Avaliação da profundidade da cárie proximal nos exames radiográfico convencional e digitalizado / Evaluation of the size of proximal caries in radiography and digitized

Introdução: A cárie dentária é uma doença multifatorial que compreende vários fatores biológicos e sociais. A superfície proximal dos dentes é uma região de difícil visualização que pode esconder pequenas lesões cariosas no esmalte dentário, impossibilitando o diagnóstico através de inspeções visuais e táteis. Objetivo: O objetivo deste trabalho foi avaliar a profundidade da cárie proximal nos exames radiográficos convencionais e digitais, comparando as profundidades das lesões consideradas nestes exames às do exame histológico. Método: Foram utilizados exames radiográficos interproximais de 40 dentes humanos, 20 pré-molares e 20 molares, com alterações clínicas em uma das superfícies proximais, como lesões de mancha branca ou acastanhada e pequenas cavitações. Três profissionais especializados em radiologia odontológica com mais de cinco anos de experiência clínica mediram a profundidade das lesões pelos exames radiográfico e digital das amostras. Para obter os resultados, utilizou-se a técnica de análise de variância (ANOVA). Resultados: Constatou-se um nível de significância de 5% nas mensurações dos exames radiográficos convencionais e digitalizados, mostrando a fidelidade das imagens radiográficas em relação a real profundidade da lesão. Conclusão: Conclui-se que os exames de imagem avaliados foram eficientes na determinação da profundidade das lesões de cárie proximal.

Introduction: Dental caries is a multifactorial disease that comprises several biological and social factors. The proximal surface of the teeth is a region of difficult visualization that can hide small carious lesions in the dental enamel, making diagnosis through visual and tactile inspection infeasible. Objective: The objective of this study was to evaluate the depth of proximal caries in the conventional and digitized radiographic examinations, comparing the depths of the lesions considered in these examinations to those of the histological examination. Method: Interproximal radiographic examinations of 40 human teeth, 20 premolars and 20 molars, with clinical alterations on one of the proximal surfaces, such as white or brown spot lesions and small cavitations, were used. Three professionals specialized in dental radiology with more than five years of clinical experience measured the depth of the lesions by radiographic examination of the samples. To obtain the results, we used the technique of analysis of variance (ANOVA). Results: A level of significance of 5% was found in conventional and digitized radiographic measurements, showing the fidelity of the radiographic images in relation to the actual depth of the lesion. Conclusion: It was concluded that the imaging tests evaluated were efficient in determining the depth of proximal caries lesions.

Accuracy of digital bitewing radiographs with and without applying horizontal tube shift in the diagnosis of residual excess cement around dental implants: an in vitro study / Precisión de las radiografías digitales bitewing con y sin aplicación de desplazamiento horizontal del tubo en el diagnóstico del exceso de cemento residual alrededor de los implantes dentales: un estudio in vitro

Purpose: This study was designed to evaluate the diagnostic value of digital Bitewing (BW) radiographs with and without horizontal tube shift in detecting Residual excess cement (REC) on the proximal and non-proximal surfaces of implant restorations. Material and Methods: Eight mandibular models were fabricated with two implants placed on each side in the premolar and first molar positions. Excess cement was applied to either proximal or non-proximal surfaces of the restorations intentionally during the process of crown cementation. BW radiographs with and without applying horizontal tube shift were acquired. Three maxillofacial radiologists were asked to determine the presence and location of REC in the radiographs. Sensitivity and specificity of the radiographic technique were assessed according to the restoration surface that contained REC. Results: Sensitivity of BW radiographs was 100% for the detection of REC on the proximal surfaces and 41-18, 80% on the non-proximal surfaces. Specificity of the technique was 85.71%-100% for the proximal surfaces and 75-94. 12% for the non-proximal areas. Specificity of the radiographic method was generally greater than its sensitivity for the non-proximal surfaces while in the proximal areas, the two variables had quite similar values. Conclusion: Digital BW radiography is generally more useful for detection of REC on the proximal surfaces. Higher specificity of this technique for the bucco-lingual surfaces suggests more reliability of the negative diagnoses in the non-proximal areas.

Objetivo: Evaluar el valor diagnóstico de las radiografías digitales bitewing (BW), con y sin desplazamiento horizontal del tubo, para detectar el exceso de cemento residual (ECR) en las superficies proximales y no proximales de las restauraciones con implantes. Material y Métodos: Se fabricaron ocho modelos mandibulares con dos implantes colocados a cada lado en las posiciones premolar y primer molar. El exceso de cemento se aplicó intencionalmente en las superficies proximales o no proximales de las restauraciones durante el proceso de cementación de la corona. Se adquirieron radiografías BW con y sin aplicación de desplazamiento horizontal del tubo. Se pidió a tres radiólogos maxilofaciales que determinaran la presencia y ubicación de ECR en las radiografías. La sensibilidad y la especificidad de la técnica radiográfica se evaluaron según la superficie de restauración que contenía ECR. Resultados: La sensibilidad de las radiografías de BW fue del 100% para la detección de ECR en las superficies proximales y del 41,18-80% en las superficies no proximales. La especificidad de la técnica fue 85-71, 100% para las superficies proximales y 75-94, 12% para las áreas no proximales. La especificidad del método radiográfico fue generalmente mayor que su sensibilidad para las superficies no proximales, mientras que en las áreas proximales, las dos variables tuvieron valores bastante similares. Conclusión: La radiografía digital BW es generalmente más útil para la detección de ECR en las superficies proximales. La mayor especificidad de esta técnica para las superficies buco-linguales sugiere una mayor confiabilidad de los diagnósticos negativos en las áreas no proximales.

