Carious Lesions In Permanent Teeth Research Articles

The effectiveness of partial pulpotomy compared with full pulpotomy in managing deep caries in vital permanent teeth with a diagnosis of non-traumatic pulpitis.

Pulpitis may be pain free or alternatively characterized by mild to severe pain and associated symptoms. Evidence has recently emerged that patients presenting with carious pulp exposure range of symptoms can be treated effectively with pulpotomy. The current systematic review aimed to answer the following research question: "In patients with deep caries lesions in permanent teeth associated with no symptoms, reversible pulpitis or signs and symptoms indicative of irreversible pulpitis (P), is partial pulpotomy (I) as effective as full pulpotomy (C), in terms of a combination of patient and clinical reported outcomes (O), with "tooth survival" as the most critical outcome? The systematic literature search was conducted in the following electronic databases: OVID, Scopus, PubMed (Including MEDLINE), and Cochrane Central Register of Controlled Trials (CENTRAL) supplemented with Grey literature and hand searching of relevant journals. The English language clinical trials comparing the patient and clinical reported outcomes between partial and full/complete were included. After a structured literature search, two authors independently performed study selection, extracted data and performed a risk of bias assessment; a third reviewer resolved disagreements. As there were only two studies with different exclusion criteria, no meta-analysis was performed and the quality of evidence was assessed by the GRADE approach. After study selection a total of two randomised clinical trials with a total of 156 teeth were included both for the management of teeth with irreversible pulpitis. There were no studies for asymptomatic teeth or teeth with reversible pulpitis. A "Low" risk of bias was noted for both studies with a high level of overall evidence. A meta-analysis was not carried out due to differences in inclusion criteria between the studies related principally to caries depth. Both studies reported a high rate of clinical success for pulpotomy with a pooled unadjusted success rate for full pulpotomy of 90% and 83% partial pulpotomy of at 1-year; however, no significant difference between the treatments was noted in either study. There was significantly reduced postoperative pain reported in the full pulpotomy group over 1-week compared with the partial pulpotomy in one but not in the other study. Pulpotomy as a definitive treatment modality is as effective in managing teeth exhibiting signs and symptoms indicative of irreversible pulpitis and challenges the established protocols to manage this condition. Although based on only two RCTs with a limited number of patients, no difference was shown in terms of clinical or radiographic outcome or postoperative pain between groups. Further well designed randomised clinical trials of longer duration are required in this area to improve the evidence available. There is no consistent difference in patient-reported pain between partial and full pulpotomy at day 7 postoperatively and the clinical success rate was similar after 1 year for both treatment modalities.

Restorations performance after selective caries removal to soft dentine: 18-month follow-up of a controlled clinical trial

ObjectiveThis randomized controlled clinical trial aimed to evaluate the clinical performance of composite resin restorations placed after selective caries removal to soft dentin (SCRSD) or stepwise excavation (SW) over an 18-month period. MethodsInclusion criteria were patients with permanent molars and/or premolars presenting deep caries lesions (≥50 % of the dentin thickness). Teeth were submitted to SCRSD (n = 76) or SW (n = 76). Evaluations were performed based on FDI (World Dental Federation) criterion. Survival analysis was performed to estimate the survival of restorations and its association with clinical variables and socio-demographic characteristics (adjusted Weibull regression model). The study was registered on Registro Brasileiro de Ensaios Clínicos (ReBEC 65ntbc). ResultsThe follow-up period ranged from 6 to 18 months (mean ± SD 16.3 ± 3.4 months). Patients' ages ranged from 9 to 55 years (mean ± SD 29 ± 10.5 years). A total of 135 teeth (SCRSD = 72; SW = 63) from 101 patients were evaluated. There were 4 failures in the SCRSD group (2 loss of restoration in need of replacement and 2 marginal fractures in need of repair) and 2 in the SW group (fracture in need of repair). The association between explanatory variables and restoration failure showed similar success rates for SW (99.4 %) and SCRSD (97.9 %) (p = 0.16). Patients presenting gingivitis (≥20 % of sites with gingival bleeding) had 8.50 times more risk for failure than those with <20 % of bleeding sites (p = 0.03). ConclusionThis study showed that placing a composite resin restoration over soft dentin (after SCRSD) did not affect its clinical performance after 18 months. Clinical significanceSCRSD is a feasible treatment option for the management of deep caries lesions in permanent teeth as it preserves tooth vitality and tooth structure without compromising restoration longevity.

