Impact of Magnifying Loupes on Interexaminer Agreement in the Detection of Noncavitated Occlusal Carious Lesions.

PURPOSE: This study aimed to assess the impact of using magnifying loupes on interexaminer agreement in the detection of noncavitated occlusal carious lesions. MATERIALS AND METHODS: A total of 155 permanent molars with no frank cavitation were selected for the study. Five examiners with different specialties and experience each examined the occlusal surfaces twice using International Caries Assessment and Detection System (ICDAS) criteria. The first examination used no magnification. The second examination, performed 4 weeks after the first, used 2.5X magnifying loupes. Later, the teeth were sectioned and inspected for caries using a stereomicroscope. The data were analysed using statistical analysis software to calculate intra-examiner reproducibility and interexaminer agreement as well as univariate marginal distribution and marginal homogeneity maximum Kappa (Kmax) statistics with and without the loupes. RESULTS: The Kmax scores for 4 of the 5 examiners showed bias compared to the histological results, with a greater likelihood of diagnosing a tooth as sound in the presence of caries (Kmax 0.26-0.73 and 0.19-0.65 with and without the loupes, respectively). For intra-examiner reproducibility, the linear weighted kappa ranged from (0.34-0.65) . Interexaminer agreement was poor both with and without the loupes. CONCLUSIONS: The use of magnifying loupes did not improve interexaminer agreement in ICDAS scores for noncavitated occlusal carious lesions.

Layered Base Plate Blocks and Operative Dentistry Skills.

AIM: Preclinical dental training is essential for the development of psychomotor skills necessary for clinical practice. The study aimed to investigate the impact of teaching with a layered base plate blocks on cavity preparations and students' self-perceived confidence, readiness, and ability. MATERIALS AND METHODS: A cross-sectional study recruited 52 dental students into two groups; one trained (test) with layered base plate and the other without (control). Students answered an eight-question survey to assess self-perceived confidence, readiness, and ability for performing cavity preparation at the start of their first preclinical operative dentistry course. Students prepared one molar tooth for a class I cavity and two for class II cavities. Preparations were assessed for different elements of depth and outline extension by two blinded examiners. RESULTS: Statistically significant differences were found between the median scores with respect to the preparation of class II cavities among students exposed to layered base plate (Mann-Whitney U-test, p < 0.05). There were no significant differences between the median scores awarded with respect to the preparation of class I cavity. A statistically significant difference was reported in self-perceived confidence among students who trained with the layered base plate (x2, p < 0.05). CONCLUSION: Training on the layered base plate blocks increased students' initial confidence level in performing cavity preparations, and improved the preparation skills in class II cavity. CLINICAL SIGNIFICANCE: This study explores the methods of enhancing motor skills taught in preclinical operative dentistry courses, especially in short academic programs.

Variables affecting the inter- and intra-examiner reliability of ICDAS for occlusal caries diagnosis in permanent molars.

OBJECTIVES: The aims of this study were to assess the validity and reproducibility of the International Caries Detection and Assessment System (ICDAS) in detecting occlusal caries in permanent molars and to investigate variables that can affect the reproducibility of ICDAS. METHODS: Five experienced, trained, and calibrated investigators examined the occlusal surfaces of 142 extracted permanent molars, ranging from sound to cavitated dentine caries. All visual examinations were conducted under standard conditions. Examinations were repeated after a period of 1 and 3 months from the initial examination. After all examinations were completed, teeth were sectioned and histologic validation was undertaken. Maximum kappa statistics were used to assess bias among examiners and linear weighted kappa was used to assess inter- and intra-examiners' reproducibility. Sensitivity, specificity, accuracy and area under the receiver operating characteristic curve were obtained at D3 threshold. RESULTS: Differences in the marginal homogeneity were observed for the general dentist. Kappa for intra-examiner reproducibility ranged between 0.66 and 0.81 and the inter-examiner reproducibility ranged between 0.42 and 0.75. ICDAS score of ≥3 presented the best Spearman's correlation coefficient (0.69) at Downer's histologic classification D3. Corresponding sensitivity and specificity values at that level were 0.73 and 0.95, respectively. While variables like the interval of time between teeth examinations did not affect the intra-examiner reproducibility, examiners' specialty influenced inter-examiner's reproducibility over time. CONCLUSIONS: ICDAS presented acceptable intra-examiners reproducibility in detecting occlusal caries over time. However, there was a clear effect for examiner's specialty and clinical experience on the inter-examiner's reproducibility of the ICDAS system at different time intervals.