Radiograph’s Reject Rate Among Universiti Kebangsaan Malaysia Dental Undergraduates And Its Implications Analisa Kadar Penolakan Imej Radiograf dan Implikasinya di Kalangan Pelajar Prasiswazah Universiti Kebangsaan Malaysia / Jurnal Sains Kesihatan Malaysia

@#The aim of this study was to evaluate the reject rate of periapical and bitewing radiographs among dental undergraduate students of Universiti Kebangsaan Malaysia (UKM), identify the type of radiographic errors which are frequently encountered and compare reject rates between Year 3, Year 4 and Year 5 dental undergraduates. 118 rejected periapical radiographs and 27 rejected bitewing radiographs were collected from the UKM dental undergraduates’ polyclinics for a duration of 10 months. These rejected radiographs were further evaluated to determine the type of radiographic error. A spiking increase in periapical radiographs reject rate from Year 3 (4%) to Year 4 (11%) was observed. This finding was consistent with the statistically significant difference in the periapical radiographs reject rates for Year 3 and Year 4 (p = 0.0475). In periapical radiographs, the most frequently committed radiographic error was apical cut, followed by high density film. Vice versa, high density film was accounted as the most common radiographic error in bitewing radiography. Analysis of periapical and bitewing radiographs’ reject rates among UKM dental undergraduate entails the necessity to supervise undergraduate students regardless of the year of their undergraduate training in all aspects of the radiographic procedures which include positioning radiographic armamentarium, the setting of radiographic exposure time and the film processing procedure.

Cárie Dentária: considerações clínicas e radiográficas para seu diagnóstico / Dental Caries: clinical and radiographic considerations for diagnosis

Introdução: O diagnóstico correto da cárie dentária é fundamental para o estabelecimento do seu tratamento. Ele pode ser realizado por diferentes métodos, os mais comuns são por meio da inspeção visual e do exame radiográfico. Objetivo: Discutir, a partir de uma revi-são de literatura, o diagnóstico clínico-radiográficoda doença cárie e a sua importância na instituição do tratamento correto para tal doença. Materiais e métodos: oi realizada uma revisão da literatura nas bases de dados eletrônicos: PubMed, BVS e Scielo, através do ras-treio de artigos relevantes publicados no período de Janeiro de 2015 à Junho 2020. Foram incluídos ainda na bibliografia selecionada 2 livros e 1 tese de doutorado, que fazem consi-derações relevantes sobre o assunto estudado. Resultados: Na inspeção visual, a apresen-tação da superfície dentária é bastante importante na determinação da atividade da lesão de cárie, devem ser considerados o aspecto, o brilho e a coloração da superfície dental para tal determinação. A radiografia é um complemento usado para auxiliar no diagnóstico forne-cendo mais visibilidade e detecção das lesões cariosas permitindo melhor visualização das superfícies proximais em dentes posteriores, auxiliando no diagnóstico das lesões nessas superfícies. Conclusão: O diagnóstico correto exige bastante conhecimento do examina-dor, pois manchas opacas presentes no esmalte nem sempre são lesões cariosas e podem refletir uma perda de mineral na estrutura desse tecido que se desenvolveu por diferentes causas, sendo elas pré ou pós-eruptivas. O diagnóstico precoce e preciso da cárie dentária é fundamental, pois essa doença ainda é a principal causa de perda dentária.

Introduction:The correct diagnosis of dental caries is fundamental for the establishment of its treatment. It can be carried out by different methods and the most common is through visual inspection and radiographic examination.Objective:to discuss, based on a litera-ture review, the clinical and radiographic diagnosis of caries disease and its importance in establishing the correct treatment for this disease.Materials and methods:a literature review was carried out on the electronic databases: PubMed, BVS and Scielo, by a search of relevant articles published from January 2015 to June 2020. Also, 2 books and 1 PhD thesis were included in the selected bibliography, since they bring relevant considerations on the subject studied.Results:In the visual inspection, the presentation of the dental sur-face is very important in determining the activity of the caries lesion, the aspect, the bri-ghtness, and the coloring of the dental surface must be considered for such determination. Radiography is a complement used to assist in diagnosis by providing more visibility and detection of carious lesions, allowing a better visualization of proximal surfaces in poste-rior teeth, helping in the diagnosis of lesions on these surfaces.Conclusion:The correct diagnosis requires a lot of knowledge from the examiner because opaque stains present in the enamel are not always carious lesions and can reflect a loss of mineral in the structure of this tissue that has developed for different causes, whether pre- or post-eruptive. Early and accurate diagnosis of tooth decay is essential, as this disease is still the main cause of tooth loss.

Cárie dentária: considerações clínicas e radiográficas para seu diagnóstico / Dental caries: clinical and radiographic considerations for diagnosis

Introdução: O diagnóstico correto da cárie dentária é fundamental para o estabelecimento do seu tratamento. Ele pode ser realizado por diferentes métodos, os mais comuns são por meio da inspeção visual e do exame radiográfico. Objetivo: Discutir, a partir de uma revi-são de literatura, o diagnóstico clínico-radiográficoda doença cárie e a sua importância na instituição do tratamento correto para tal doença. Materiais e métodos: oi realizada uma revisão da literatura nas bases de dados eletrônicos: PubMed, BVS e Scielo, através do ras-treio de artigos relevantes publicados no período de Janeiro de 2015 à Junho 2020. Foram incluídos ainda na bibliografia selecionada 2 livros e 1 tese de doutorado, que fazem consi-derações relevantes sobre o assunto estudado. Resultados: Na inspeção visual, a apresen-tação da superfície dentária é bastante importante na determinação da atividade da lesão de cárie, devem ser considerados o aspecto, o brilho e a coloração da superfície dental para tal determinação. A radiografia é um complemento usado para auxiliar no diagnóstico forne-cendo mais visibilidade e detecção das lesões cariosas permitindo melhor visualização das superfícies proximais em dentes posteriores, auxiliando no diagnóstico das lesões nessas superfícies. Conclusão: O diagnóstico correto exige bastante conhecimento do examina-dor, pois manchas opacas presentes no esmalte nem sempre são lesões cariosas e podem refletir uma perda de mineral na estrutura desse tecido que se desenvolveu por diferentes causas, sendo elas pré ou pós-eruptivas. O diagnóstico precoce e preciso da cárie dentária é fundamental, pois essa doença ainda é a principal causa de perda dentária.