Biodentine™ as a temporary filling in deep carious lesions in permanent teeth: a prospective observational 33-month follow-up study.

The study aimed to evaluate temporary fillings using Biodentine™ in asymptomatic deep carious lesions after 12, 24, and 36months in school children from the remote village of Kerung, Nepal. From November 2018 to November 2019, 91 temporary fillings were placed using Biodentine™ (a hydraulic calcium silicate cement) in permanent molars with deep carious lesions of schoolchildren in the remote district of Kerung, Nepal. These restorations were performed after selective caries removal in a non-dental setting with hand instruments and cotton roll isolation, as electric motors and saliva ejection systems were unavailable. In total, 78 single-surface and 13 multi-surface fillings were placed. Clinical and radiographic follow-up periods encompassed 12, 21, and 33months, respectively. After 12months, all single-surface fillings (100%) survived, whilst all multi-surface fillings were partially or entirely lost. The survival rate of single-surface restorations after 21 and 33months was 67.6% and 50%, respectively. Radiographically, no pathology was observed. This study showed that Biodentine could be used in deep carious lesions as a temporary filling in single-surface lesions for at least up to 1year and in a substantial number of cases for up to 21 and 33months.

Clinical Comparison of Three Indirect Pulp Capping Restorative Protocols: A Randomized Controlled Prospective Study.

The objective of this prospective double-blind clinical trial was to compare clinical outcomes of indirect pulp capping restorative protocols on permanent teeth over a 12-month period. Deep carious lesions in permanent teeth (90) were randomly assigned to three indirect pulp capping protocols (n=30: TheraCal LC, Dycal, and no liner). All teeth were restored with resin composite. The outcome measures were pain (VAS scale) and success rate (pulp vitality based on percussion, palpation, cold test, and radiographic findings), collected at screening, intervention, and 24-hour, 7-day, 3-month, 6-month, and 12-month follow-up visits. There was no statistically significant difference in tooth sensitivity among the three indirect pulp capping protocols nor in success rates among the restorative protocols after 1 year of follow-up (p>0.1).The respective success rates, as defined by the tooth remaining vital, after 1 year were: 96.2% for TheraCal LC, 100% for Dycal, and 100% for no liner. After 12-month evaluation, the success rate of indirect pulp capping therapy on permanent teeth was not affected by the pulp capping restorative protocol.

Assessment of Decision-Making and Material Selection for Vital Pulp Therapy in Deep Carious Lesions: A Study at the Faculty of Dentistry, King Abdulaziz University.

