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

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.

Restorative Treatment Decisions in Posterior Teeth: A Systematic Review.

PURPOSE: To determine the stage of caries in posterior permanent teeth at which dentists decide to intervene invasively. MATERIALS AND METHODS: A search of the literature from January 1980 to November 2015 available in MEDLINE-PubMed, EMBASE, and the Cochrane Library was conducted. The main search terms used were decision-making, restorative treatment, dental caries lesion, occlusal surface, and approximal surface. The inclusion criterion was studies including dentists only. Three reviewers independently screened titles and abstracts to determine the eligibility of studies. Subsequently, the full texts of the papers deemed eligible were perused and included in the data extraction process. RESULTS: The review encompassed 11 studies and the methodological quality was considered moderate. Most dentists would restore lesions confined to enamel and reaching the outer half of the dentin, irrespective of the surface involved. With regard to the occlusal surface, the percentage of dentists who restored enamel lesions ranged from 4.6% to 17.8%. Regarding dentin lesions (outer half), 50.2%-70.2% of the dentists opted for invasive treatment. For the approximal surface, the choice for invasive treatment of enamel lesions ranged from 5%-88%. In dentin lesions, 4.4%-94% of dentists restored lesions in the outer half of the dentin. CONCLUSION: Despite the progress achieved in the understanding of the development and management of caries, dentists still recommend restorative treatment in its early stages.

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.

Radiolucent halos beneath composite restorations do not justify restoration replacement.

PURPOSE: To determine the correlation between the presence of radiolucent areas (RA) beneath composite restorations and gaps and remaining demineralized tissue (RDT). METHODS: 50 extracted teeth (sound and carious) were studied. After caries removal, cavities were filled. Artificial cavities were created and filled in the sound teeth. Samples were sectioned and analyzed with stereomicroscopy. RESULTS: Gap/RDT was observed in 38.9% [95% confidence interval (CI) =28.2-50.5] and 68.9% (95% CI = 57-78.6) of sound and carious teeth, respectively, (P = 0.001). Gap/RDT was associated with RA (P < 0.001). Sensitivity, specificity, predictive positive values (PPV), predictive negative value, and accuracy for carious teeth were 77.1% (95% CI = 63.7-87.3), 54.5% (95% CI = 33.8-74.1), 78.7% (95% CI = 65.3- 88.7), 52.2% (95% CI = 32.1-71.7), and 70% (95% CI = 58.5-79.8), and for sound teeth were 73.7% (95% CI = 62.9-82.6), 59.1% (95% CI = 47.0-70.4), 67.5% (95% CI = 56.9-76.9), 66.1% (95% CI = 53.4-77.3), and 66.9% (95% CI = 58.9-74.3). Only the PPV differed between the sound and carious teeth (P = 0.024).There was a correlation between radiolucency and gap/RDT, but a high number of false positives were found.

Results after two years of non-operative treatment of occlusal surface in children with high caries prevalence.

The aim of this study was to describe the 2-year results of an individualized treatment program designed to control occlusal caries in erupting first permanent molars. The sample consisted of 145 five-to-six-year-old students divided into a control group (n = 71) and a test group (n = 74). All test children received a biannual basic preventive program and a recall system according to individual disease activity. The basic program consisted of 3 (March) and 2 (August) sessions of oral hygiene orientation and toothbrushing with fluoride gel. The analysis of the baseline and 1-2-year data showed a significant reduction in the number of active lesions in the test group. In the control group, there were initially 70 active lesions and after two years 68 surfaces remained with disease and 24 surfaces had been filled. The children in the test group had 80 surfaces with active lesions initially and after two years only 3 surfaces with disease remained. From the 15 cavitated lesions, only 5 surfaces needed to be filled. This program showed that care of erupting teeth on an individualized basis can control occlusal caries.