Introduction:The correct diagnosis of dental caries is fundamental for the establishment of its treatment. It can be carried out by different methods and the most common is through visual inspection and radiographic examination.Objective:to discuss, based on a litera-ture review, the clinical and radiographic diagnosis of caries disease and its importance in establishing the correct treatment for this disease.Materials and methods:a literature review was carried out on the electronic databases: PubMed, BVS and Scielo, by a search of relevant articles published from January 2015 to June 2020. Also, 2 books and 1 PhD thesis were included in the selected bibliography, since they bring relevant considerations on the subject studied.Results:In the visual inspection, the presentation of the dental sur-face is very important in determining the activity of the caries lesion, the aspect, the bri-ghtness, and the coloring of the dental surface must be considered for such determination. Radiography is a complement used to assist in diagnosis by providing more visibility and detection of carious lesions, allowing a better visualization of proximal surfaces in poste-rior teeth, helping in the diagnosis of lesions on these surfaces.Conclusion:The correct diagnosis requires a lot of knowledge from the examiner because opaque stains present in the enamel are not always carious lesions and can reflect a loss of mineral in the structure of this tissue that has developed for different causes, whether pre- or post-eruptive. Early and accurate diagnosis of tooth decay is essential, as this disease is still the main cause of tooth loss.

Comparison of the Accuracy of Digital Radiography with Conventional Radiography and Visual Examination in the Detection of Permanent Teeth Interproximal Caries

Objective: To compared the accuracy of digital radiography in the diagnosis of interproximal caries in permanent teeth with conventional radiography and visual examination. Material and Methods: In this descriptive-analytical study, 78 human premolars, which seem normal in primary examination, are mounted on the plaster in a pair-wise manner and their caries are visually evaluated. Conventional and digital radiographic images are taken under the same conditions and their caries are graded with Confidence Score. To determine the golden standard, after mesiodistal incision, the teeth are examined using stereomicroscopy. Finally, the results obtained by visual observation and conventional radiography as well as digital images were compared with those obtained from the stereomicroscopy to determine their accuracy in detecting the interproximal caries. Results: The consistencies between the visual, digital, and conventional methods with the standard method (microscopic histology) are 53%, 78%, and 50% respectively - all of them are significant (p<0.05). The highest and the lowest sensitivities are related to the digital (96%) and visual (88%) methods respectively, while the highest and lowest specificities are related to the digital (79%) and conventional (50%) methods respectively. The highest and lowest positive predictive value is related to the digital (79%) and conventional (80%) methods respectively. The highest and lowest negative predictive values are related to the digital (90%) and visual (71%) methods respectively. Compared with the standard methodology, the most accurate diagnostic accuracy can be seen for the digital method (91%). Conclusion: There is no significant difference in the diagnosis of interproximal caries by different methods, and the only advantage of digital radiography, compared with the conventional one, is storing radiographs without losing important information and the lower dose of radiation for the patient.

Additional intraoral radiographs may change the judgment regarding the final position of orthodontic mini-implants

ABSTRACT Objective: This study aimed to assess if additional vertical bitewing (VBW) and/or occlusal (OC) radiographs may change initial judgment based only on periapical radiograph (PAR) about the final position of orthodontic mini-implants (OMI). Methods: Subjective and objective analyses were performed. Radiographic images of 26 OMI were divided into four groups: PAR, PAR+VBW, PAR+OC and ALL (PAR+VBW+OC). For subjective analysis, five observers were asked to assess if the position of OMI was favorable to its success, using questionnaires with a four-point scale for responses: 1= definitely not favorable, 2= probably not favorable, 3= probably favorable, or 4= definitely favorable. Each group containing sets of images was presented to them in four different viewing sessions. Objective evaluation compared horizontal distances between OMI tip and the root nearest to the device in PAR and VBW. Results: Most of observers (3 out of 5) changed their initial judgment based on PAR about OMI position when additional radiographs were analyzed. Differences between groups (i.e. PAR vs. PAR+VBW; PAR vs. PAR+OC; and, PARvs.ALL) were statistically significant for these observers. For those that changed their judgment about OMI position, confidence level could significantly increase, decrease or even be maintained, not indicating a pattern. There was no agreement for distances between OMI tip and the root nearest to the device in PAR and VBW. Conclusion: Considering the limitations of the study, it is concluded that additional radiographic images may change the judgement about OMI final position without necessarily increasing the degree of certainty of such judgment.