The purposes of this study were to assess decision-making, material selection, and management of deep carious lesions in permanent teeth requiring vital pulp therapy (VPT); investigate the intradepartmental and interdepartmental consensus in the management of those cases; and correlate this study's results to the current scientific literature, clinical experience, and postgraduate training among staff and postgraduate students at the Faculty of Dentistry,King Abdulaziz University. The survey included faculty from pedodontics, endodontics, and restorative/operative dentistry; postgraduate students; and interns, excluding specific categories such as retired faculty, external trainers, non-faculty hospital specialists, general practitioners, students, interns outside the institution, and other departments. An anonymous electronic questionnaire was developed and validated. Ethical approval was obtained, and the questionnaire was distributed to all 148 English-proficient members of the targeted populationvia email and WhatsApp, accompanied by a cover letter. The questionnaire encompassed demographic, education, experience, assessment, decision-making, and management sections. Data were collected and analyzed using Microsoft Excel, with results presented using categorical variables, Pareto charts, and statistical tests. There were 86 responses, representing 58% of the target population, with the key findings including the prominence of "Pre-operative vitality test result" as the most important factor in assessing deep carious lesions, with no significant differences among specialties. The (one-step and one-visit) management approach was preferred by 50% of participants, with no significant specialty differences. For deep carious lesions without pulpal exposure, glass ionomer (GI)/resin-modified glass ionomer (RMGI) base was the top choice, with no variation among all specialties. In cases with pulpal exposure, the one-visit approach (direct pulp capping (DPC), base, and restoration) was the most favored, with no specialty differences. Material availability significantly influenced decision-making, with no specialty variations. The study highlights the crucial role of pre-operative vitality tests in assessing deep carious lesions for VPT or root canal treatment (RCT). Participants generally favored VPT for cases with normal pulp vitality, with some departmental variation. Controlling bleeding post-pulpal exposure was a central concern. Mineral trioxide aggregate (MTA) was the most commonly used VPT material, followed by Ca(OH)2 and Biodentine. Factors such as treatment access, patient compliance, remaining dentin thickness, and oral hygiene had minimal impact on treatment choice. Limited availability of VPT materials was the primary reason for non-use. The survey's acceptable response rate raises concerns about potential non-response bias, though limitations include a lack of data on non-responders. Nevertheless, the survey's strength lies in its comprehensive coverage of key clinical aspects, engaging professionals from diverse specialties and educational levels who are collectively interested in addressing deep caries cases.

Remineralizing potential of the biomimetic P11-4 self-assembling peptide on noncavitated caries lesions: A retrospective cohort study evaluating semistandardized before-and-after radiographs

BackgroundSelf-assembling peptide (SAP) P11-4 was introduced to treat initial caries lesions by means of guiding hydroxyapatite regeneration within the lesion. The objective of this study was to assess its effectiveness in a practical clinical setting. MethodsCaries lesions in permanent teeth treated with monomeric and polymeric SAP P11-4 from May 2015 through October 2020 were retrospectively analyzed at lesion and child levels by means of bite-wing radiography for changes in stage and cavitation and restoration. ResultsTwo hundred and nineteen children aged 10 through 19 years with a total of 405 proximal lesions in posterior teeth were followed from 0.4 through 5.5 years (median, 7 months; interquartile range, 6-19 months). Regression occurred in 37% of stage RA1 (radiolucency in the outer one-half of enamel) (95% CI, 31% to 44%), 38% of stage RA2 (radiolucency in the inner one-half of enamel plus or minus the enamel–dentin junction) (95% CI, 30% to 45%), and 40% of stage RA3 (radiolucency limited to the outer one-third of dentin) (95% CI, 16% to 68%) lesions. The proportion of lesions with no cavitation was 0.96 (95% CI, 0.94 to 0.98) after 1 year and 0.91 (95% CI, 0.88 to 0.95) after 2 years. ConclusionsReal-world clinical data indicate that SAP P11-4 can lead to recovery and a healthier tooth stage. Practical ImplicationsSAP P11-4 is a safe treatment for initial caries lesions in permanent teeth that remineralizes in the deepest zone of the lesion and can be introduced easily into routine dental practice.

A systematic review on the effect of silver diamine fluoride for management of dental caries in permanent teeth.

