8- 32 (enamelcaries) and >32 (dentin caries). The LFpen presented higher sensitivity values than BW for primary teeth (0.58 vs. 0.32 at D1 and 0.80 vs. 0.47 at D3) and permanent teeth (0.80 vs. 0.57 at D1 and 0.94 vs. 0.51 at D3). Specificity did not show a significant difference between the methods. Rank correlations with histology were 0.59 and 0.83 (LFpen) and 0.36 and 0.70 (BW) for primary and permanent teeth, respectively, considering all lesions. ICC values for LFpen were 0.71 (inter) and 0.86 (intra) for permanent teeth and 0.94 (inter) and 0.90/0.99 for primary teeth. Kappa values for BW were 0.69 (inter) and 0.68/0.90 (intra) for permanent teeth and 0.64 (inter) and 0.89/0.89 for primary teeth. CONCLUSION: LFpen presented better reproducibility for primary and permanent teeth and higher accuracy in detecting caries lesions at D1 threshold than BW for permanent teeth. LFpen should be used as an adjunct method for approximal caries detection.

The performance of conventional and fluorescence-based methods for occlusal caries detection: an in vivo study with histologic validation.

BACKGROUND: The authors conducted an in vivo study to determine clinical cutoffs for a laser fluorescence (LF) device, an LF pen and a fluorescence camera (FC), as well as to evaluate the clinical performance of these methods and conventional methods in detecting occlusal caries in permanent teeth by using the histologic gold standard for total validation of the sample. METHODS: One trained examiner assessed 105 occlusal surfaces by using the LF device, LF pen, FC, International Caries Detection and Assessment System (ICDAS) criteria and bitewing (BW) radiographic methods. After tooth extraction, the authors assessed the teeth histologically. They determined the optimal clinical cutoffs by means of receiver operating characteristic curve analysis. RESULTS: The specificities and sensitivities for enamel and dentin caries detection versus only dentin caries detection thresholds were 0.60 and 0.93 and 0.77 and 0.52 (ICDAS), 1.00 and 0.29 and 0.97 and 0.44 (BW radiography), 1.00 and 0.85 and 0.77 and 0.81 (LF device), 0.80 and 0.89 and 0.71 and 0.85 (LF pen) and 0.80 and 0.74 and 0.49 and 0.85 (FC), respectively. The accuracy values were higher for ICDAS, the LF device and the LF pen than they were for BW radiography and the FC. CONCLUSIONS: The clinical cutoffs for sound teeth, enamel carious lesions and dentin carious lesions were, respectively, 0 through 4, 5 through 27 and 28 through 99 (LF device); 0 through 4, 5 through 32 and 33 through 99 (LF pen); and 0 through 1.2, 1.3 and 1.4 through 5.0 (FC). The ICDAS, the LF device and the LF pen demonstrated good performance in helping detect occlusal caries in vivo. The ICDAS did not seem to perform as well at the D(3) threshold (histologic scores 3 and 4) as at the D(1) threshold (histologic scores 1-4). BW radiography and the FC had the lowest performances in helping detect lesions at the D(1) and D(3) thresholds, respectively. CLINICAL IMPLICATIONS: Occlusal caries detection should be based primarily on visual inspection. Fluorescence-based methods may be used to provide a second opinion in clinical practice.

Avaliação do desempenho de métodos baseados em indução de fluorescência na detecção de lesões de cárie residual / Performance of fluorescence-based methods for residual dentinal caries detection

O objetivo da presente pesquisa foi avaliar o desempenho dos métodos baseados na captação de fluorescência induzida por luz (DIAGNOdent (DD) , DIAGNOdent Pen (DDP), câmera Vista Proof (VP) e Quantitative Light-induced Fluorescence (QLF) na detecção de lesões de cárie residual após a remoção de tecido cariado dentinário. Foram utilizados 94 terceiros molares humanos hígidos. Foram excluídos aqueles que apresentavam, áreas hipoplásicas, restaurações, selantes ou manchas. O esmalte oclusal foi seccionado horizontalmente e a superfície dentinária subjacente foi polida a fim de remover restos de esmalte remanescente e alisar a superfície. Os ápices radiculares foram preenchidos com resina composta e todo o restante do dente recoberto por resina epóxi e verniz ácido-resistente deixando uma janela de dentina onde foi desenvolvido a lesão de cárie artificial utilizando um protocolo microbiológico in vitro desenvolvido para esse fim. Todos os espécimes foram avaliados por dois examinadores independentes, utilizarando o método de inspeção visual-tátil para determinar a presença ou ausência de lesão de cárie. Os espécimes foram aleatoriamente divididos em dois grupos (n=47) de acordo com o método de remoção da lesão: fresa em baixa rotação convencional e escavação manual. A quantidade de tecido removido foi determinada de acordo com os parâmetros determinados pelos exames visual e tátil. As lesões também foram examinadas pelos métodos de indução de fluorescência: DD; DDpen; VP e QLF, antes do desenvolvimento da lesão, com o dente cariado e após a remoção, para determinar a presença ou ausência de lesão cariosa e de remanescente após a remoção. Após todas as avaliações, os dentes foram seccionados perpendicularmente ao longo eixo, no sentido mesio-distal, e essas secções de dentes foram observadas e fotografados em lupa estereoscópica...

The aim of this study was to evaluate the performance of light-induced fluorescence methods (DIAGNOdent (DD), DIAGNOdent Pen (DDP), Proof camera View (PV) and Quantitative Light-induced Fluorescence (QLF) to detect residual caries. 94 human molars were used . Teeth with those who had, hypoplastic areas, fillings, sealants or stains were excluded. The occlusal enamel was sectioned perpendicular to the long axis of the tooth using a low-speed diamond saw under water cooling (Isomet, Buehler Ltd, Lake Bluff, IL, USA) to expose adjacent dentin. The dentin surface was wet ground flat with 180 and 400 grit silicon carbide abrasive paper until all enamel had been removed. Samples were covered with acid-resistant nail varnish leaving an uncoated window in the center of the dentin surface for caries development. All specimens were evaluated by two independent observers,in use the method of visual-tactile inspection to determine the presence or absence of caries. The specimens were randomly divided into two groups (n = 47) according with the method of removal of the lesion: at low speed and conventional hand excavation. The amount of removed tissue was determined in accordance with the parameters determined by visual and tactile examinations. The lesions were also examined by fluorescence methods: DD; DDpen, VP and QLF, at baseline, after induction lesion of caries like lesion and after caries removal to determine the presence or absence of carious lesion and remaining after the removal. After all evaluations, the teeth were sectioned perpendicular to the long axis in the mesio-distal direction, and those sections of teeth were observed and photographed under a stereomicroscope with 30x increase by an examiner independent. Was determined by the visual inspection of images of the magnifying glass and also with the aid of an explorer, the presence or absence of caries, to determining the gold standard...