RESUMO Objetivo: avaliar se a adição de radiografias interproximais verticais (IV) e/ou oclusais (OC) pode alterar o julgamento inicial sobre a posição final dos mini-implantes ortodônticos (MI) baseado somente na radiografia periapical (PA). Métodos: foram realizadas análises subjetivas e objetivas. Imagens radiográficas de 26 regiões contendo MI foram divididas em quatro grupos: PA, PA+IV, PA+OC e TODAS (PA+IV+OC). Na análise subjetiva, cinco observadores foram convidados a avaliar se a posição do MI era favorável para o seu sucesso, utilizando questionários com uma escala de quatro pontos para respostas: 1 = definitivamente não favorável; 2 = provavelmente não favorável; 3 = provavelmente favorável; ou 4 = definitivamente favorável. Cada grupo contendo conjuntos de imagens foi apresentado aos observadores em quatro sessões diferentes. Adicionalmente, uma avaliação objetiva comparou as distâncias horizontais entre a ponta do MI e a raiz dentária mais próxima ao dispositivo na PA e IV. Resultados: a maioria dos observadores (3 de 5) mudou seu julgamento inicial sobre a posição do MI baseado na PA quando radiografias adicionais foram analisadas. Diferenças entre os grupos (ou seja, PA vs PA+IV; PA vs PA+OC; e PAvsTODAS) foram estatisticamente significativas para esses observadores. Para aqueles que mudaram seu julgamento sobre a posição do MI, o nível de confiança das respostas aumentou, diminuiu ou foi mantido, não indicando um padrão. Houve diferença estatisticamente significante entre as distâncias da ponta do MI para a raiz mais próxima ao dispositivo na PA e IV. Conclusão: considerando-se as limitações desse estudo, concluiu-se que imagens radiográficas adicionais podem alterar o julgamento sobre a posição final de MI sem, necessariamente, aumentar o grau de certeza de tal julgamento.

Effect of Clinical Experience on Accuracy and Reliability of Radiographic Caries Detection / Efecto de la Experiencia Clínica en la Precisión y Concordancia de Detección de Caries en Radiografías

ABSTRACT: The purpose of this study was to investigate the accuracy and interobserver reliability of examiners with different levels of clinical experience, when diagnosing radiographic proximal caries lesions. Bitewing radiographs were selected from a patient attending Operative Dentistry Clinic, Universidad de Chile. Radiographic examination was performed by three different groups: A: third year dentistry students, B: fourth year dentistry students, and C: dentist recently graduated. Thirty-two proximal surfaces were scored as: 0, sound; 1: enamel caries; and 2: dentinal caries. The data were analysed and accuracy and interexaminer reliability were calculated. Accuracy values for enamel caries were: A (0.54), B (0.55) and C (0.58), and dentinal caries were: A (0.55), B (0.61) and C (0.63). Interexaminer reliability denoted marginal agreement for all groups, A (0.249), B (0.213) and C (0.282) for enamel caries and A (0.058), B (0.102), and C (0.344) for dentinal caries. The results of this study indicate that the accuracy and interexaminer reliability of bitewing radiographic examination were influenced by the clinical experience when detecting radiographic proximal caries, however low values of accuracy and interexaminer reliability were noted, reinforcing the necessity of improving education and training in radiographic caries detection.

RESUMEN:El objetivo de este trabajo fue evaluar la precisión y concordancia entre examinadores con distinto nivel de experiencia clínica, al diagnosticar lesiones de caries proximales en radiografías. Un set de radiografías bitewing fue seleccionado de un paciente que acudió a la Clínica de Operatoria de la Facultad de Odontología, Universidad de Chile. El examen radiográfico fue realizado por tres grupos distintos: A: estudiantes de Odontología de tercer año, B: estudiantes de Odontología de cuarto año, y C: dentistas recientemente graduados. Treinta y dos superficies proximales fueron analizadas y evaluadas como: 0, sana; 1: lesión de caries de esmalte, 2: lesión de caries dentinaria. Los datos obtenidos fueron analizados y la precisión y concordancia entre examinadores fueron calculadas. Los valores de precisión en lesiones de esmalte fueron: A (0,54), B (0,55) y C (0,58), y para lesiones dentinarias fueron: A (0,55), B (0,61) y C (0,63). La concordancia entre examinadores denotó ser marginal para todos los grupos, A (0,249), B (0,213) y C (0,282) en lesiones de esmalte y A (0,058), B (0,102), y C (0,344) en lesiones dentinarias. Los resultados de este estudio indican que la precisión y la concordancia entre examinadores está influenciada por la experiencia clínica, sin embargo los valores encontrados fueron bajos, lo que refuerza la necesidad de mejorar la educación y entrenamiento en detección de lesiones de caries en radiografías

Detection of proximal caries using quantitative light-induced fluorescence-digital and laser fluorescence: a comparative study

PURPOSE: The purpose of this study was to evaluate the in vitro validity of quantitative light-induced fluorescence-digital (QLF-D) and laser fluorescence (DIAGNOdent) for assessing proximal caries in extracted premolars, using digital radiography as reference method. MATERIALS AND METHODS: A total of 102 extracted premolars with similar lengths and shapes were used. A single operator conducted all the examinations using three different detection methods (bitewing radiography, QLF-D, and DIAGNOdent). The bitewing x-ray scale, QLF-D fluorescence loss (ΔF), and DIAGNOdent peak readings were compared and statistically analyzed. RESULTS: Each method showed an excellent reliability. The correlation coefficient between bitewing radiography and QLF-D, DIAGNOdent were −0.644 and 0.448, respectively, while the value between QLF-D and DIAGNOdent was −0.382. The kappa statistics for bitewing radiography and QLF-D had a higher diagnosis consensus than those for bitewing radiography and DIAGNOdent. The QLF-D was moderately to highly accurate (AUC = 0.753 – 0.908), while DIAGNOdent was moderately to less accurate (AUC = 0.622 – 0.784). All detection methods showed statistically significant correlation and high correlation between the bitewing radiography and QLF-D. CONCLUSION: QLF-D was found to be a valid and reliable alternative diagnostic method to digital bitewing radiography for in vitro detection of proximal caries.