The objective of this review is to assess the available literature systematically related to the effect of silver diamine fluoride (SDF) for the management of occlusal and root carious lesions in permanent teeth regardless of age. MATERIALSANDMETHODS: This systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Review and Meta-Analyses statement. A literature search was performed usingPubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, DOAJ, and Open Gray with no language restrictions up to December 2022. Three reviewers critically assessed the studies for eligibility. Any disputes between the reviewers were handled by a fourth independent reviewer. The quality assessment and data extraction of the studies were performed. A total of 2176 studies were screened. The titles and abstracts of the studies were then reviewed (n = 346), and 52 studies met the search criteria. Following the full-text review, 11 studies investigated the effect of SDF against other treatments such as chlorhexidine, sodium fluoride, ammonium bifluoride, tricalcium silicate paste, casein phosphopeptide amorphous calcium phosphate, glass ionomer cement (GIC) combined with fluoride varnish, resin-modified GIC, and atraumatic restorative treatment were assessed. Within the limitations of this review, the use of SDF is promising with high preventative fractions in permanent teeth of children and older populations when compared to other topical applications such as dental varnish containing sodium fluoride.

Diagnostic performance of different fluorescence systems on occlusal caries of permanent teeth correspondence

Background/Aim: Evaluating the performance of two fluorescence-based methods on the detection of occlusal carious lesions in permanent teeth, compared with visual inspection and radiographic examination was the aim of this study. Material and Methods: Occlusal surfaces of 150 extracted human permanent molars were examined by two researchers using the International Caries Detection and Assessment System ll (ICDAS-II), FluoreCam (Daraza) and DIAGNOdent Pen® (KaVo). Standardized periapical radiographs were taken. The teeth were sectioned for histological validation and examined under 25x magnification under a stereomicroscope (Leica M27.5) using Downer criteria 0-4 as the gold standard. The correlation of diagnostic methods with histological analyses was evaluated using Spearman's rank correlation coefficients (rho). Results: All teeth were scored from 0 to 6 for ICDAS-II. The highest correlation of the gold standard was found with ICDAS-II followed by FluoreCam and DIAGNOdent Pen®. The association strength of ICDAS-II, Radiography, FluoreCam and DIAGNOdent Pen® with the histological evaluation was quite strong (p&lt;0.05). Both fluorescence-based methods performed similarly. Conclusions: Radiograph is not specific for early carious lesions but may be used as an adjunct method for dentin caries. ICDAS-II classification is an accurate method for clinical examination of occlusal caries however additionally using fluorescence as a quantitative and visual examination is quite supportive and reinforcing especially for detecting enamel caries lesions.

Comparative evaluation of remineralization potential of shelcal, calcium sandoz and shelcal with Vitamin C on artificially induced carious lesions in permanent teeth: An in vitro study

Comparative evaluation of remineralization potential of shelcal, calcium sandoz and shelcal with Vitamin C on artificially induced carious lesions in permanent teeth: An in vitro study

Selective removal to soft dentine or selective removal to firm dentine for deep caries lesions ın permanent posterior teeth: a randomized controlled clinical trial up to 2years.

The aim of this randomized clinical trial was to compare selective removal to soft dentin (SRSD) and selective removal to firm dentin (SRFD) in permanent teeth. The primary outcome of the study was to compare the success rates of the two caries removal techniques. The secondary outcome of the study was to investigate whether or not calcium silicate-based material (CS) had an effect on the success rate of the treatment. Between November 2018 and March 2020, patients with deep caries lesions were invited to participate in the study. Posterior teeth (N = 165) with primary caries lesion radiographically extending ¾ of dentin and positive response to cold test were randomly selected. A total of 134 participants meeting the inclusion criteria were randomized to SRSD and SRFD (control) groups. After the caries removal procedure, teeth with exposed pulps were assigned to the pulp exposure (PE) group, and the SRSD group was further divided into test 1 (with CS) and test 2 groups (without CS). Success was defined as a positive response to the cold test, a negative response to percussion, the absence of pain, an abscess, a fistula, and periapical alterations. Fisher-Freeman-Halton exact tests, Kaplan-Meier survival analysis, and the log-rank tests were performed for comparisons between groups. No statistically significant difference was found between the success rates of test 1 (100%) and test 2 (93.5%) groups, whereas the proportion of success in control (82.4%) and PE (84%) groups were significantly lower when compared with test groups (p = 0.024; p < 0.05) at the end of 2-year follow-up. SRSD had a higher success rate when compared to SRFD to treat deep carious lesions after 2years of follow-up. The use of CS material after SRSD as a liner had no effect on the treatment outcome. SRSD with good coronal sealing might be recommended without CS application for the treatment of deep caries lesions in permanent teeth. Clinical trial registration number NCT04052685 (08/09/2019).

