Caries Depth Research Articles

Pulpal status of human primary molars with coexisting caries and physiological root resorption

This study sought to investigate the effect of caries, in association with physiological root resorption, on the pulpal status of human primary molars. Fifty-three mandibular primary molars were obtained from children requiring extractions under general anaesthesia. Following extraction, teeth were split longitudinally and placed in Zamboni's fixative. Teeth were categorised according to i) the depth of caries (less than or greater than halfway through dentine thickness) and ii) the degree of physiological root resorption (<33%, 34-66% or >67% of the root length). Ten-micrometre pulp sections were subject to indirect immunofluorescence using a combination of PGP 9.5 (a general neuronal marker), CD45 (a general neuronal marker), and Ulex europaeus agglutinin I (a marker of vascular endothelium). Image analysis was used to determine the percentage area of staining (PAS) for innervation and immune cells. Marked differences were seen between different samples, but there were no significant differences in mean PAS for PGP 9.5 or CD45 according to the degree of caries or extent of physiological root resorption (two-way anova, P > 0.05). Findings suggest that even if primary molars are undergoing exfoliation, they show comparable caries-induced changes to teeth without physiological root resorption, thus retaining potential for healing and repair.

Noninvasive cross‐sectional imaging of proximal caries using swept‐source optical coherence tomography (SS‐OCT) in vivo

The aim of this study was to determine the diagnostic accuracy of swept-source optical coherent tomography (SS-OCT) in detecting and estimating the depth of proximal caries in posterior teeth in vivo. SS-OCT images and bitewing radiographs were obtained from 86 proximal surfaces of 53 patients. Six examiners scored the locations according to a caries lesion depth scale (0-4) using SS-OCT and the radiographs. The results were compared with clinical observations obtained after the treatment. SS-OCT could detect the presence of proximal caries in tomograms that were synthesized based on the backscatter signal obtained from the proximal carious lesion through occlusal enamel. SS-OCT showed significantly higher sensitivity and larger area under the receiver operating characteristic curve than radiographs for the detection of cavitated enamel lesions and dentin caries (Student's t -test, p < 0.05). SS-OCT appears to be a more reliable and accurate method than bitewing radiographs for the detection and estimation of the depth of proximal lesions in the clinical environment.

In vitro Comparison of Conventional Film and Direct Digital Radiography in Proximal Caries Detection

Introduction: Various systems for intraoral digital radiography have been available as an alternative to film-based radiography. In consideration of several advantages of digital radiography such as less patient absorbed dose, manipulation of im- age quality and elimination of processing, it has been extensively used in different fields of denti- stry in recent years. The purpose of this study was comparison of conventional film and digital radiography in the proximal caries diagnosis. Materials and Methods: In this in vitro study, 60 extracted premolar teeth were selected and mounted in acrylic blocks. The teeth were radio- graphed using F-speed film and a complementary metal oxide semiconductor digital sensor (CMOS). Two observers evaluated interproximal surfaces for detection of presence and extent of caries. True caries depth was determined by his- tological examination. The diagnostic accuracy of each radiographic system were assessed by means of receiver operating characteristic curve (ROC) analysis. Results: There was no significant difference be- tween two imaging modalities. The AZ values in cases without caries and dentinal caries were greater than caries restricted to enamel and Den- tino Enamel Junction (DEJ). The differences among observers also were not statistically sig- nificant. Conclusion: Both imaging modalities were com- parable in the detection of proximal carious le- sions.

Comparative study of the effect of direct and indirect digital radiography on the assessment of proximal caries

IntroductionClinical assessment of proximal tooth contacts leads to unacceptable false negative results especially in cases of tight proximal contacts where precise clinical assessment is not possible. Therefore radiographic evaluation seems imperative for proximal caries detection. Materials and methods70 posterior permanent teeth were divided into blocks of 5 teeth. Digital and conventional Bitewing radiographs with D-speed and E-speed films were taken from samples. Conventional radiographs were digitalized with a scanner whereas direct digital images were saved in either standard or filtered mode. Presence of proximal caries was evaluated by three observers and samples were scored accordingly. As golden standard, teeth were then sectioned horizontally for histological evaluation of caries depth. ResultsDiagnostic specificity of each radiography method was evaluated with sub curve analysis of ROC (Az). Spearman test was used for inter- and intra-observers agreement. No significant difference was reported between the sensitivity and specificity of the four studied methods (P > 0.05). The digital filtered image had the highest sensitivity. The highest specificity was attributed to D-speed films. ConclusionIndirect digital images of scanned D-speed and E-speed films and direct standard and filtered digital images (CMOS receptor) have high specificity and there is no significant difference in the diagnosis of proximal caries between them.