Comparison of three diagnostic techniques for detecting occlusal dental caries in primary molars: An in vivo study.

Aim: To compare the accuracy and repeatability of three diagnostic systems; visual inspection, bitewing radiography, and CarieScan PRO for occlusal caries diagnosis in primary molars. Materials and Methods: 216 occlusal surfaces of primary molars examined in turn by two examiners using each of three diagnostic systems (visual inspection, bitewing radiography, and CarieScan PRO). Examiners indicated operative intervention (validation method) for 104 teeth which were used for statistical analysis. The validation method was cavity preparation when the two examiners agreed about the presence of dentinal caries. Sensitivity, specificity, likelihood ratio, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each diagnostic technique. Inter‑ and intra‑examiner repeatability was calculated for each diagnostic system using the Cohen’s kappa statistics. Results: Visual inspection showed the highest sensitivity (0.93). The highest sensitivity and NPVs were provided by CarieScan PRO (0.97 and 0.95, respectively) however this was offset by a lower specificity (0.82) compared to other techniques. The CarieScan PRO gave the highest values of Cohen’s kappa statistics. Conclusion: This study showed low sensitivity but substantial specificity with visual inspection. Bitewing radiography performed poorly overall when compared with the other two systems. The CarieScan PRO technique gave the highest overall combination of sensitivity and specificity for detection of occlusal caries.

Saúde bucal de adolescentes que receberam assistência odontológica na primeira década de vida / Oral health of adolescents who received dental care in first decade of life

O presente estudo realizou uma avaliação clínica cujo propósito foi verificar as condições de saúde bucal de adolescentes que participaram de um programa odontológico de natureza educativa e preventiva. Este programa é dividido em duas fases: sendo que a primeira, compreende o atendimento da criança desde o primeiro ano de vida até completar 4 anos de idade e a segunda fase na Clínica de Prevenção os cuidados odontológicos são mantidos até os 9 anos de idade. Participaram da amostra 201 adolescentes, sendo 56% do gênero feminino e 44% do gênero masculino, que se submeteram a um exame odontológico para avaliar as condições de saúde bucal. O exame odontológico consistiu em uma avaliação da prevalência de cárie dentária pelo índice de CPOD e exame radiográfico interproximal, da saúde gengival pelo índice periodontal comunitário, verificação da oclusão dentária pelo índice de estética dentária e a ocorrência de fluorose dentária (índice da OMS). O índice médio de CPOD dos participantes desta pesquisa foi 1,18. Em relação a condição gengival 86% da amostra apresentou índice de tecido gengival hígido. Na avaliação ortodôntica, 198 pacientes (98,5%) apresentaram overjet maxilar, 1 paciente (0,5%) apresentou overjet mandibular e 2 pacientes (1%) apresentaram mordida aberta anterior. Observou-se também que 92% dos adolescentes não apresentaram fluorose dentária. Pode-se concluir que os pacientes participantes desta pesquisa exibiram índices que refletem, em sua maioria, ótimo estado de saúde bucal.

This study conducted a clinical evaluation whose purpose was to investigate the oral health status of adolescents who participated in an educational and preventive dental program. This program is divided into two phases, the first of which comprises the child’s care from the first year of life until they are 4 years old and in the second phase, dental care are kept in the Preventive Clinic up to 9 years old. The sample included 201 teenagers, 56% female and 44% male, who underwent a dental exam to assess oral health status. The dental exam consisted of an assessment of dental caries prevalence and radiographic bitewing examination interproximal, gingival health by community periodontal index; dental occlusion by dental aesthetics index and dental fluorosis occurrence (WHO index). The participants DMFT index was 1.18. Regarding gingival condition, 86% of the sample presented healthy gum tissue. In orthodontic evaluation, 198 patients (98,50%) presented maxillary overjet, one patient (0.5%) had mandibular overjet and 2 patients (1.0%) had anterior open bite. It was also observed that 92% of adolescents did not have dental fluorosis. It can be concluded that patients participating in this study exhibited indexes that reflect, a great state of oral health.

Evaluation of alveolar crest bone loss via premolar bitewing radiographs: presentation of a new method

PURPOSE: This study aimed to assess the interdental bone level in premolar bitewing radiographs while retracting the cheeks. METHODS: Seventy-two horizontal bone defects were created on dried mandibles and maxillae. The distance from the bone level to the cement-enamel junction of premolars was detected by a modified digital caliper (considered the gold standard). The reliability of all radiographs was assessed by intraclass correlation coefficient (ICC), and the validity was compared to the gold standard using the analysis of variance test. P-values less than 0.05 were considered statistically significant. RESULTS: This study showed that the reliability of radiographs without a cheek simulator and with 0.16 second exposure time was significantly higher than that of the two other groups (ICC=0.96 compared to 0.93 and 0.88, respectively). The results from the radiographs without a cheek simulator and with 0.16 second exposure time were more similar to the gold standard measures than those of the two other groups, although the difference was not statistically significant. CONCLUSIONS: Retracting the buccal soft tissue plays an important role in increasing the accuracy of radiographs in detecting the interdental alveolar bone level and produces more accurate results than increasing the exposure time, although it does not have a significant role in reliability of results.