Detection of Cavitated Proximal Carious Lesions in Permanent Teeth: A Visual and Radiographic Assessment

Detection of proximal carious lesions involves the combination of clinical and radiographic methods, both with inherent difficulties. The present cross-sectional study is aimed at estimating the prevalence of cavitation in proximal carious lesions, based on a direct clinical assessment of previously detected radiographic lesions, in permanent molars and premolars. Proximal dental surfaces were radiographically evaluated using the ADA coding system and cavitation was determined through clinical visual examination of the surfaces after separation with elastomeric bands. One-hundred and twenty-six patients attending the dental clinics at the University of Talca were examined, comprising 508 proximal surfaces with radiographic codes ranging from E1 to D3. Two examiners were trained and calibrated for radiographic and clinical detection of proximal lesions. Most participants were females (61.9%). The age mean of participants was 28.7 (0.8) years old. A total of 22.2% of the examined surfaces were cavitated. Only few lesions coded as E1 (n = 4; 2.1%) and E2 (n = 9; 9.8%) were cavitated. Fifty D1 (35.5%) and 22 D2 (41.5%) lesions were cavitated after separation. Most lesions coded as D3 (n = 28; 84.8%) were cavitated. The multilevel binary regression model (p = 0.003) demonstrated that sex, age, jaw, tooth type, surface, and side were not associated with the likelihood of having proximal cavitation. Challenging conventional wisdom, most D1 and D2 lesions were not cavitated. Combining detection methods seems desirable to increase the accuracy in assessing approximal posterior lesions. The low proportion of cavitated lesions reinforces the idea of cautiously indicating invasive approaches for managing proximal carious lesions.

Is professionally applied topical fluoride effective in treating incipient caries? A systematic review.

The present systematic review aimed to investigate the effectiveness of professionally applied topical fluoride as therapeutic agent for incipient carious lesions in permanent teeth. Randomised clinical trials (RCTs) comparing the effectiveness of professionally applied topical fluoride (varnish or gel) with that of placebo, no intervention, and toothbrushing (control group) in the treatment of incipient carious lesions in permanent dentition were included. An electronic search was performed in the PubMed, Web of Science, Scopus, Virtual Health Library, Embase, and Cochrane databases, in the grey literature, and in clinical trials registered until January 2021. Two reviewers independently screened titles and abstracts and assessed the risk of bias using the Cochrane tool. The certainty of evidence was classified using GRADE. A total of 2,223 articles were screened using titles/abstracts. After full-text reading of the 22 selected studies, nine RCTs were included. Five RCTs found that topical fluoride may be effective in reversing incipient carious lesions in permanent teeth. Overall, five studies were classified as having a low risk of bias and four as having some concerns. Only descriptive analysis was performed because of the heterogeneity of the data. Studies comparing fluoride varnish with usual home care oral hygiene have demonstrated topical fluoride does not appear to be more effective in improving the appearance of incipient carious lesions. Therefore, usual home care oral hygiene with fluoride toothpaste may be sufficient to treat incipient carious lesions in permanent dentition. Further studies with greater methodological rigor are, however, required to reduce bias, to allow a meta-analysis, and to draw well-founded conclusions (CRD42019120406).

Loss of dental tissue after restoration or sealing of occlusal carious lesions: 3-4-year results of randomized clinical trials.

