Abstract
This study determined the validity of marginal ditching and staining as criteria for the diagnosis of secondary caries around amalgam restorations. One hundred and twenty-four Class I amalgam restorations on extracted human teeth were submitted to standardized clinical examinations. A calibrated examiner recorded the presence of ditching in the tooth/restoration interface, the occurrence of bluish-grey staining on the occlusal surface, and their relationship with the presence and severity of secondary carious lesions. Examinations were repeated after 4 days to calculate the intra-examiner reliability. Stereomicroscopic inspection of the serial tooth sections was used as the gold-standard. Six teeth were lost during the study. Of the 118 remaining teeth, 19 (16%) showed occlusal bluish-grey staining and 26 showed more than 0.20 mm wide marginal ditches. Of the latter, 14 presented narrow ditches (0.20-0.45 mm), while 12 presented wide ditches (0.45 mm). The evaluation criteria presented low sensitivity and positive predictive values. Positive and negative likelihood ratios showed that the criteria exhibited, indistinctly, the same odds to determine a positive or negative result for a diseased or healthy tooth. It was concluded that marginal ditching and staining were not valid criteria for the diagnosis of secondary caries around occlusal amalgam restorations.
Highlights
Amalgam restoration is still considered one of the main restorative treatment options in several dental practices, due to its low cost and long-term cost-effectiveness
Marginal ditches wider than 50 μm at the tooth/amalgam interface correlate with the presence of recurrent caries [2]
Gingival margins of Class II and Class V are at higher risk of having secondary caries, which is proportional to the degree of marginal damage, whereas no such relationship exists on occlusal surfaces [1]
Summary
Amalgam restoration is still considered one of the main restorative treatment options in several dental practices, due to its low cost and long-term cost-effectiveness. The clinical diagnosis of secondary caries has been the most common indication for replacement of amalgam restorations [1]. Secondary caries are derived from the action of cariogenic biofilms at the restoration margins. The determination of lesion extension is hindered by the presence of restoration and can be observed only when an advanced stage is reached, causing enamel discoloration, cavitation, and even dental fracture. The relationship between the width of the marginal defect and the presence of secondary carious lesions has been verified by clinical and laboratory studies. Marginal ditches wider than 50 μm at the tooth/amalgam interface correlate with the presence of recurrent caries [2]. Some authors have stated that the presence of defective margins does not necessarily indicate need
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