Diagnóstico clínico e radiográfico na detecção de cáries proximais em molares decíduos e permanentes / Concordance between clinical and radiographic diagnosis for approximal caries in primary molars and first permanent molars

O objetivo deste estudo foi comparar a concordância dos exames clínico e radiográfico na detecção de cáries proximais em molares decíduos e primeiros molares permanentes. Foram selecionadas 200 crianças na faixa etária de 3 a 11 anos de idade, atendidas na Faculdade de Odontologia, da Universidade Federal do Maranhão. Todas as crianças deveriam apresentar os dentes posteriores com as cristas marginais íntegras, independente do estado das superfícies proximais. O exame clínico foi conduzido por um examinador com o auxílio de fio dental e sonda exploradora. A técnica "bite-wing" foi utilizada nas tomadas radiográficas, e a avaliação radiográfica foi realizada por um examinador utilizando negatoscópio e lupa. As características clínicas e radiográficas foram avaliadas, segundo critérios padronizados. Os dados foram analisados pelo teste McNemar com nível de significância de 5%. O exame radiográfico identificou um maior número de cáries proximais em esmalte (p<0,0001) e dentina (p<0,05), quando comparado ao exame clínico. Ao investigar o grau de concordância entre os exames, o exame radiográfico foi mais eficaz no diagnóstico de cáries proximais (p=0,0001). Conclui-se que o exame radiográfico detectou maior número de lesões cariosas proximais em relação ao clínico, sendo considerado um importante diagnóstico complementar para esse tipo de lesão.

This study aimed to compare the clinical and radiographic diagnosis for approximal caries in primary molars and first permanent molars. Two hundred children from 3 to 11 years old assisted by University Of Maranhão School Of Dentistry, were selected. All children should present the posterior teeth with intact marginal ridges, regardless of the status of proximal surfaces. Clinical examination was performed by an examiner using dental floss and dental explorer. The "bite-wing" technique was used in the radiographic examination, and radiographic analysis was performed by an examiner using a light box and a magnifying glass. The clinical and radiographic characteristics were evaluated according to standardized criteria. Data were analyzed by McNemar test with a significance level of 5%. The radiographic examination identified a higher number of proximal caries in enamel (p<0.0001) and dentin (p<0.05) compared to the clinical examination. Regarding the concordance between clinical and radiographic diagnosis, the radiographic examination was more effective in the diagnosis of proximal caries (p=0.0001). It was concluded that radiographic examination detected a higher number of proximal carious lesions in relation to clinical diagnosis, being considered as an important complement for diagnose this type of lesion.

Hidden caries' challenge diagnosis: case report

Introduction: Hidden caries is a term used to describe occlusal dentine caries that is missed on a visual examination, but is large and demineralised enough to be detected by another exam for example, radiographs. Case report: This article reports a case of large dentine caries, which presented as to be a small pit-and-fissure carious lesion on the occlusal surface of the right mandibular permanent first molar in a 10-year-old girl. The treatment included root canal treatment and the sealing of the cavity with composite resin. Conclusion: Careful visual examination, with cleaning and drying of teeth, associated to bitewing radiographs may improve occlusal caries detection. Dentists should examine bitewing radiographs carefully for proximal caries and occlusal demineralization. Radiographs are an effective method of caries diagnosis that can avoid large destruction and allows less invasive treatment.

Desempenho de sistema de diagnóstico óptico para detecção de lesões de cárie / Performance of optical diagnostic systems for detection of caries lesions

O objetivo deste trabalho foi avaliar o desempenho de sistemas de diagnóstico óptico para detecção de lesões de cárie. No estudo in vitro, a viabilidade da transiluminação com laser infravermelho próximo (TI-NIR) para o diagnóstico de lesões iniciais de cárie foi avaliada. Dois examinadores avaliaram 94 sítios na superfície oclusal de molares e pré-molares humanos recém extraídos, classificados com escore 0, 1, 2 ou 3 ICDAS, utilizando um protótipo TI-NIR, a radiografia (RX), o DIAGNOdent Pen (DDPen) e o Quantitative Light-induced Fluorescence (QLF). Para validação, a análise histológica foi considerada como o padrão ouro. A reprodutibilidade intra e interexaminador foi avaliada com o coeficiente Kappa. Concluiu-se que o desempenho da TI-NIR bom, e constitui-se como uma alternativa válida e confiável para o diagnóstico de lesões iniciais na superfície oclusal de dentes permanentes. No segundo estudo, in vivo, o objetivo foi avaliar o desempenho do exame visual com os critérios Nyvad (EV), radiografia interproximal (RX), dispositivo de fluorescência a laser (DIAGNOdent Pen - DDPen) e suas associações no diagnóstico de lesões proximais em dentes decíduos. Para isso, foram selecionadas 45 crianças (n=59 superfícies) de ambos os sexos com idades entre 5 e 9 anos que apresentavam molares deciduos com sinais sugestivos da presença de lesão de cárie ou hígidos. As superfícies foram avaliadas clinicamente e codificadas segundo os critérios Nyvad, e logo depois com o DDPen. O exame radiográfico foi realizado apenas naquelas superfícies codificadas com os escores Nyvad 2, 3, 5 ou 6. Lesões de cárie ativas e/ou com superfície descontinuada foram restauradas, considerando-se a profundidade da lesão como padrão de referência. O desempenho do exame visual, radiográfico e DDpen e suas associações foi bom, porém a utilização dos critérios NYVAD se mostrou suficiente para o diagnóstico de lesões interproximais. Por meio deste trabalho, observou-se que as tecnologias ópticas podem auxiliar no diagnóstico de lesões de cárie