Although preservation of the tooth structure is quoted as the main advantage of sealing of carious lesions, there are no long-term studies comparing the maintenance of dental tissue after restoration or after caries sealing. To measure the radiographically visible loss of dental tissue after conventional restoration and sealing of carious lesions. This study was a secondary analysis of two randomized controlled clinical trials, one conducted in Brazil and another in Belgium, which evaluated two different therapies for the treatment of occlusal carious lesions in permanent teeth: sealant (SE) without previous carious tissue removal or restoration (RE) with total removal of carious dentin. The greater depth and width of sealed carious lesions and restorations were compared. The independent t-test was used to compare therapies at different time points, while the paired t-test was used to compare the same therapy over time. Carious lesions in the RE and SE groups showed similar measurements at baseline (P > 0.05). Over time, significantly greater loss of tooth structure was observed in the RE group than in the SE group. No increase in lesion depth or width was observed in the SE group, suggesting no progression of sealed lesions. Sealing of carious lesions resulted in greater preservation of dental tissue.

Clinical success of infiltrant and resin sealant on incipient caries of permanent teeth: an integrative review of literature

ABSTRACT Objective: To perform an integrative literature review, presenting techniques to seal incipient caries, their advantages, indications and failures, and comparing their clinical success. Methods: The guiding question for this literature review was: What technique, sealant or resin infiltration, provides longer clinical longevity in sealing incipient caries lesions in permanent teeth? 1707 scientific articles published from 2005 to 2019 were searched in the PubMed, LILACS and SciELO databases, using the following keywords: “caries sealing”, “resinous infiltrant,” and “caries progression”. After their titles and abstracts were read, 10 papers were selected according to the inclusion criteria: papers written in the English language, randomized clinical control trials lasting at least one year, and techniques using infiltration sealing or resin sealant as the treatment method of active carious lesions in occlusal and proximal surfaces of permanent teeth with involvement up to the outer layer of dentin. The Mann-Whitney statistical test was used to compare the techniques (alpha=0.05). Results: Six studies used a split mouth design, and 4 studies had a parallel design, for a total sample of 1316 teeth. The studies achieved a high rate of clinical success in controlling carious lesion progression, with an average rate of 80% for the sealant, and 88% for the infiltrant, and with no statistical difference between the techniques (p-value=0.358). Conclusions: No difference in the clinical efficacy was observed between the resinous sealing and infiltrative resin techniques of incipient lesions in permanent teeth in one to seven years of follow-up.

Penetration of Silver Diamine Fluoride in Deep Carious Lesions of Human Permanent Teeth: An In Vitro Study.

Background When silver diamine fluoride (SDF) is used in conjunction with conservative caries removal in deep carious lesions, the distribution depth of silver is critical for safety and effectiveness. Objective The purpose of this study is to determine the effect of selected caries removal on silver penetration when 38% SDF is applied to deep carious lesions in permanent teeth. Methods Extracted permanent teeth with caries extending to the inner third of the dentin were used (N = 18). The periphery of the carious lesion was completely removed to the dentinoenamel junction (DEJ). In group A (n = 9), no further removal of carious tissue was performed, leaving necrotic dentin inner to the DEJ, whereas in group B (n = 9) superficial necrotic dentin was completely removed until leathery, slightly moist, reasonably soft dentin remained. SDF was applied for 3 minutes in both groups. Microcomputer tomography (micro-CT) and field emission scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy (FESEM-EDS) were used to measure mineral density and silver distribution. The silver penetration depth/lesion depth (PD/LD) ratio was calculated for each sample. The Mann–Whitney U test was used to compare differences between the two groups. Results The micro-CT analysis showed that the PD/LD ratios of group B (1.07–2.29) were marginally greater than those of group A (1.00–1.31). However, a statistically significant difference was not observed (pvalue = 0.5078). When stratified by remaining dentin thickness (RDT), the PD/LD ratios of group B were still greater than those of group A only when RDT was >500 µm. The FESEM-EDS analysis indicated that silver particles precipitated throughout the entire thickness of the carious lesions. Conclusion Applying SDF on a deep carious lesion and leaving the necrotic dentin pulpally did not affect silver penetration. However, the extent to which silver penetrates the remaining dentin beneath the lesions is dependent on the amount and characteristics of that dentin.