Influence of cross-infection control methods on performance of pen-type laser fluorescence in detecting occlusal caries lesions in primary teeth

The aim of this in vitro study was to determine the influence of cross-infection control methods, as probe tip autoclaving and polyvinyl chloride (PVC) wrapping, on the performance of laser fluorescence device (DIAGNOdent pen--LFpen) on occlusal surfaces of primary molars. One experienced examiner carried out all examinations (n = 78). For the probe tip autoclaving study, 62 sites (sample A, 40 teeth) were used. The sites were assessed with LFpen using tips in six different conditions: without autoclaving and after autoclaving for 10, 20, 30, 40, and 50 cycles of 10 min. For the PVC wrapping study, we selected other 58 sites (sample B, 38 teeth). The sites were assessed with the LFpen device in two conditions: with and without PVC wrapping. The teeth were sectioned and histologically assessed for caries depth. LFpen values, sensitivity, and specificity were compared among the different conditions. The LF readings were slightly higher after successive examinations, independently of autoclaving. In both studies, no statistical differences in the sensitivity and specificity were observed for all conditions. In conclusion, probe tip autoclaving and PVC wrapping do not influence the performance of LFpen device on occlusal surfaces of primary molars.

In vitro comparison of intraoral films and four image plate systems in radiographic caries diagnosis

ABSTRACT In vitro comparison of intraoral films and four image plate systems in radiographic caries diagnosis Objectives: Detecting early caries lesion on a radiograph may be a difficult task. The aim of this study was to compare four image plate and two film-based systems by evaluating the accuracy of caries detection under standard conditions. Methods: Two hundred teeth were attached in groups of five onto plastic Lego®blocks. Radiographs were taken from each block under standard bitewing conditions with an X-ray device. Phosphor plates (Dentsply DenOptics®, Durr Vistascan II®, Soredex Digora FMX®, Soredex Digora Optime®) were exposed at 60 kV and 7 mA. The caries depths were analyzed by eleven observers and microscopic investigation was used to compare the histological findings. The caries depth was calculated as the difference between microscopic and radiological findings. Results: Data analysis showed a small impact of different sensors on the diagnostic accuracy. The largest differences between microscopic and radiographic caries ratings were found with DenOptix and Digora FMX. When it was calculated over all surfaces no statistical significance was found.

Radiographic Assessment of Proximal Caries: A Comparison between Film-based and Dexis Digital Imaging Systems

This study compared Kodak Ektaspeed film and Dexis digital imaging systems for their diagnostic accuracy in detection of proximal caries in 210 proximal surfaces from 105 extracted human teeth (20 premolars and 85 molars), 129 of which were carious. Ground teeth were evaluated histologically. The images were assessed by an observer. ANOVA revealed that groups differ in scoring patterns with f-value of 26.72 and p < 0.01. The mean caries score by histologic assessment was significantly (p < 0.01) more when compared with the scores obtained by conventional and Dexis digital radiographic methods. The mean score for conventional radiographic method was slightly more than Dexis digital radiographic method, but the difference was statistically insignificant (p < 0.05). Both the radiographic methods were less accurate in detecting proximal caries confined to enamel, but as the lesion depth was increased to dentin, the rate of caries detection increased dramatically. It was concluded that both conventional and Dexis digital radiographic methods under estimated caries depth when compared with histologic method. Lastly, conventional film radiographs and Dexis digital radiographs did not perform significantly different from each other in the detection of caries.