The aim of this study was to evaluate the performance of optical diagnostic systems for detection of caries lesions. In the in vitro study, the viability of the near infrared laser transillumination (TI-NIR) for diagnosis of incipient carious lesions was evaluated. Two examiners evaluated 94 sites in occlusal surface of molars and premolars freshly extracted, selected with score 0, 1, 2 or 3 ICDAS using the TI-NIR prototype, bitewing radiographs (RX), the DIAGNOdent Pen (DDPen) and Quantitative Light-induced Fluorescence (QLF). For validation, histological analysis was considered as the gold standard. The performance of TI-NIR was good, and its constitutes as a reliable and valid alternative for the diagnosis of early lesions in the occlusal surface of permanent teeth. In the second study, in vivo, the performance of the visual examination with the criteria Nyvad (EV), radiographs (RX), laser fluorescence device (DIAGNOdent Pen - DDPen) and their associations in the diagnosis of proximal lesions in deciduous teeth was evaluated. Were selected 45 children (n = 59 surfaces) of both sexes aged between 5 and 9 years who had deciduous molars with signs suggestive of the presence of caries or sound. The surfaces were evaluated clinically and scored with the Nyvad criteria, and DDPen. Radiographic examination was performed only on those surfaces scored with Nyvad 2, 3, 5 or 6. Caries active and / or discontinued surface were restored, considering the depth of the lesion as a reference standard. The performance of visual examination, and radiographic DDpen and their associations was good, but the use of the criteria NYVAD proved sufficient for the diagnosis of interproximal lesions. It could be observed that optical technologies appear to contribute positively in the diagnosis process in the diagnosis of caries. However, they should be considered as adjuncts to conventional methods in this process

Accuracy of radiographic examination in determining the depth ofapproximal carious lesions in primary molars / Desempenho do exame radiográfico na determinação da profundidade de lesões de cárie proximais em molares decíduos

Objective: The purpose of this study was to evaluate the accuracy of the depth of carious lesions on bitewing radiographs. Methods: Recently extracted primary molars had their proximal surfaces evaluated visually (EC) and classified as healthy surface (0), signs that suggest thepresence of carious lesions in enamel (1), signs of a superficial lesion in dentin (2) and carious lesions in deep dentin (3). Results: The results were obtained by consensus between the investigators. The gold standard was determined by histological analysis. The valuesof sensitivity, specificity, accuracy and area under the ROC (Receiver Operating Characteristic) curve were evaluated. There was equilibriumbetween sensitivity (76.92% EC and 88.46% ER) and specificity (95.83% EC and 95.83% ER). Accuracy was 86.01% (EC) and 88.46% (ER).The Spearman correlation test was used to prove the correlation between clinical and radiographic examinations (0.886), for clinical andhistological (0.736) and for radiographic and histological analysis (0.843).Conclusion: The radiographic examination showed better performance in detection of proximal caries in primary teeth.

Objetivo: Avaliar a exatidão da profundidade da lesão de cárie em radiografias interproximais. Métodos: Molares decíduos recentemente extraídos tiveram suas superfícies proximais avaliadas visualmente (exame clínico) e classificados como superfície hígida (0), sinais que sugerem presença de lesão de cárie em esmalte (1), sinais de lesão superficial em dentina (2) e cavidades sugerindo lesões profundas em dentina (3). As superfícies dentárias foram também examinadas em radiografias interproximais (exame radiográfico) e classificadas como ausência de radiolucidez (0), lesão de cárie em esmalte (1), lesão de cárie superficial em dentina (2) e lesão de cárie em dentina profunda (3).Resultados: Os resultados foram obtidos por meio de consenso entre os examinadores. O padrão ouro foi determinado pela análise histológica. Foram avaliados os valores de sensibilidade, especificidade, acurácia e área sob a curva Receiver Operating Characteristic. Observou-se um equilíbrio entre os valores de sensibilidade (76,9% exame clínico e 88,4% exame radiográfico) e especificidade (95,8% exame clínico e 95,8% exame radiográfico). A acurácia foi de 86,0% (exame clínico) e 88,4% (exame radiográfico). O teste de correlação de Spearman foi utilizado paraa comprovação da correlação entre os exames clínico e radiográfico (0,89), para clínico e histológico (0,7) e para os exames radiográfico ehistológico (0,8). Conclusão: O exame radiográfico apresentou melhor desempenho na detecção da lesão de cárie proximal em dentes decíduos.

Diagnóstico de lesão de cárie proximal por imagem: Revisão Sistemática / Lesion of approximal cries' diagnosis by image: A Sistematic Review

O diagnóstico de lesões cariosas proximais incipientes continua sendo um grande desafio para a Odontologia, principalmente devido à impossibilidade do acesso visual durante o exame clínico. Dessa forma, exames complementares por imagem assumem papel importante como meio auxiliar ao diagnóstico dessas lesões. O objetivo deste estudo foi avaliar as diretrizes propostas para o diagnóstico da cárie proximal por imagem mediante uma revisão sistemática da literatura dos últimos cinco anos.

The diagnosis of incipient proximal caries remains a major challenge for dentistry, mainly due to the impossibility of visual access during the clinical examination, and imaging methods play an important role as an aid to diagnosis of these lesions. The aim of this study was to evaluate the guidelines for the diagnosis of proximal caries' image through a systematic review of the literature produced at the last five years.