Comparative Evaluation of the Efficacy of Stepwise Caries Excavation vs Indirect Pulp Capping in Preserving the Vitality of Deep Carious Lesions in Permanent Teeth of Pediatric Patients: An In Vivo Study.

Aims and objectivesTo comparatively evaluate the clinical efficacy of stepwise caries excavation with indirect pulp capping (IPC) in managing the young permanent teeth in pediatric patients who have deep carious lesions.Materials and methodsEighty-eight teeth (first/second permanent molars) were included and randomly divided into two groups: group I (stepwise caries excavation) and group II (IPC). For group I, i.e., stepwise caries excavation, in the initial visit, bulk caries removal was done from walls of the cavity, however, soft and infected dentin was left untouched on the pulpal floor. The final excavation was performed after 2 months. The dentin parameters like the color, the consistency, and the humidity of dentin were noted at the first and second visits. A final follow-up to assess the primary outcome, i.e., sustained pulp vitality, was done after 1 year.ResultsWhen both the groups were compared with each other using the Chi-squared test, a highly significant difference was found (p < 0.05) between them. The success rate of stepwise caries excavation (97.3%) was found to be significantly greater than IPC (82.4%). After doing statistical analysis, a significant difference between stepwise excavation at baseline and at re-entry for parameters like the color, the consistency, and the humidity (p < 0.05), where dentin was observed to be darker in color, harder in consistency, and drier to touch at re-entry was found.ConclusionStepwise caries excavation was considered a safer technique than IPC for preserving the vitality of young permanent teeth. Also, the clinical changes recorded during the re-entry in the case of stepwise caries excavation technique indicated the arrest of the carious process.Clinical significancePulp preservation is of utmost importance especially in the case of young permanent teeth which have open apex to aid in apexogenesis. Failure to do so in maintaining the vitality of pulp before root completion may lead to the unfavorable crown to root ratio resulting in thin dentinal walls which are prone to fracture.How to cite this articleManhas S, Pandit IK, Gugnani N, et al. Comparative Evaluation of the Efficacy of Stepwise Caries Excavation vs Indirect Pulp Capping in Preserving the Vitality of Deep Carious Lesions in Permanent Teeth of Pediatric Patients: An In Vivo Study. Int J Clin Pediatr Dent 2020;13(S-1):S92–S97.

Performance of ICDAS II and fluorescence methods on detection of occlusal caries-An ex vivo study.

The aim of this ex vivo study was to compare the performance of the visual ICDAS II scale and two fluorescence methods (DIAGNOdent Pen and VistaCam iX) in detecting occlusal caries lesions in permanent teeth using cone beam computed tomography (CBCT) as a reference test. One hundred-sixty molars and premolars were qualified for the study. The visual, the DIAGNOdent Pen and VistaCam iX examinations were carried out by two examiners. The actual extent of the lesions was determined using CBCT. For the three methods, inter- and intra-examiner reproducibility was calculated using intraclass correlation coefficient. The sensitivity, specificity, and accuracy of these methods were compared using the mid-P McNemar test. The level of significance was set at p < 0.05. For all data, intraclass-correlation coefficients (ICC) for intra- and inter-examiner reproducibility were high. With regard to the enamel threshold, the sensitivity and accuracy were significantly higher for VistaCam iX and ICDAS II compared with the DIAGNOdent Pen (p < 0.05). The results obtained with the DIAGNOdentu Pen indicated significantly higher specificity values for the enamel threshold (p < 0.05). The results obtained with the VistaCam iX showed the lowest sensitivity but the significantly highest specificity and accuracy for the dentin threshold (p < 0.05). The ICDAS II is an effective method for detecting early carious lesions, characterized by a higher sensitivity compared with devices using fluorescence. To improve the diagnostic efficiency of the evaluated devices, modifying the cut-off values recommended by the manufacturers should be considered.