Restorative treatment thresholds: factors influencing the treatment thresholds and modalities of general dentists in Kuwait.

OBJECTIVES: This study investigated the thresholds at which general dentists in Kuwait would restore approximal and occlusal carious lesions and examined the demographic characteristics of the dentists in relation to their decision making. SUBJECTS AND METHODS: The study population consisted of a random sample of 185 general dentists practicing in the Ministry of Health of Kuwait. A survey questionnaire was administered. The questionnaire presented different stages and locations of carious lesions; the participants were asked to identify the stage at which a restoration is required under different conditions, the preparation technique, and their choice of restorative material. RESULTS: For approximal carious lesions, 74 (40%) of the participants reported that they would restoratively intervene when the carious lesion reached the outer third of the dentin. A total of 91 (49.2%) reported the use of traditional class II restorations. For occlusal carious lesions, 128 (69.2%) said they would intervene when lesions reached the middle third of the dentin. 146 (78.9%) said they would remove the carious tissue only in their preparation. For both approximal and occlusal lesions, the participants preferred resin composite as the material for restoration. CONCLUSIONS: The respondents tended to delay restorative intervention until dentinal penetration of the caries. Resin restorative materials were used in conservatively prepared cavities. Participants chose a conservative approach for occlusal lesions but still believed in a traditional approach when it concerned approximal lesions. Experience, university dental education, and participation in continuous education courses were most significantly related to restorative treatment.

Factors relating to usage patterns of amalgam and resin composite for posterior restorations--a prospective analysis.

OBJECTIVES: This study prospectively analyzed the use of amalgam and resin composite posterior restorations placed by general dentists in relation to dentist, patient and cavity factors. METHODS: One thousand posterior restorations placed by a representative sample of general dentists working in the Ministry of Health (MOH), Kuwait, during routine clinical practice were included. Information about the restorations was recorded using a survey questionnaire. Descriptive statistics and multivariate logistic regression analysis were used to determine the factors associated with the use of amalgam versus tooth coloured restoratives. RESULTS: Dentists chose amalgam for 30.8% of the 1000 restorations. Dentists with longer work experience (>15 years) were more likely to choose amalgam (OR=2.61, 95% CI=1.06, 6.40). Younger dentists (≤30 years) were less likely to choose amalgam (OR=0. 45, 95% CI=0.26, 0.77). Amalgam was more likely to be chosen for patients with poor oral hygiene (OR=1.58, 95% CI=1.08, 2.32) and a higher number (≥4) of restorations (OR=1.44, 95% CI=1.07, 1.94) with large cavity sizes (OR=6.33, 95% CI=3.88, 10.32). Tooth-coloured restorations were more likely to be chosen for cavities of smaller sizes. CONCLUSIONS: The use of resin composite materials as the dominant choice among dentists in Kuwait reflects the trend worldwide. Nevertheless, clinicians still find a use for amalgam in posterior load-bearing teeth and in the high-caries risk population. CLINICAL SIGNIFICANCE: The findings give insight into factors influencing material usage under different clinical conditions and provides information about the perceived deficiencies or shortcomings of resin composite materials in a general dental practice setting. This information can be useful for identifying perceived barriers to the usage of newer restorative materials and finding ways to overcome them.

Effect of LED curing modes on cusp deflection and hardness of composite restorations.

This in vitro study measured cusp deflection associated with MOD resin composite restorations in maxillary premolars with different curing light modes. Soft-start polymerization may reduce cusp deflection by reducing polymerization shrinkage stress. Forty maxillary premolars were mounted in stone and slot MOD cavities were prepared. The teeth were randomized into four groups: Group A--cavities were etched, bonded and restored with two increments of Z-100 composite. Each increment was cured with an LED curing light (fast curing mode). Group B--similar to Group A except that the LED curing light with pulse curing mode was used. Group C--similar to Group A except that the LED curing light with stepped curing mode was used. Group D--a visible curing light was used for curing the composite. The distance between the indexed cusp tips was measured before the restorations were completed and five minutes after, 24 hours after and two weeks after completion of the restorations. The mean contraction of the cusps in microm at five minutes, 24 hours and two weeks, respectively, for each group was A: 25.4, 16.2 and 8.2, B: 6.4, 3.4 and 2.2, C: 11.6, 7.0 and 4.4, D: 33.0, 21.6 and 15.8. Group D resulted in the highest deflection, Group A was intermediate and Groups B and C were the lowest. Ten samples of the composite for each group with 2-mm thickness were prepared for the Vickers hardness test. No difference among the samples was found.