Occlusal Caries Depth Measurements Obtained by Five Different Imaging Modalities

The study aimed to assess the accuracy and reproducibility of occlusal caries depth measurements obtained from different imaging modalities. The study comprised 21 human mandibular molar teeth with occlusal caries. Teeth were imaged using film, CCD, two different cone-beam computerized tomography (CBCT) units and a microcomputer tomography (micro-CT). Thereafter, each tooth was serially sectioned, and the section with the deepest carious lesion was scanned using a high-resolution scanner. Each image set was separately viewed by three oral radiologists. Images were viewed randomly, and each set was viewed twice. Lesion depth was measured on film images using a digital caliper, on CCD and CBCT images using built-in measurement tools, on micro-CT images using the Mimics software program, and on histological images using AxioVision Rel. 4.7. Intra- and inter-rater reliabilities were assessed according to the Bland/Altman method by calculating Intraclass Correlation Coefficients (ICCs). Mean/median values obtained with intraoral systems were lower than those obtained with 3-D and histological images for all observers and both readings. Intra-observer ICC values for all observers were highest for histology and micro-CT. In addition, intra-observer ICC values were higher for histology and CBCT than for histology and intra-oral methods. Inter-observer ICC values for first and second readings were high for all observers. No differences in repeatability were found between Accuitomo and Iluma CBCT images or between intra-oral film and CCD images. Micro-CT was found to be the best imaging method for the ex vivo measurement of occlusal caries depth. In addition, both CBCT units performed similarly and better than intra-oral modalities.

Comparison of digital systems and conventional dental film for the detection of approximal enamel caries

The aims of this study were (1) to compare the accuracy of the detection of approximal enamel caries lesions using three intraoral storage phosphor plate digital systems and one conventional film-based radiographic system; and (2) to determine whether there is a correlation between the histological and radiographic measurements of enamel caries. 160 approximal surfaces were radiographed under standardized conditions using three storage phosphor stimulable systems (DenOptix and Digora FMX with white and blue plates), and one film system (Insight film). 17 observers scored the images for the presence and depth of caries using a 4-point scale. The presence of caries was validated histologically (gold standard). Two-way analysis of variance was used to test the differences in sensitivity, specificity and overall accuracy (TP + TN). The data from the radiographic and histological measurements were statistically analysed by Spearman's rank correlation coefficient. Two-way analysis of variance and the post hoc t-test demonstrated that Digora (white plate) had higher specificity and overall accuracy values than DenOptix (P = 0.021); there was no statistically significant difference among the other imaging modalities (P > 0.05). There was no significant correlation between the histological depth measurements and the radiographic measurements from Digora (blue plate) (P = 0.43), Digora (white plate) (P = 0.15), DenOptix (P = 0.17) and Insight film (P = 0.06). The results suggest that (1) the performance of the three storage phosphor image plate systems was similar to that of the Insight film for detection of approximal enamel caries, and (2) the increase in histological depth of enamel caries was not significantly correlated with radiographic measurements.

In vivo performance of a laser fluorescence device for the approximal detection of caries in permanent molars

Objectives The aim of this randomised clinical trial was to investigate if a laser fluorescence device is able to discriminate between sound and carious approximal sites and between enamel and dentinal lesions, as well as to find appropriate cut-off values. Methods One hundred and seventeen sound or uncavitated carious sites in permanent molars were visually and radiographically examined, then either opened or not, after which their laser fluorescence was measured. Forty-three lesions were opened, the caries removed and the clinically identified caries depths were registered in addition to the radiographical scoring. Seventy-four sites were radiographically deemed sound or had enamel caries and were not opened. Here, the radiographical scorings were registered. Results Taking the radiographic scoring as gold standard for all investigated approximal sites, sound sites ( D 0, n = 40) showed significantly lower laser fluorescence measurements than carious sites ( D 1–4, n = 77) (Mann–Whitney test, P < 0.025) suggesting a cut-off at 7 (sensitivity = 0.68, specificity = 0.7). Comparing measurements of D 0–2 ( n = 74) and D 3,4 ( n = 43), the results were also different by a statistically significant amount ( P < 0.025) and the cut-off calculated to be 16 (sensitivity = 0.6, specificity = 0.84). A fair positive correlation between laser fluorescence values and radiographical scoring was found (rho = +0.47, P < 0.01). Analysing the 43 opened lesions with their clinically found lesion depths as gold standard, there was a fair positive correlation to the laser fluorescence values (rho = +0.34, P = 0.03) and a moderately strong correlation to the radiographic scoring (rho = +0.67, P < 0.01). Conclusion The device may be an adjunct tool in the approximal detection of caries along with established procedures.

