Abstract
The aim of this study was to investigate the efficiency of different diagnostic methods in detection of residual dentinal caries in excavated cavities. Fifty extracted molar with deep dentinal carious lesions were excavated using a slow-speed handpiece. All cavities were assessed by laser fluorescence(LF) device, electronic caries monitor(ECM), and caries detector dye(CDD) by three independent observers blindly. The measurements were repeated after two weeks. Specimens containing dentin slices 150 μm in thickness were prepared for histological analyses. The existence and absence of carious dentin was determined using a lightmicroscope. The average intraobserver accuracy was 1.00 (perfect agreement) for CDD, 0.86 (excellent agreement) for ECM, and 0.50 (good agreement) for LF. The average interobserver accuracy values were 0.92 (excellent agreement), (0.36 marginal agreement) and 0.48 (good agreement), for CDD, ECM, and LF, respectively. The average specificity was 0.60 for CDD, 73% for ECM, and 0.50 for LF. The average sensitivity was 0.55 for CDD, 0.85 for LF, and 0.47 for ECM. The average accuracy values were 0.53, 0.51, and 0.81 for CDD, ECM, and LF, respectively. LF had the greatest sensitivity and accuracy values of any of the methods tested. As a conclusion, LF device is appeared to most reliable method in detection of remain caries in cavity. However, because of its technical sensitivity it may susceptible to variations in measurements. To pay attention to the rule of usage and repeated measurements can minimize such variations in clinical practice. It was concluded that LF is an improvement on the currently available aids for residual caries detection.
Highlights
The main aim of a dentist is to remove the irreversibly demineralised superficial tissue and to remove the highly infected biomass of carious dentin during the carious process
The highest intra- and interobserver accuracy values were observed in caries detector dye (CDD)
An objective and accurate technique to aid the clinician in differentiating heavily infected dentin from affected dentin during excavation is still needed. This present study aimed to investigate the efficiency of different diagnostic methods in detection of residual dentinal caries in excavated cavities
Summary
The main aim of a dentist is to remove the irreversibly demineralised superficial tissue and to remove the highly infected biomass of carious dentin during the carious process. Long-term prognosis of the final restoration is adversely affected [1, 2] This assumes that the bacteria within the dentin are important. The weight of experimental evidence might suggest that the bacteria in the biofilm are what matters [3], some authors accept that this statement is controversial. It appears that lesion progression can be arrested either by simple removal of the biofilm or by the sealing of bacteria within the cavity and restoration of the tooth so that regular removal of the biofilm is possible [2]. In 1859, Tomes [4] wrote “it is better that a layer of discolored dentine should be allowed to remain for the protection of the pulp rather than run the risk of sacrificing the tooth”, but in 1908, Black [5] disagreed claiming “... it is better that it is removed of all decayed dentine overlaying”
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