Selective versus stepwise removal of deep carious lesions in permanent teeth: a randomised controlled trial from Egypt—an interim analysis

ObjectivesTo compare the success, survival and costs of selective versus stepwise carious tissue removal (SE/SW) in permanent teeth with deep (>2/3 dentine depth) carious lesions.DesignRandomised controlled, unicentre, clustered two-arm superiority...

Brushing RemInder 4 Good oral HealTh (BRIGHT) trial: does an SMS behaviour change programme with a classroom-based session improve the oral health of young people living in deprived areas? A study protocol of a randomised controlled trial

BackgroundAlmost one-half of 12–15 year olds living in deprived areas of the UK have dental caries (tooth decay) with few oral health promotion programmes aimed at children of this age. Mobile phone-based interventions such as short messaging service (SMS) interventions have been found effective at changing certain behaviours and improving health outcomes. This protocol describes the BRIGHT Trial, investigating the clinical and cost-effectiveness of a behaviour change intervention—classroom-based session (CBS) embedded in the curriculum and a series of SMS delivered to participants twice daily to remind them to brush their teeth, compared to usual curriculum and no SMS—to reduce the prevalence of dental caries in young people from deprived areas.ObjectivesTo investigate the clinical and cost-effectiveness of a complex intervention to improve the oral health of young people living in deprived areas.Methods/designThis is a school-based, assessor-blinded, two-arm cluster-randomised controlled trial with an internal pilot trial. Overall, the trial will involve approximately 5040 11–13 year olds in 42 schools with a 3-year follow-up. The trial will take place in secondary schools in England, Scotland and Wales. The primary outcome is the presence of carious lesions in permanent teeth at 3 years. Secondary outcomes are: number of carious teeth, frequency of twice-daily toothbrushing, plaque levels, gingivitis, child health-related quality of life and oral health-related quality of life. A cost-utility analysis will be conducted.DiscussionThe findings of the trial have implications for embedding oral health interventions into school curricula guidance produced by national bodies, including departments for education and dental public health and guideline-development organisations.Trial registrationISRCTN registry, ISRCTN12139369. Registered on 10 May 2017.

Effect of Different Liners on Pulpal Outcome after Partial Caries Removal: A Preliminary 12 Months Randomised Controlled Trial

Aim: The aim of this double-blinded parallel randomised controlled trial was to compare the effect of different liners on 12-month pulp health outcomes after partial caries removal (PCR) with composite restorations in permanent molars. Methods: The study was registered at clinicaltrials.gov with registration No. NCT0328695 and conducted in the Department of Conservative dentistry and Endodontics, Post Graduate Institute of Dental Sciences Rohtak with no external financial support. One hundred and ninety-eight participants (116 males, 82 females and age 14–54 years) with vital permanent mature mandibular molars having deep caries involving two-thirds or more of dentin were randomised to calcium hydroxide (CH), resin-modified GIC (RMGIC) and no liner (DC) groups after PCR. After a follow-up time of 12 months, success was defined as positive response to pulp sensibility and absence of periapical alterations. Results: Categorical variables were compared using chi-square test. Two analytical approaches were used, such as intention-to-treat and per-protocol approach. Success rates in per-protocol approach were 96.8, 96.5, and 94.6% for CH, RMGIC and DC groups, respectively with no significant difference between 3 groups (p = 0.811). None of the baseline variables had any significant influence on the treatment success. Conclusion: Partial caries excavation has a high success rate to treat deep carious lesions in permanent teeth after 12 months of follow-up, indicating that the retention of carious dentin does not interfere with pulp vitality or restoration survival. Also, the success of the treatment is independent of the lining material used over the demineralized dentin.