The usefulness of caries frequency, depth, and location in determining cariogenicity and past subsistence: A test on early and later agriculturalists from the Peruvian coast

Dental markers have been used to unravel particularities of paleodiet, subsistence, social structure, and health. This article aims to compare oral pathology among four pre-Columbian groups with different degrees of agricultural and socio-cultural development but comparable ecological conditions who lived on the coastal desert of Peru. Three of these groups are assigned to distinct phases of the Formative Period (2500-1 BC), a time critical for our understanding of the development of agriculture and social complexity. The fourth group corresponds to the Late Intermediate Period (1000-1470 AD), when agriculture had its apogee and society was highly stratified. In this study we test whether there is an increase (1) in the frequency of carious lesions and (2) in caries depth, and (3) if there is a shift from occlusal to extra-occlusal caries locations with the development of agriculture. Therefore, we analyze the frequencies of carious lesions and antemortem tooth loss (AMTL), the caries distributions by age, sex, and type of tooth, as well as the tissues affected by, and the location of the carious lesions. Since there are no significant differences in the frequencies of carious lesions and AMTL between the groups, we reject hypothesis 1. In contrast, caries depth does increase, and caries location changes from occlusal to extra-occlusal sites with agricultural development. However, we can only corroborate hypothesis 2 and 3 when taking into consideration dental wear. Thus, we recommend that caries depth and locations should be used with evaluations of dental wear to reconstruct subsistence in ancient populations.

Diagnostic performance of the universal visual scoring system (UniViSS) on occlusal surfaces

Aim of this investigation was to evaluate the validity and reproducibility of the universal visual scoring systems (UniViSS) on occlusal surfaces in vitro. The validity study included 65 third molars. Following to reach a UniViSS consensus diagnosis for each surface, all teeth were histologically prepared and evaluated according to the newly developed caries-extension-index (CE-index). The reproducibility study consisted of 149 molars. These teeth were examined by two dentists and four students without any calibration training. In result, the CE-index provided the exact caries depth for each UniViSS criterion, which could further be associated with a distinct preventive or treatment strategy. The mean intra-/inter-examiner weighted Kappa values amounted to 0.685/0.551 (UniViSS/severity) and 0.628/0.542 (UniViSS/discoloration). The cumulative Logit-model underlined that UniViSS/severity criteria were more frequently reproduced in comparison to the UniViSS/discoloration criteria. In conclusion, this study on the diagnostic performance of UniViSS showed encouraging results and give valuable hints for future studies.

The Evaluation of the Vector System in Removal of Carious Tissue

The aim of this study was to evaluate the Vector system in comparison to the conventional technique in cavity preparation. Four extracted primary teeth with no restorations and similar fissure carious lesions and four permanent teeth extracted for orthodontic reasons were used. Class I preparations were made provided that the caries depth remained within the dentin limits. Two teeth were treated with an aerator, the other two had carious tissue removed with the Vector system. Prepared cavities were evaluated with scanning electron microscopy for the surface roughness of the dentine and enamel and for the carious tissue removal efficiency. This pilot study determined that it is possible to remove carious tissue and perform cavity preparation with the Vector system. According to this preliminary evaluation of surface quality, a cavity prepared with the Vector treatment system, allows for a slicker floor, and a more regular enamel-dentine line than that prepared with an aerator. However, the Vector system requires a longer treatment time which we believe may be a negative point, especially for young patients.

Diagnostic accuracy of digitized conventional radiographs by camera and scanner in detection of proximal caries.

Background and aims Digital radiographs have some advantages over conventional ones. Application of digital recep-tors is not routine yet. Therefore, there is a need for digitizing conventional radiographs. The aim of the present study was to compare the diagnostic accuracy of digitized conventional radiographs by scanner and camera in detection of proximal car-ies. Materials and methods Three hundred and sixteen surfaces of 158 extracted posterior teeth were radiographed. The radiographs were digitized using a digital camera and a scanner. Five observers scored the images for the presence and depth of caries. Histopathologic sections were the gold standard. Kappa agreement coefficient was used for statistical analysis. Results Kappa agreement coefficients between the camera and the scanner and also between each one with the gold stan-dard in detecting the depth of caries were 0.504, 0.557 and 0.454, respectively. In detection of caries, the indexes were 0.571, 0.553 and 0.527, respectively. Conclusion Diagnostic accuracy of camera images in caries detection was more than that of scanned images, but there was also a moderate consistency between them. The consistency of detecting the presence of caries was more than that of detecting their depths. It seems that both digital cameras and scanners can be used interchangeably.

