Sealing Carious Fissures with Resin Infiltrant in Association with a Flowable Composite Reduces Immediate Microleakage?

Abstract Objective: To compare the immediate microleakage of carious fissures sealed with a caries infiltrant covered by a flowable composite or solely with a flowable composite. Material and Methods: Extracted carious molars (n=20) were selected and paired among the experimental groups according to caries progression scores. Experimental groups (n=10) were divided according to the following sealing techniques: 1) caries infiltrant (Icon) + flowable composite (Z350 flow); 2) flowable composite (Z350 flow). Specimens were immersed in 3% methylene blue and evaluated in a stereomicroscope. Microleakage scores were attributed independently by two calibrated evaluators and the mode value was considered as the mean for the specimen. Binomial tests were used to test differences between two independent sample proportions at 5% significance level. Results: In the flowable composite group, a higher prevalence of dye penetration along the full depth of the fissure was observed, compared with caries infiltrant + flowable composite (p<0.05). For specimens showing dye penetration up to half of the fissure, in caries infiltrant + flowable composite group, all specimens showed dye penetration into the sealant, but not over the infiltrant. Conclusion: Using caries infiltrant as sealing material under a flowable composite cover is effective to improve the immediate sealing ability in carious fissures compared to sealing with flowable composite.

Accuracy of visual and image-based ICDAS criteria compared with a micro-CT gold standard for caries detection on occlusal surfaces.

The aim of this study was to check the in vitro accuracy of ICDAS criteria on digital images compared to visual examination for the diagnosis of occlusal caries against a micro-CT gold standard. ICDAS was scored in 40 extracted permanent molars by means of visual inspection and stereomicroscopic images. Visual examinations were performed in duplicate and at a one-week interval by three different calibrated examiners. The analysis of digital images by ICDAS criteria was also performed in duplicate, 1 month after visual examinations. The detection methods were compared by means of sensitivity, specificity, area under the curve, predictive positive and negative values, and accuracy for two different thresholds (1- sound vs. carious teeth; 2- tooth requiring operative vs. non-operative treatment). Sensitivity and accuracy values for threshold 1 in the visual ICDAS and image-based ICDAS methods were high for sensitivity (0.93 and 0.97) and for accuracy (0.83 and 0.85), but low for specificity (0.55 for both methods). Specificity values for threshold 2 were 0.77 and 0.82, while sensitivity was 0.33 and 0.28 for each method. Spearman's rank correlation coefficient was 0.53 and 0.43 (p<0.05) for visual and image-based ICDAS compared to the gold standard scores. Both visual and image-based ICDAS scores were similar to each other in terms of diagnostic accuracy when compared to the micro-CT gold standard. Low specificity for the presence of caries and sensitivity for the detection of caries requiring operative treatment were found.

Accuracy of visual and image-based ICDAS criteria compared with a micro-CT gold standard for caries detection on occlusal surfaces

Abstract The aim of this study was to check the in vitro accuracy of ICDAS criteria on digital images compared to visual examination for the diagnosis of occlusal caries against a micro-CT gold standard. ICDAS was scored in 40 extracted permanent molars by means of visual inspection and stereomicroscopic images. Visual examinations were performed in duplicate and at a one-week interval by three different calibrated examiners. The analysis of digital images by ICDAS criteria was also performed in duplicate, 1 month after visual examinations. The detection methods were compared by means of sensitivity, specificity, area under the curve, predictive positive and negative values, and accuracy for two different thresholds (1- sound vs. carious teeth; 2- tooth requiring operative vs. non-operative treatment). Sensitivity and accuracy values for threshold 1 in the visual ICDAS and image-based ICDAS methods were high for sensitivity (0.93 and 0.97) and for accuracy (0.83 and 0.85), but low for specificity (0.55 for both methods). Specificity values for threshold 2 were 0.77 and 0.82, while sensitivity was 0.33 and 0.28 for each method. Spearman's rank correlation coefficient was 0.53 and 0.43 (p<0.05) for visual and image-based ICDAS compared to the gold standard scores. Both visual and image-based ICDAS scores were similar to each other in terms of diagnostic accuracy when compared to the micro-CT gold standard. Low specificity for the presence of caries and sensitivity for the detection of caries requiring operative treatment were found.

