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.

In vitro effect of amorphous calcium phosphate paste applied for extended periods of time on enamel remineralization

Abstract Dental applications based on the unique characteristics of amorphous calcium phosphate stabilized by casein phosphopeptides (CPP-ACP) have been proposed, as well as the improvement of its properties. Objectives: The objective of this study was to determine the ability of topically applied CPP-ACP from a commercial product to remineralize subsurface lesions when applied for extended periods of time (3 h and 8 h). Material and Methods: Artificially induced carious lesions were produced in 50 bovine enamel blocks previously selected by surface hardness. After treatments with gel without F and CPP-ACP applied for 1 minute (Placebo); 2% NaF neutral gel applied for 1 minute (Fluoride 1 min); CPP-ACP applied for 3 min (ACP 3 min); and CPP-ACP applied for 3 h (ACP 3 h) and for 8 h (ACP 8 h), the enamel blocks were submitted to the remineralization pH-cycling. Surface hardness and synchrotron micro-tomography were used to determine the percentage of surface hardness recovery (%SHR) and to calculate mineral concentration (gHAp.cm−3), respectively. The data were submitted to ANOVA followed by the Student-Newman-Keuls test (p<0.05). Results: Fluoride gel presented higher %SHR followed by ACP 3 min (p<0.001). No difference (p = 0.148) was found for Placebo, ACP 3 h and ACP 8 h groups for %SHR. Fluoride gel showed greater mineral concentration (p<0.001) when compared with the other groups. ACP 3 min demonstrated a significant difference (p<0.001) from ACP 3 h and ACP 8 h. The ACP 3 h and 8 h presented a subsurface lesion with development of laminations in all blocks. Conclusion: In this in vitro study the use of CPP-ACP for extended periods of time did not produce an additive effect in the remineralization process.

A randomized clinical trial on the sealing of occlusal carious lesions: 3-4-year results

Abstract This randomized clinical trial aimed to assess the efficacy of sealing occlusal carious lesions in permanent teeth. The sample consisted of 54 occlusal carious lesions in permanent molars and premolars of 49 patients aged 8–43 years (median: 19 years). The inclusion criteria comprised the presence of a cavity with no access allowing biofilm control. The maximum depth of the lesion was the middle third of the dentin thickness, as assessed by bitewing radiography. The teeth were randomly assigned to sealant treatment (n = 28) or restorative treatment (n = 26). Clinical and radiographic examinations were performed after 1 year and after 3–4 years. The outcomes depended on the clinical performance of the sealant/restoration and the control of caries progression observed radiographically. Survival analysis was performed to assess success rates. Over the 3-4 years of monitoring, 2 sealants were totally lost, 1 needed repair, and 1 showed caries progression, totaling 4 failures in the sealant group. In the restoration group, 1 failure was observed (in need of repair). The success rates were 76% and 94% in the sealant and the restoration groups, respectively (p > 0.05). The sealing of occlusal carious lesions in permanent teeth succeeded in controlling caries over a 3–4-year period. However, sealed carious lesions require patient compliance in attending regular follow-ups to control the occurrence of clinical failures of the sealants.

Reliability of Logicon caries detector in the detection and depth assessment of dental caries: An in-vitro study.

Background: Digital radiography has so far not resulted in improved rates of proximal caries detection. Historically, automated caries detection tools have been largely academic. Opinions regarding the performance of the only such commercially available tool, viz., Logicon caries Detector (LCD) have been equivocal. This study was conducted to evaluate the reliability of LCD in the detection and depth assessment of proximal caries. Materials and Methods: Digital images were obtained of 100 proximal tooth surfaces using the Kodak RVG 5000 sensor and analyzed by three observers. The images were then analyzed by the principal investigator using the LCD software. The teeth were then sectioned and magnified photographic images were obtained which were taken as the gold standard. All the grades were entered in proformas and the data were statistically analyzed using the chi-square test. Five parameters of reliability were calculated. Results: The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of LCD for the grade No caries were 33, 96, 73, 82, and 81%, respectively; for the grade Enamel caries were 5, 97, 33, 80, and 79%, respectively; and for the grade Dentin caries were 100, 96, 50, 100, and 96%, respectively. Conclusions: In conclusion, LCD appears to be more reliable in ruling out (both enamel and dentin) caries than in detecting caries.

A color contrast aided density imaging technique to differentiate between dental hard tissues and its relevance.

Aim: Radiographic interpretation of a disease requires knowledge about normal structures. The calcifying jaw diseases can range from radiolucent areas to varying degrees of calcification. Therefore, it is vital to differentiate radiographically between various hard tissues. Materials and Methods: We have illustrated the use of computed tomography scan to quantify the calcified structures as dentin and enamel in a case of ameloblastic fibro-odontoma. Results: The enamel, dentin and cementum showed different values. Conclusion: The "Dentascan" can be used to distinguish the hard tissues in a variety of calcifying diseases of jaws.

The relative diagnostic yields of clinical, FOTI and radiographic examinations for the detection of approximal caries in youngsters.

Background: The detection of carious lesions in the initial stages of development is very important in order to prevent the occurrence of cavitation. Aims and Objectives: The aim of the present study was to compare three methods-visual examination, FOTI, and bitewing radiographic examination-for the detection of noncavitated and cavitated approximal carious lesions. Materials and Methods: Seventy students (mean age 14 years) with low caries prevalence were examined by three examiners. The tooth surfaces judged as having caries by at least one examiner or one diagnostic method were scheduled for tooth separation. Results: The results showed that the incorporation of FOTI and radiographic examination represented an additional diagnostic yield of 50% and about 110%, respectively, compared to clinical examination alone. Conclusion: We conclude that FOTI or radiographic examination, or both, used as adjuncts to clinical examination, could improve the detection of noncavitated and cavitated approximal carious lesions. Although FOTI should not replace bitewing radiographic examination, it does seem to have additional value for the detection of carious lesions on approximal surfaces of the posterior teeth in school children with low caries prevalence.

[Determination of sexual dimorphism from maxillary premolars thickness in bitewing radiography]

Sexual dimorphism plays an important role in forensic medicine. Sexual differences in the human skeleton have been well studied in many populations but odontometric analysis of the human sexual variation has been less investigated. This study was designed to determine the sexual dimorphism by enamel and dentin thickness in radiography of maxillary premolars in an Iranian sample.For this descriptive and analytic study, 100 individuals, [so males and so females] aged 20 to 35 years old, from an Iranian population were selected. The bitewing radiographs of the right permanent maxillary premolars were taken under standard conditions using a film holder. The radiographs were digitally scanned, and after calculation of image magnification, maximum mesiodistal diameter of dentin, and mesial and distal enamel margins were measured. Data were analysed by SPSS statistical software using T- test and Step function. Mesiodistal dentin dimension was significantly greater in males, but there was no sexual dimorphism in the maximum mesiodistal diameter of crown, and distal margin of enamel. Enamel was significantly thicker on the mesial margin in females. First premolar displayed greater sexual dimorphism than second premolar. According to the study results, for determining sexual dimorphism in forensic medicin, the mesiodistal dentin dimension as well as the width of the enamel mesial margin of upper premolar teeth are acceptable parameters in Iranian population