The Efficiency of Operating Microscope Compared with Unaided Visual Examination, Conventional and Digital Intraoral Radiography for Proximal Caries Detection

Objective. The purpose of this study was to evaluate the efficiency of operating microscope compared with unaided visual examination, conventional and digital intraoral radiography for proximal caries detection. Materials and Methods. The study was based on 48 extracted human posterior permanent teeth. The teeth were examined with unaided visual examination, operating microscope, conventional bitewing and digital intraoral radiographs. Then, true caries depth was determined by histological examination. The extent of the carious lesions was assessed by three examiners independently. One way variance of analysis (ANOVA) and Scheffe test were performed for comparison of observers, and the diagnostic accuracies of all systems were assessed from the area under the ROC curve (A z). Results. Statistically significant difference was found between observers (P < .01). There was a statistically significant difference between operating microscope-film radiography, operating microscope-RVG, unaided visual examination-film radiography, and unaided visual examination-RVG according to pairwise comparison (P < .05). Conclusion. The efficiency of operating microscope was found statistically equal with unaided visual examination and lower than radiographic systems for proximal caries detection.

Histological comparison of pulpal inflammation in primary teeth with occlusal or proximal caries

A number of clinical and histological studies have investigated caries-related changes in the primary tooth pulp, but the effect of caries site, as a clinical variable, has not been previously considered. This study sought to compare inflammatory changes within the pulp of primary molars according to the location of the caries lesion (occlusal or proximal). Eighty-three primary molars were extracted under general anaesthesia for caries and/or orthodontic reasons, and were split immediately after removal and fixed in 10% formalin. Teeth were then decalcified, sectioned, and stained with haematoxylin and eosin for histological examination using light microscopy. Caries depth was measured using a graticle, and the site of the caries lesion noted as occlusal or proximal. Samples were further classified into one of five subgroups according to the observed degree of pulpal inflammation. Key findings were that where caries depth was less than 50% of the total dentine thickness, there were no significant differences in inflammatory status according to caries site. In contrast, marked inflammatory changes were significantly more likely throughout the coronal pulp of teeth with proximal caries compared to teeth with occlusal caries where caries depth was equal to, or greater than, 50% of the total dentine thickness (P = 0.017, Fisher's exact test). Primary teeth with proximal carious lesions extending more than 50% through the dentine thickness appear to have more extensive inflammatory pulpal changes than teeth with occlusal caries of a similar depth. This finding has clinical implications and may help inform treatment decisions in the management of primary teeth with deep carious lesions.

Clinical performance of a new laser fluorescence device for detection of occlusal caries lesions in permanent molars

Objectives To determine the clinical performance of a laser fluorescence device (DIAGNOdent pen, KaVo) to discriminate between different occlusal caries depths (D 0–D 1–4; D 0–2–D 3,4) in permanent molars. Methods In this prospective, randomized two-centre-study 120 sound/uncavitated carious sites in 120 patients were measured after visual and radiographic caries assessment. In cases of operative intervention ( n = 86), the lesion depths after caries removal were recorded (reference). In cases of preventive intervention ( n = 34), the sites were reassessed visually/radiographically after 12 months to verify the status assessed before (reference). The discrimination performance was determined statistically (Mann–Whitney test, Spearman’s rho coefficient, and areas under the receiver operating characteristic curves (AUCs)). Sensitivities (SE) and specificities (SP) were plotted as a function of the measured values and cut-off values for the mentioned thresholds suggested. Results Sound sites ( n = 13) had significantly minor fluorescence values than carious sites ( n = 107) ( P < 0.0001) as had sites with no/enamel caries ( n = 63) compared to dentinal caries ( n = 57). The AUCs for the same discriminations were 0.92 and 0.78 ( P < 0.001). For the D 0–D 1–4 threshold, a cut-off at a value of 12 (SE: 0.88, SP: 0.85) and for the D 0–2–D 3,4 threshold at 25 (SE: 0.67, SP: 0.79) can be suggested. A moderate positive correlation between the measurements and the caries depths was calculated (rho = +0.57, P = 0.01). Conclusion Within this study, the device’s discrimination performance for different caries depths was moderate to very good and it may be recommended as adjunct tool in the diagnosis of occlusal caries.