Assessment of enamel-dentin caries lesions detection using bitewing PSP digital images

OBJECTIVES: The aim of this study was to evaluate the detection of enamel-dentin occlusal caries using photostimulable phosphor plates. MATERIAL AND METHODS: The ability to detect enamel-dentin occlusal caries in 607 premolars and molars from 47 patients between 10 and 18 years old, referred to the School of Dentistry of the Federal University of Bahia, Brazil, was evaluated based on clinical and radiographic examinations, using the criteria proposed in a previous study. A total of 156 bitewing digital images were obtained using Digora® (Soredex Medical Systems, Helsinki, Finland) phosphor plates. The plates were scanned and the images were captured and displayed on a computer screen. Image evaluation was done using Digora® for Windows 2.1 software, Soredex®. The radiologists were allowed to use enhancement tools to obtain better visibility during scoring of the teeth based on the radiographic criteria proposed in a previous study. Descriptive analysis and chi-squared proportion tests were done at 5 percent significance level. RESULTS: The results of clinical examination showed a higher prevalence of teeth with a straight dark line or demineralization of the occlusal fissure (score 1) and a lower prevalence of sealed teeth (score 5). In the bitewing digital images, 47 teeth presented visible radiolucency, circumscribed, in dentin under occlusal enamel (enamel-dentin caries lesions). CONCLUSIONS: Correlating the clinical and radiographic findings, it was found that in the majority of teeth diagnosed by radiographic images as having enamel-dentin caries, no caries could be detected by clinical examination.

Cárie Proximal em Dentes Decíduos Posteriores: Diagnóstico e Fatores Associados / Approximal Caries in Primary Posterior Teeth: Diagnosis and Associated Factors

Objetivo: O objetivo desse estudo foi avaliar as lesões de cárie proximais posteriores em dentes decíduos, comprovar a melhora no diagnóstico clínico com o uso da imagem radiográfica interproximal e verificar associações com variáveis demográficas, socioeconômicas, clínicas e com o relato de frequência de escovação e do uso do fio dental. Método: Cinquenta crianças com idades entre cinco e oito anos, atendidas na Clínica Infantil da Faculdade de Odontologia da Universidade Federal de Pelotas, foram submetidas ao exame clínico e radiográfico interproximal bilateral realizado pelo único operador treinado, seguindo técnica padronizada. Dados demográficos e de higiene bucal foram coletados da entrevista com a mãe. O diagnóstico da imagem radiográfica foi conduzido por dois avaliadores calibrados (Kappa 0,85), a partir dos critérios de Rolla et al.,1996 modificados. Os resultados foram analisados utilizando de estatística descritiva e teste T (α=0.05). Resultados: Houve incremento de lesões de cárie proximais posteriores com o exame radiográfico, de 5,48 para 6,14 (p=0,001), ou seja, 25% das lesões. Dessas, 84,6% eram lesões em esmalte e 10,8% lesões em dentina. As lesões de cárie proximais posteriores em dentes decíduos mostraram-se associadas com a faixa etária (p=0,005), aumentando de 4,29 (5-6 anos) para 7,48 (7-8anos), com o estágio de irrupção dos primeiros molares permanentes (p=0,018), com a presença de sangramento gengival (p=0,040) e com a escolaridade materna (p=0,049). Não houve associação com o sexo, renda e com o relato da frequência de escovação e do uso do fio dental. Conclusão: Mesmo considerando a dificuldade técnica, a radiografia interproximal incrementa o diagnóstico clínico de lesões proximais posteriores em crianças

Objective: The aim of this study was to evaluate the posterior approximal caries in primary teeth, show improvement in clinical diagnosis with the use of radiography bitewing and explore associations with demographic, socioeconomic, clinical and reporting of frequency of brushing and flossing. Method: Fifty children (5 to 8 years old), attending in the Pediatric Clinic of the College of Dentistryû Federal University of Pelotas, were clinically examined and a bilateral bitewing radiographic was taken by one previously trained operator with a standard technique. Demographic data and information on oral hygiene were collected from an interview answered by the childrenÆs mothers. The diagnostic assessment from the radiographic images was conducted by 2 calibrated examiners (Kappa 0.85), following Rolla et al., 1996 modified criteria. Results were analyzed with descriptive statistics and t test (α=0.05). Results: Posterior approximal caries identification increased with the bitewing examination, from 5.48 to 6.14 (p=0.001). From the 25% lesions detected with the radiographic exam, 84.6% were enamel lesions and 10.8% were dentine lesions. Posterior approximal caries in primary teeth showed statistically significant association with: age range (increasing from 4.29 at 5-6 years to 7.48 at 7-8 years, p=0.005); first permanent molars eruption stage (p=0.018); the gingival bleeding (p=0.040); and with mother´s educational level (p=0.049). Associations with gender, family income, frequency of brushing and use of dental floss were not observed (p>0.05). Conclusion: Even considering the difficulties of the technique, bitewing radiographs improve the clinical diagnosis of posterior approximal carious lesions in children

Diagnostic performance of cone-beam computed tomography on detection of mechanically-created artificial secondary caries

PURPOSE: The aim of this study was to compare the diagnostic accuracy of cone-beam computed tomography (CBCT) images and bitewing images in detection of secondary caries. MATERIALS AND METHODS: One hundred and twenty proximal slots of Class II cavities were randomly prepared on human premolar and molar teeth, and restored with amalgam (n=60) and composite resin (n=60). Then, artificial secondary caries lesions were randomly created using round steel No. 4 bur. The teeth were radiographed with a conventional bitewing technique and two CBCT systems; Pax-500ECT and Promax 3D. All images were evaluated by five observers. The area under the receiver operating characteristic (ROC) curve (Az) was used to evaluate the diagnostic accuracy. Significant difference was tested using the Friedman test (p value<0.05). RESULTS: The mean Az values for bitewing, Pax-500ECT, and Promax 3D imaging systems were 0.882, 0.995, and 0.978, respectively. Significant differences were found between the two CBCT systems and film (p=0.007). For CBCT systems, the axial plane showed the greatest Az value. CONCLUSION: Based on the design of this study, CBCT images were better than bitewing radiographs in detection of secondary caries.