Detection of caries around restorations on bitewings using deep learning.

OBJECTIVE: Secondary caries lesions adjacent to restorations, a leading cause of restoration failure, require accurate diagnostic methods to ensure an optimal treatment outcome. Traditional diagnostic strategies rely on visual inspection complemented by radiographs. Recent advancements in artificial intelligence (AI), particularly deep learning, provide potential improvements in caries detection. This study aimed to develop a convolutional neural network (CNN)-based algorithm for detecting primary caries and secondary caries around restorations using bitewings. METHODS: Clinical data from 7 general dental practices in the Netherlands, comprising 425 bitewings of 383 patients, were utilized. The study used the Mask-RCNN architecture, for instance, segmentation, supported by the Swin Transformer backbone. After data augmentation, model training was performed through a ten-fold cross-validation. The diagnostic accuracy of the algorithm was evaluated by calculating the area under the Free-Response Receiver Operating Characteristics curve, sensitivity, precision, and F1 scores. RESULTS: The model achieved areas under FROC curves of 0.806 and 0.804, and F1-scores of 0.689 and 0.719 for primary and secondary caries detection, respectively. CONCLUSION: An accurate CNN-based automated system was developed to detect primary and secondary caries lesions on bitewings, highlighting a significant advancement in automated caries diagnostics. CLINICAL SIGNIFICANCE: An accurate algorithm that integrates the detection of both primary and secondary caries will permit the development of automated systems to aid clinicians in their daily clinical practice.

Comparison of two clinical approaches based on visual criteria for secondary caries assessments and treatment decisions in permanent posterior teeth.

BACKGROUND: This cross-sectional study aimed to compare two clinical approaches based on visual criteria for secondary caries assessments and treatment decisions in permanent posterior teeth. METHODS: The two clinical visual criteria tested for the assessments of restored teeth were: FDI criteria-based on the caries presence, marginal adaptation and staining criteria, adapted from the FDI (International Dental Federation) criteria and CARS criteria-"Caries Associated with Restorations or Sealants" (CARS) criteria described by the International Caries Classification and Management System. Adults were randomized according to the criteria. One calibrated examiner assessed the restorations and assigned the treatment according to the criteria. The primary outcome was replacement indication. RESULTS: A total of 185 patients were included, totalling 718 restorations. The strongest correlation founded between the methods was for the presence of caries lesions (Rho = 0.829). A moderate correlation (Rho = 0.420) was founded between the treatment decisions proposed by the CARS and by the FDI criteria. The multilevel regression analysis showed that the FDI criteria indicated five times more replacements when compared to the CARS (< 0.001). Also, using the FDI criteria restorations were 2.7 times more related to caries around restorations (p < 0.001) compared to the other criterion. CONCLUSIONS: The visual criteria used on the restoration's assessment directly influences the treatment decision to intervene or not on the restoration. The use of a minimally invasive based approach for assessing secondary caries may prevent overtreatment.

Study protocol for a diagnostic randomized clinical trial to evaluate the effect of the use of two clinical criteria in the assessment of caries lesions around restorations in adults: the Caries Cognition and Identification in Adults (CaCIA) trial.

BACKGROUND: The assessment of restored teeth in dentistry remains a challenge, mainly related to the detection of caries around restorations. There is a diversity of clinical criteria available to assess the caries lesions, resulting in differences in the dentists' diagnosis and treatment decisions. In addition, there is a lack of evidence regarding the best criteria to detect caries lesions around the restorations. Thus, the present protocol aims to evaluate the effect of using 2 visual criteria to assess restored teeth on the outcomes related to oral health in adults. METHODS: The design protocol of the Caries Cognition and Identification in Adults trial correspond to a triple-blind randomized, controlled clinical trial with parallel-groups. Two groups will be compared: patients who will receive the diagnosis and treatment decision according to FDI (World Dental Federation) criteria-FDI group; and patients who will receive diagnosis and treatment decision according to the "Caries Associated with Restorations or Sealants" criteria defined by the International Caries Classification and Management System (ICCMS group). The participants will be followed up after 6, 12, 18, 24, and 60 months, and the restoration failure will be the primary outcome. The analysis will be conducted through Cox regression with shared frailty. The impact of oral health on quality of life and the cost-effectiveness of the methods used will be the secondary outcomes. Two-tailed analyzes will be used, considering a level of significance of 5%. DISCUSSION: This is the first clinical trial to assess the effect of using two visual methods to detect caries lesions around restorations on the outcomes related to oral health in adults. The findings of this study will define what is the best diagnostic strategy for the assessment of caries around restorations in permanent teeth. Trial registration NCT03108586 (registered 11 April 2017).

A satisfação profissional de cirurgiões-dentistas da atenção básica em um município no sul do Brasil com diretrizes municipais de saúde bucal / The professional satisfaction of primary health care dentists in a city in southern Brazil with municipal oral health guidelines

Objetivo: identificar a satisfação profissional de cirurgiões-dentistas atuantes na atenção básica do Sistema Único de Saúde em um município do sul do Brasil, que foi pioneiro na implantação de diretrizes municipais de saúde bucal. Sujeitos e método: para a coleta dos dados, foram utilizados componentes descritivos a partir de dados secundários obtidos por meio de um questionário aplicado para todos os cirurgiões-dentistas atuantes no referido serviço. Resultados: no total, 46 profissionais foram incluídos na amostra, sendo que 82,5% estavam satisfeitos em seu trabalho e, desses, o reconhecimento dos usuários do serviço foi o fator que os cirurgiões-dentistas mais associaram à felicidade. Já os fatores mais relacionados à infelicidade no trabalho são as críticas ao salário e os usuários não colaboradores; 97,8% acreditavam que seu trabalho fazia diferença na comunidade em que estavam inseridos. Conclusão: este estudo sugere que estabelecer diretrizes no processo de trabalho pode ter um impacto positivo na prática e na satisfação dos profissionais, e essas estratégias podem ser utilizadas como amparo para planejamento em gestão de saúde bucal de forma sistematizada. (AU)

Objective: to identify the professional satisfaction of dentists working in the primary health care of the public health system, in a city in southern Brazil, which was a pioneer for implementing municipal oral health guidelines. Subjects and method: the data were collected by descriptive components from secondary data obtained through a questionnaire applied to all dentists working in the referred service. Results: a total of 46 professionals were included in the sample, whereas 82.5% were satisfied with their work, and the acknowledgment from service users was the factor that these professionals mostly associated with happiness. On the other hand, the factors most associated with unhappiness in the workplace are complaints of low wages and uncooperative patients. In addition, 97.8% of the professionals believed that their work made a difference in the community in which they were inserted. Conclusion: this study suggests that establishing guidelines in the work process may have a positive impact on the practice and the professional satisfaction and that these strategies may be used as a planning support for the systemic management of oral health. (AU)