Confocal laser scanning microscopic analysis of the depth of dentin caries-like lesions in primary and permanent teeth

This study analyzed comparatively, by confocal laser scanning microscopy (CLSM), the depth of caries-like lesions produced by biological and chemical artificial models in permanent and primary dentin. Six primary molars and six premolars were used. The occlusal enamel was removed and a nail polish layer was applied on the specimens, except for a 4 x 2 mm area on dentin surface. Half of specimens were immersed in acid gel for 14 days (chemical model) and the other half was immersed in BHI broth with S. mutans for 14 days (biological model). After development of artificial caries, the crowns were longitudinally sectioned on the center of the carious lesion. Three measurements of carious dentin depth were made in each specimen by CLSM. Measurements depths were compared between the caries models and between tooth types by one-way ANOVA and Tukey test (alpha=5%). For permanent teeth, the biological model showed significantly higher (p<0.05) caries depth values than the chemical model. For primary teeth, no statistically significant difference (p>0.05) was found between the caries models. The artificial caries model influenced caries depth only in permanent teeth. There was no difference in carious dentin depth between permanent and primary teeth, regardless of the artificial caries model.

Accuracy of digital subtraction radiography in combination with a contrast media in assessment of proximal caries depth.

Background and aims Radiography is used to diagnose the demineralization process and carious lesions; however, conventional radiography and direct digital images do not show these lesions when the amount of demineralization is less than 40%. Digital subtraction radiography has recently been used to improve the diagnostic quality of these le-sions. The purpose of this study was to compare the caries depth estimated by digital subtraction radiog-raphy in combination with barium sulfate in diag-nosing proximal dental caries with histopathologic evaluation. Materials and methods In this study 30 molars and premolars (24 demineralized lesions with cavity, 8 without cavity) were studied. Direct digital images were taken (kVp: 68, mA: 8; t: 0.12 for premolars and t: 0.16 for molars) whereas the position of X-ray tube and CCD receptor and teeth was fixed. To prepare the second images 135 gr/L barium sulfate was used. The images obtained with the same exposure and geometry and then subtracted. The depth of the lesions in direct digital and subtracted images were assessed and compared with the depth measured in histopathologic assessments. Results The mean depths (± SD) of the lesions were 1.80 ± 0.77 mm in direct digital radiography, 2.32 ± 0.76 mm in subtracted images after barium sulfate treatment, and 2.51 ± 0.43 mm in histopathologic sections. The statistical difference between direct digital radiography and the other methods was significant (P < 0.05). However, the differences were not statistically significant between subtracted images and histopathologic sections. The average intra-class correlation coefficient was 0.7241 (CI: 95%). Conclusion The present study has demonstrated that digital subtraction radiography images have the potential to measure the depth of proximal caries with no significant difference with histopathologic evaluation.

Film tomography compared with film and digital bitewing radiography for proximal caries detection

The purpose of this study was to evaluate the efficiency of conventional tomography for proximal caries detection compared with conventional bitewing and digital intraoral radiography. In this study, 48 extracted human posterior permanent teeth were used. Conventional bitewing radiographs, digital intraoral radiographs and conventional tomograms were obtained of the teeth. The presence or absence of caries was scored according to a five-point scale by two oral and maxillofacial radiologists. True caries depth was determined by histological examination. The diagnostic accuracy of each radiographic system was assessed by means of receiver operating characteristic (ROC) curve analysis. The mean of areas under the ROC curve (A(z)) was analysed by pairwise comparison of ROC curve. The interobserver agreement was evaluated using a t-test. The statistical analysis of A(z) scores has shown no significant difference for three imaging modalities (P>0.05). There was no statistically significant difference between interobserver agreement (P>0.05). This study has demonstrated that the diagnostic accuracy of conventional tomograms is comparable to that of conventional bitewing and digital intraoral radiographs for proximal caries detection.