Acurácia de um sistema de diagnóstico de cárie visual e da estereofotografia de superfícies oclusais comparado à um padrão ouro em micro-CT / Acuracy of a carie diagnosis visual system and stereophotography of surface occlusal compared to a gold standard in micro-CT

O objetivo do presente estudo foi verificar a acurácia in vitro do ICDAS visual e baseado em imagens digitais no diagnóstico de cárie oclusal incipiente em molares permanentes e compará-los com um padrão ouro em micro-CT. Para este fim, foram utilizados 40 molares permanentes, obtidos através de um biorrepositório, onde três avaliadores calibrados atribuíram escores ICDAS. Primeiramente os escores foram atribuídos através de exame visual e este foi repetido após uma semana. Em seguida, passado um mês da primeira avaliação visual, os mesmos avaliadores receberam imagens digitais dos espécimes utilizados anteriormente para nova atribuição de scores ICDAS, sendo repetido também após uma semana. Os dentes foram então escaneados através de micro-CT que foi definido como método padrão-ouro para comparação. O coeficiente de correlação de Spearman foi utilizado para comparar as pontuações de consenso com o padrão-ouro. Os métodos de detecção foram comparados por meio de sensibilidade, especificidade, área sob a curva (AUC), valores preditivos positivos e negativos e precisão para dois limiares diferentes (dentes hígidos versus dentes cariados e dentes que necessitam de tratamento operatório versus tratamento não ­ operatório). Os valores médios de kappa para o intra-examinador foram 0,68 e 0,74 para inspeção visual e método baseado em imagens, respectivamente. Os valores de sensibilidade para o limiar de "presença de cárie" no método ICDAS visual e ICDAS fotográfico foram elevados quando comparados com micro-CT (0,93 e 0,97, respectivamente), mesmo com valores de precisão (0,83 e 0,85). Já a especificidade foi mais expressiva para o limiar de "cárie com necessidade de tratamento operatório" com 0,77 e 0,82 para os mesmos métodos. O coeficiente de correlação de Spearman foi de 0,53 e 0,43 (p <0,05). Em vista disso, conclui-se que o ICDAS visual e o baseado em imagens digitais foram semelhantes quanto à exatidão diagnóstica em comparação com um padrão - ouro em micro-CT, podendoe ser uma prosposta para estudos epidemiológicos. (AU)

The aim of the present study was to verify the in vitro accuracy of visual and digital-based ICDAS in the diagnosis of incipient occlusal caries in permanent molars compared to a micro-CT gold standard. For this purpose, 40 permanent molars were obtained from a pool of extracted teeth, cleaned and mounted in gypsum bases where three calibrated examiners assigned ICDAS scores. The scores were attributed by means of visual examination and were repeated after one week. One month after the first visual evaluation, the same examiners received digital images of the previously used specimens for re-assignment of ICDAS scores, which were also repeated after one week. The teeth were then scanned through a micro-CT device which was defined as gold standard method for comparison. The Spearman correlation coefficient was used to compare the consensus scores with the gold standard. The detection methods were compared by means of sensitivity, specificity, area under the curve (AUC), positive and negative predictive values and precision for two different thresholds (healthy teeth X decayed teeth and teeth requiring operative treatment X non - operative treatment). Mean kappa values for the intra-examiner agreement were 0.68 and 0.74 for visual inspection and image-based method, respectively. Sensitivity values for the "decayed teeth" threshold in the visual ICDAS method and the photographic ICDAS were high compared with the micro-CT golden standard (0.93 and 0.97, respectively), even with precision values (0.83 and 0.85). The specificity was more significant for the "caries in need for operative treatment" threshold, with 0.77 and 0.82 for the same methods. The Spearman correlation coefficient was 0.53 and 0.43 (p <0.05). It can be concluded that the visual and digital-based ICDAS were similar in terms of diagnostic accuracy compared to a gold standard in micro-CT, and may be advocated for epidemiological studies. (AU)